Objective 1:
Coordinate, strengthen, and manage the CLM mechanism in the National Capital District [1.1. Coordination: Engage stakeholders and government partners in the implementation of, and accountability for, CLM quality-improvement recommendations; 1.2. Management: Support and maintain the CLM team, ensuring mechanisms, activities, and implementers are funded to carry out plans and service quality improvements, especially as these benefit key populations. ]

Objective 2:
Conduct capacity-building and training for KPAC Community Champions (community monitors) to implement CLM. [2.1. Capacity-building training and development for a cadre of CLM data collectors (Community Champions)]

Objective 3:
Support KPAC Community Champions (community monitors) to collect and analyze qualitative and quantitative data from communities. [3.1. Data collection and analysis: Collect and analyze CLM data, and translate insights into actionable recommendations to increase the quality of service provision]

Objective 4:
Guide advocacy with national and provincial leaders for the improvement of HIV services. [4.1. Advocacy and action planning: Engage government partners and local stakeholders in line with the advocacy plan, and build capacity to communicate demands for change; 4.2. Monitoring and accountability: Monitor improvements in the quality of HIV services to reach targets set by community stakeholders, including CSOs and organizations of people living with HIV and key populations.]

The CLM in PNG led by KPAC aims to accomplish 3 expected results by end of 2023:

1. 1. A national and provincial level platform for KPs is in place to raise issues affecting KP access to HIV and other health services. 

   2. Friendliness to KPs, quality of HIV and health services and environment of health clinics are assessed.

   3. Reasons or barriers leading to non-return or non-access of HIV services by KPs are documented.

7 Categories of Service Quality
(adopted from 72 global CLM indicators, June 2022 draft)

1. Awareness about the services - Information about the facility services are disseminated outside the facility (catchment area); Providers are providing additional information about the service and the facility. 

2. Accessibility of services - Clients did not wait for more than one hour before the service was provided; Clients did not hesitate to go to the facility (because of accessibility issues). 

3. Availability of services - The intended service was available and provided; For services that were not, clients were provided information where to avail it (or referred). 

4. Affordability of services - Client did not pay for or use its own money for the service provided (for services that are free). 

5. Appropriateness of services - Services specific to KP was provided; Services specific to young person (24 and younger) was provided. 

6. Acceptability of services - Client did not feel stigmatized or discriminated when the service was provided; Client did not feel afraid to access the service (did not worry about people knowing its KP or HIV status). 

7. Accountability of Service Providers - Client is aware of mechanisms to report complaints about the service; Client feels confident that the provider made him/her fully aware of the service provided. 

(see Facility Exit Interview Tool [word] [pdf])

14 Individual Quality Indicators
(adopted from 72 global CLM indicators, June 2022 draft)

 A1. You had information on the service before going to the facility.

 A2. You were given more information on the service when you were at the facility. 

 B3. You did not wait for more than 1 hour before being served at the facility.

 B4. You did not delay going to this facility the moment you felt that you needed the service (did not hesitate because of inaccessibility like distance).

 C5. You were provided with the service you intended to avail in the facility. 

 C6. You were given information (became aware) on how or where to avail for services that were not available in the facility. 

 D7. You were not asked to pay for the services availed to you. 

 D8. You were not expected to use your personal money (expected service to be free) to spend on items (medicines, etc) related to the service.

 E9. You were provided with at least one service specific to your need as KP. 

 E10. You were provided with at least one service specific to my need as a Young Person (<25yo).

 F11.  You did not feel stigmatized or discriminated at the facility. 

 F12. You did not feel afraid to avail of the service as you did not worry that someone may learn your status (as KP or PLHIV). 

 G13. You were aware of a mechanism or a person to make complaints related to the services at the facility .

 G14. You fully understand the information provided by the service providers at the facility.

(see Facility Exit Interview Tool [word] [pdf])

Scorecard - Quality Score
Each of the 14 quality indicators are scored between 1-4

4 - Extremely Satisfactory - Strongly Agree

3 - Satisfactory - Agree

2 - Unsatisfactory - Disagree

1 - Extremely Unsatisfactory - Strongly Disagree

(see Facility Exit Interview Scorecards [webpage dashboard])

Non-access and Demand for Services
(locally developed indicators)

1. 1. Awareness about the services - Ever heard of any HIV and health services (by type, by facility).

   2. Demand for the services that are known - If these services are available today, which ones will the KP avail (and why).

   3. Demand for other services - As KP - MSM, TG, SW, PWID, partners of KP - are there any other services needed (eg legal, other health, etc).

