Interview with Naomi Wanjiru, member of the Global Fund Advocates Network, and nurse practitioner working in a TB and HIV clinic in Kenya.
1. As a nurse, you have been dedicating your work to access to health. How do community health systems contribute to breaking down human rights and gender-related barriers and address health inequalities?
Community Health Systems play a critical role by complementing the work of the formal health system. Through established Community Units, the health needs of community members are taken into consideration and advocated for.
Community Health Volunteers are a key component of the community health systems who are involved in providing basic health care services to the community. They are also an integral part in the referral system where they identify and link up vulnerable populations with health facilities for specialized care. They also distribute key health commodities to community members for example condoms, lubricants, mosquito nets, and hygiene packs among other items. This increases access to prevention commodities that might otherwise not have been available to the communities. Because there is a lot of stigma against people with HIV, TB and malaria, and currently also COVID-19, clients prefer to talk to community health volunteers, who they know and trust not to reveal their status, to provide them with support.
Through the advocacy of Community Health Volunteers, community members are able to access health services including disease prevention, care, support and also treatment. These help in breaking inequalities and enhancing access to all, including the hard-to-reach and marginalized populations. There is however a need to further support this cadre of health volunteers by ensuring they are well remunerated and motivated for them to continue undertaking the great work they do.
2. What do you think was the impact of Covid-19 in equal access to diagnostic and treatment for HIV, TB, and malaria? How did you notice it in your daily work?
I have been working at an HIV and TB clinic for almost 13 years and I can tell you that the advent of COVID-19 had a significant impact in access to diagnostics and treatment for these diseases. For once, members of the public avoided going to health facilities for the fear of getting COVID-19. This resulted in delayed diagnosis for HIV, TB, and Malaria. For example, in HIV programming, the onset of COVID-19 led to a report of very low numbers of those newly tested. Given that some of the TB symptoms were similar to those of COVID-19, some people resorted to self-treatment thinking they had COVID-19 only to later discover they had TB, which had advanced without treatment, and in some cases was too late for them to recover.
Attention was also given to COVID-19 testing and this resulted in some vital HIV tests and TB diagnoses not being undertaken such as the PCR tests for children, Viral load tests for People living with HIV, and gene experts test for those suspected to have TB. There was also a lack of a consistent supply of diagnostic tools because of COVID-19.
In some countries, some areas, safe spaces for accessing youth-friendly Sexual Reproductive Health Services were changed to cater to those who had COVID-19 impacting negatively on access to HIV prevention and SRHR services.
3. In your view, what is the role of the Global fund in advancing health equity?
The Global fund has been playing a critical role in providing resources to allow all to have access to health services and leaving no one behind. Through the Global Fund, we are able to provide services to hard-to-reach and marginalized populations, including the key populations such as people who inject drugs, the transgender, the men who have sex with men, and sex workers who previously did not receive much attention This ensures that there is health equity.
In most health facilities including where I work, the Global Fund provides commodities such as falcon tubes and GeneXpert® machines among others for clients to be tested and screened. If the test comes back positive, it is also thanks to the Global Fund that they are provided with free medication. When I got infected with TB, one of the first questions I had was who is going to support me with my medication. I was devastated to hear I had multidrug-resistant TB but during the 24 months of treatment, I never had to pay for anything and the medication was always available, I never missed a day.
The resources that the Global Fund provides also trickle down up to the grassroots level, not only concentrating on major towns. I am grateful for the efforts of the Global Fund to support community health volunteers that follow up with clients to ensure they are taking their medications, which further ensures access to health services for all.
4. What do you think needs to be done to achieve the targets of SDG 3 ”Good health and well being” by 2030? What are your recommendations to world leaders?
There is a need to invest more to address major diseases that still pose a health threat to the public such as HIV, TB, and Malaria including addressing pandemics such as COVID-19 that threaten to reverse the gains that have been made so far in addressing the 3 epidemics. The drugs, the test kits, the machines, are very expensive. We are asking leaders to commit and invest more in them so we can achieve good health for all. The leaders should commit to supporting the Global Fund through the mobilization of resources both locally and globally.
Additionally, there is a need to continue addressing health inequalities and human rights violations as these tend to fuel the epidemics and hinder access to prevention and treatment services.
There should also be an efficient and effective use of available resources to ensure that we are able to reach more and create synergies when need be. If we were better prepared for any pandemic, we would have not had these negative effects in the fight against HIV, TB and malaria due to the Covid-19 pandemic. We need to invest in pandemic preparedness so that when the next one hits us, it will not destabilize everything like COVID-19 did.
Finally, there is the importance of accountability. We need to make sure that the funds reach the communities. Indeed, grassroots actors are the most aware of the needs, and the funds should be only used to reach communities suffering. While we are currently getting the medication, test kits and other things, there are still challenges. For instance, some clients have a low body mass index (BMI), and we cannot do much about it because we do not have nutritional support. You cannot take medication on an empty stomach and therefore it is crucial to receive funding for nutritional support because, without it, the client might not get the chance to be cured from the disease.