Providing health services to MSM and LGBT Communities in public health facilities=
In March 2019, curtains came down on the Towards Universal Comprehensive Health Care (TOUCH) Plus project, whose main aims were twofold:
- To integrate HIV and Sexual and Reproductive Health (SRH) services for Lesbian, Gay, Bisexual, Transgender (LGBT) persons in 27 public health facilities in Kenya.
- To reduce harmful social outcomes, resulting from stigma and discrimination, violence and sexual abuse as some of the documented challenges faced by the LGBT community who have recorded high HIV prevalence rates.
The 2 year project, which was implemented in Nairobi, Mombasa, Vihiga, Kakamega Bungoma and Siaya counties, and was a continuation of phase 1 TOUCH project which had successfully offered the same services to Men who have Sex with Men (MSM) in Mombasa County.
One of the key successes attributed to the project was its ability to reduce the barriers to access and uptake of HIV & SRH services by MSM and LGBT persons and integrate them in public health facilities.
The close-out meeting was graced by the National AIDS and STI Coordination Programme (NASCOP), health officials from the six implementing counties, and 2 LGBT network community organizations involved in the implementation, namely NYARWEK (Western Kenya) and PEMA-K (Mombasa). Also in attendance were other counties interested in learning about the project’s findings and achievements.
Speaking at the event, Helgar Musyoki from NASCOP termed the project as another ‘first’ from LVCT Health, which addressed the process of integrating health services to key populations in public health facilities. Helgar applauded LVCT Health for ensuring participation of the counties and community organisations in all aspects of the project’s life, and more specifically in identifying gaps in offering health services to KPs through a service provision model, which was developed and piloted in Mombasa after which it was scaled up to other health facilities and counties.
“Partnership is at the centre of integration. Bringing government, communities and implementing partners thinking and planning together helped in the success of the project and this is part of achieving universal health coverage”.
She said that it would be critical to ensure that TOUCH Plus data and any other documented evidence that shows LGBT and other groups are at risk of HIV is well packaged, so as to better advocate for their inclusion in the Kenya AIDS Strategic Framework (KASF), which is the guiding document for addressing HIV in Kenya.
Annrita IKahu from LVCT Health, who led the project implementation informed participants that the success to working with the county governments, was better achieved through understanding their work and interests as well as in assisting them understand the facts and evidence to inform how they would provide the people with services.
“We were able to present evidence based data to the counties, which showed that indeed the KPs existed and needed services. This was the entry point and later on we agreed on the different players and their roles. Showing evidence that is reliable and not hearsay is the way to go.” Annrita said.
Counties present shared their experience in implementing the project and how these provided an eye opener to achieving key health outcomes. Initially, some health care workers were unwilling to provide services to MSM while those that were willing felt they did not have adequate knowledge and skills to facilitate this.
“What actually surprised us is that we had MSM in our community, we thought these things belong to big cities like Mombasa, Nairobi and maybe Kisumu but not in Vihiga county but when we went for the sensitization we realized that they were in the community, so as healthcare providers we had to find a way of accommodating them like any other member of the society that we swore to protect his/her life.” A health care provider from Vihiga County.
Community organizations said the project helped them strengthen their capacity and advocacy skills in reaching out to counties and the public. Community involvement included peer educators training & mentorship; peer-led approach in identifying KPs & service provision and participation in technical working group meetings where they articulated their views and came up with solutions.
‘TOUCH plus has been a success from zero to more than 7,000 KPs accessing health services in western Kenya.‘ Daniel from NYARWEK
‘We were able to put in Gender Based Violence (GBV) reduction mechanisms through TOUCH Plus by interacting with the general population and providing advocacy platforms to other key stakeholders like the police and county inspectorate’ Ishmael from PEMA- Kenya
Dr. Wanjiru Mukoma, the LVCT Health Executive Director, while moderating the next steps session said that trust was key in achieving the results. Considering that same sex relations are criminalized in Kenya, there were fears of arrests and clashes with the cultural and religious values in offering health services to the LGBT community. Notwithstanding these and other challenges the project was able to reach out to people and touch their lives.
The TOUCH project was funded by the Elton John Foundation and the lessons learnt will inform future national and international projects in integrating HIV and SRH services for MSM and LGBT in public health facilities as highlighted in the technical brief.
By Alfred Itunga