- Organisation: Alliance Nationale pour la Santé Senegal
- Country: Senegal
- Region: Western and central Africa
- Stage of innovation: Stage 6: In the market and ready to scale
- Start date: 2018
- End date: 2020
- Type of innovation: Service innovation: new or improved service
- Budget: US$10,000
- Funded by: The Global Fund
Summary of intervention
In Senegal, people from marginalised groups are often reluctant to use HIV and SRHR services due to the criminalisation, stigma and discrimination they face. Yet they are often the people who need these services the most.
This innovation identifies, recruits and trains health mediators from marginalised communities to increase access to HIV and SRHR services and improve their quality. The mediators guide their peers through health appointments, run support groups, lead treatment literacy sessions, mediate if conflict arises within families or with law enforcement, organise community meals, cooking demonstrations and nutritional advice sessions, run treatment adherence clubs, distribute condoms, staff mobile clinics in hot spots, conduct home visits, provide HIV screening and self-testing, refer people screening HIV positive to clinics, support people diagnosed with HIV to start treatment, and help marginalised people and their families enrol in health insurance schemes.
This approach has led to higher levels of retention in care and viral suppression. It has made task-shifting between health professionals and community workers more effective and also increased HIV self-testing. Public clinics have become more welcoming, and collaboration between community-based organisations and facilities has improved. Individual and organisational leadership skills of marginalised people have also been developed.
- The Senegal Government has recognised the mediator approach and endorsed it as a flagship model to achieving the UNAIDS 90-90-90 targets. The government has included the intervention in its latest national strategic plan and Global Fund concept note to ensure its sustainability.
- The Ministry of Health has begun recruiting health mediators at care and support service sites that it manages as a way to strengthen the national health system and formalise task shifting, further demonstrating the value of the mediators’ work. The Government is providing ongoing training for mediators and healthcare providers to meet the changing needs of marginalised communities, consolidating and expanding the approach to all government-run care and support sites, and reviewing mediator incentives.