(see Community Forum Tool [word] [pdf])

RESULTS DASHBOARDS (Power BI)

• CLM 3 - Round 1, June 2022 [webpage dashboard]

• CLM 3 - Round 2, September 2022 [webpage dashboard]

• Preliminary results of CLM 3 - Facility Exit Interviews (Round 1 - June 2022) - download HERE

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)

   • CLM 2 - Social Media (Facebook Page, Facebook Messenger, Whatsapp Groups)

2. CLM in Communities (routine)

1. • CLM 3 - Facility Exit Interviews (1-3 times a year)

   • CLM 4 - KP Community Forums (1-3 times a year)

3. CLM in Facilities (continuous)

1. • CLM 5 - Facility Observations through KP Mystery Clients (1-3 times a year)

See the CLM Recipes (documentations) 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.

Main Page: here: https://www.kpacpng.org/clm-recipes

• • CLM 1 Recipe - National Response Center

  • CLM 2 Recipe - Social Media Group

  • CLM 3 Recipe - Facility Exit Interviews

  • CLM 4 Recipe - Community Forums

  • CLM 5 Recipe - Facility Observations (Mystery Client)

Holiday Inn Hotel, Port Moresby

8 September 2022, 9am to 4pm

Results: 9 monitors retrained | Tools and plans for Round 2 finalized | CLM 3 form reviewed

𝐴𝑛 𝑖𝑛𝑖𝑡𝑖𝑎𝑡𝑖𝑣𝑒 𝑙𝑒𝑑 𝑏𝑦 𝑡ℎ𝑒 𝐾𝑒𝑦 𝑃𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝐴𝑑𝑣𝑜𝑐𝑎𝑐𝑦 𝐶𝑜𝑛𝑠𝑜𝑟𝑡𝑖𝑢𝑚 (𝐾𝑃𝐴𝐶) 𝑃𝑁𝐺 𝑎𝑖𝑚𝑖𝑛𝑔 𝑡𝑜 ℎ𝑎𝑣𝑒 𝑎 𝐾𝑃𝐴𝐶-𝑙𝑒𝑑, 𝑐𝑜𝑚𝑚𝑢𝑛𝑖𝑡𝑦-𝑙𝑒𝑑 𝐻𝐼𝑉 𝑎𝑛𝑑 ℎ𝑒𝑎𝑙𝑡ℎ 𝑠𝑒𝑟𝑣𝑖𝑐𝑒𝑠 𝑓𝑜𝑟 𝑡ℎ𝑒 𝑐𝑜𝑚𝑚𝑢𝑛𝑖𝑡𝑦. 𝑇ℎ𝑖𝑠 𝑖𝑛𝑖𝑡𝑖𝑎𝑡𝑖𝑣𝑒 𝑖𝑠 𝑠𝑢𝑝𝑝𝑜𝑟𝑡𝑒𝑑 𝑏𝑦 𝑈𝑁𝐴𝐼𝐷𝑆, 𝑈𝑆𝐴𝐼𝐷-𝑃𝐸𝑃𝐹𝐴𝑅, GF-WVI, 𝑎𝑛𝑑 𝑡ℎ𝑒 𝐴𝑢𝑠𝑡𝑟𝑎𝑙𝑖𝑎𝑛 𝐷𝐹𝐴𝑇.

Objective 1
To design and finalize the multi-year CLM Design and workplan for PNG Coordination and Outreach [consultation meetings, consultants, design workshops, coordinators, communication channels, hotline].

Objective 2
To train the national and provincial KPAC members as data collectors to implement the community-led monitoring work and provide institutional strengthening support to CSOs implementing CLM. [ training design, skills training, operational consultants, program management]

Objective 3
To support the KPAC data collectors to collect qualitative and quantitative data from communities. [mystery client, exit interviews, data analysis, workshops, promotion, demand creation, report mechanism]

Objective 4
To guide advocacy for improvement of HIV services with national and provincial leadership. [advocacy, dissemination, monitoring visits]

Still early to capture key CLM implementation challenges but the following are noted in NCD CLM:

Challenges of KPAC as CLM implementing organization:

• • Received funds only in April 2022. KPAC needed to implement the 12-month plan into just 6-months

Challenges in data collection: 

• • KPAC monitors and champions, especially on CLM 3 - Facility Exit Interviews, are being capacitated as "survey research" learning scientific data collection, effective interviewing, proper use of mobile and online data encoding tools (KOBO webform), data analysis using statistical softwares and visualization tool (KOBO, STATA, Excel Pivot, Power BI), data dissemination platforms (website, powerpoint). Learning by mistakes.

Challenges in data validation and triangulation: 

• • Need to work with NCDPHA and FHI360 to link CLM data with routine services statistics (prevention, testing, ART, viral load, GBV, stigma, discrimination)

Challenges in engaging decision makers:

• • Understanding of PNG CLM design and objectives need to be clarified - as government partners, in the beginning, thought CLM would be in conflict  with or a duplication of the current M&E and reporting system.

Challenges in financing and sustainability of CLM:

• • Currently supported through grants from development partners. Need to get financing and partnership with private and business sector (B4H)