2023 CLM in PNG

• An estimated 11.7 million people in PNG (NSO 2021) with an overall HIV prevalence of 1% among 15-49 years old (NDoH 2022) 

• Mixed epidemic of growing concern affecting key populations (KPs) including female sex workers (FSW), men having sex with men (MSM) and transgender persons (TG) and their sexual partners, as well as priority populations of pregnant women and their children (NDoH 2022). 

• Much higher HIV prevalence among KPs: 16% among FSW and their sexual partners, and 8% among MSM and TG (IBBS 2017). 

• Estimated 18,300 KPs in NCD: 12,600 FSW; 5,300 MSM and 400TG (PSE 2023).  

• High levels of violence, stigma & discrimination (S&D) and other socio-cultural barriers limit access to quality HIV/STI services among KPs. 

• The ‘Kommuniti Wok Senis Kamap’ (CLM) project started in 2021 with funding support from USAID, to help improve the quality of HIV services; address key barriers to achieving the 95-95-95 goals; and empower civil society, PLHIV, and members of the KP community in NCD. 

The objectives and activities of the CLM initiative are to:

1. Coordinate, strengthen, and manage the CLM mechanism

2. Build the capacity of KP Advocacy Consortium (KPAC) Community Champions/monitors to implement CLM

3. Support KPAC Community Champions/monitors) to collect and analyze qualitative and quantitative data from communities.

4. Guide advocacy with national and provincial leaders for the improvement of HIV services through continuous feedback on CLM findings.

1. Identification, training and retraining of community monitors including the use of the Google Classroom

2. Deployment of mixed models and tools for monitoring and data collection. 

3. Data cleaning to enhance the quality of results.

4. Triangulation of results to remove individual biases.

5. Multiple feedback loop and dissemination channels.

The CLM Platforms: Virtual-CLM | community-CLM | Facility-CLM

There are 5  interlinked CLM Models across 3 platforms:

1. CLM in Virtual Spaces (continuous)

   • CLM 1 - KPAC National Response Center (calls, visits, and messages) - Managed by KP Response Center Operators (RCO). |Open several days a week and accessible to KPs through multiple platforms (calls to landline; mobile phone and social media; text, direct messages and comments to KPAC’s Facebook, messenger groups and pages, WhatsApp, Website and Email; and face-to-face visits to KPAC office in NCD (if necessary and convenient).

   • CLM 2 - Social Media (Facebook Page, Facebook Messenger, Whatsapp Groups) - Managed by KPAC provincial delegates in Morobe and Eastern Highlands Provinces. | Supported by the GFATM.

2. CLM in Communities (routine)

1. • CLM 3 - Facility Exit Interviews (1-3 times a year) - Led by community monitors using a health service quality scorecard administered to KPs clients and PLHIV. |Carried out every four months.

   • CLM 4 - KP Community Forums (1-3 times a year) - Led by community monitors using health service quality scorecard administered to KPs who have accessed services in the last 6 months or non-access documentation tool KPs who have not availed any services. | Carried out every four months.

3. CLM in Facilities (continuous)

1. • CLM 5 - Facility Observations through KP Mystery Clients (1-3 times a year) - Community monitors disguise as mystery clients to access and rate  facility-based services using an expanded health service quality scorecard. | Carried out every four months.

See the CLM Recipes (documentations) HERE

1. CLM-1 and CLM-2 Response Center Issue Documentation Tools 

2. CLM-3 Facility Exit Interview Scorecard 

3. CLM-4 Community Forum Scorecard 

4. CLM-5 Facility Observation Tool 

5. Dashboards

RESULTS DASHBOARDS (Power BI)

• Summary of Findings 2022-2023 [here]

• CLM 3-Round 2 (scores), Sep 2022 [dashboard]

• CLM 3-Round 2 (qualitative), Sep 2022 [dashboard]

• CLM 3-Round 1 (scores), Jun 2022 [dashboard]

• CLM 3-Round (prelims) - Facility Exit Interviews (Round 1 - June 2022) - download HERE

Modes of data dissemination and utilization :

1. 1. Same-day Feedback - real-time data utilization, same-day, immediate feedback at the facility for urgent issues.

   2. Facility Visits - Summary Feedback and Awarding of Certificates of Recognition, approximately 2-4 weeks from data collection. 

   3. Dissemination Workshops - province-level gathering of facilities and community members.

   4. Online (KPAC website) and Social Media communications (Facebook page, Whatsapp group) for general findings.

• 25 community members trained on data collection, monitoring, and management of CLM - 3 RCOs, 4 Supervisors, 9 exit interview monitors, 9 community forum monitors.

• An average of 78 (range: 20 – 139) clients received monthly by the 3 operators at the 

• Four rounds of Facility Exit Interviews (16 clinics; 477 interviews)

• Three rounds of Community Forums (53 respondents)

• Two rounds of Facility Observations (15 clinics; 63 observations).

• 15 feedback/dissemination session with stakeholders.

Community

• Improved capacity of Community Monitors for CLM data collection and dissemination of results Platform is in place for KPs barriers to accessing STI/HIV and other health services. 

Clinics

• 15 NCD PHA clinics were sensitized on KP needs and service delivery.

• Clinics taking actions to address physical barriers to service access (erection of signpost at St. Therese Clinic)

Government

• Strong political will from the NCD PHA (memo to all clinics to adjust clinic hours) 

• CLM program given prominence in the PNG National STI and HIV Strategy (NSHS) - 2024-2028 

• CLM integrated into the National HIV Data System

1. Identifying trainable Community Monitors; high turnover and availability of trained monitors.

2. Inconsistent information and social media campaigns to promote the response centre. 

3. Some barriers are beyond the control of thee health care providers

4. Inability to scale up the implementation to other provinces due to limitation of funding and donor preference.

5. Sustainability of funding for the CLM program (currently 100% donor-funded). 

1. Improve on data storage management

2. More extensive/granular data analysis and knowledge Sharing 

3. Cost analysis of implementing CLM as part of the sustainability efforts efficiencies and has started to measures for sustainability. 

4. Gradually scale up implementation to other provinces.

5. Develop KPAC policies (HR, Ethic, Finance, and Operational)

Kommuniti Wok; Senis Kamap’ Project has provided a platform for greater engagement of the KP community in NCD in addressing barriers to STI and HIV services. The strong support and active participation of the PHA leadership in CLM Activity have been crucial to the progress made.

Visit the KPAC CLM Webpage (main CLM summary): https://www.kpacpng.org/clm-recipes/clm-community-led-monitoring