Remarkable Changes at Fatsi Health Center, Ethiopia
A remarkable change has happened in Fatsi Health Center in eastern Tigray, Ethiopia, in terms of patient quality of care and adherence to treatment, willingness of HIV-positive people to disclose their status and HIV/ AIDS care and treatment of family members. The number of patients who have dropped out of care or stopped taking their medicine has dropped to zero. Much of this change is due to the efforts of one case manager, Equbay Desta, who joined the facility in January 2011 under the support of the US President’s Emergency Plan for AIDS Relief (PEPFAR) funded USAID program, the Ethiopia Network for HIV/AIDS Treatment, Care and Support (ENHAT-CS), led by Management Sciences for Health (MSH).
When Equbay joined the health facility in 2011, the Fatsi health center had a shortage of case management job aids and tools. The documentation system was weak so Equbay did not receive case records of patients who stopped attending the clinic. On his own initiative, Equbay drafted a register that traces if family members of current patients have been tested for HIV and a registration format that identifies and traces HIV-positive patients who stopped attending the clinic.
Of the patients enrolled since January 2011 in case management services because of diverse problems, 90% have been discharged due to good outcomes, with the remaining patients still under Equbay’s care.
Equbay regularly addresses and discusses treatment adherence and social issues with patients who come to the center for antiretroviral therapy. He also provides monthly health education for patients attending HIV-positive support groups and coffee ceremonies.
Equbay has good communication with community based health extension workers, volunteer outreach workers, and community mobilizers. With them, he shares a list of patients who have missed appointments so they can help find and convince the patients to return to care. He also makes sure that each patient folder includes a family matrix that traces if the patient’s family members have been tested for HIV, and a completed personalized care plan for those eligible that is updated every three months.
One impoverished, HIV-positive patient, Mulu, had compromised nutritional status and a record of poor adherence to HIV treatment. She contracted TB and found it difficult to come to the health facility daily to collect her TB drugs. But, case management follow-up successfully provided her with additional support. Mulu said, “I have received close follow-up with adherence counseling and a health extension worker now brings the anti-TB drugs to my home daily … With the help of Equbay and his colleagues, I am getting better and taking my drugs correctly.”
Equbay and 20 community volunteers and a referral network mobilizer pool small savings per month to help patients who have financial problems.
Equbay is one example of the variety of health care strengthening done by ENHAT-CS throughout Tigray and Amhara. The program assists the Government of Ethiopia in rapidly expanding coverage of comprehensive HIV and AIDS services to health centers and the communities that they serve.