Community-led Access & Support for Epidemic control (CASE Project)

Technical Application

Name of Organization Brokline Foundation

Proposal Date 16th July, 2021

PEPFAR Small Grants for Community-Led

Proposal Program Title
Monitoring in Akwa Ibom State

Program period proposed start and end

February 2022 – January 2023
date

The purpose of this program is to increase access to

quality HIV services for people living with HIV
through a client-centered, data/evidence driven and
inclusive approach. The goal is to develop a shared
understanding of the enablers and barriers to
Brief purpose of the program accessing and utilizing HIV services, in a manner
that is productive, collaborative, respectful, and
solutions-oriented, toward improved service delivery
and client outcomes for end users of services at the
facility and community levels.

3. Proposal Narrative (8 pages maximum):

Executive Summary
In response to the notice of funding opportunity, Brokline Foundation (BLF) proposes to
implement the Community-Led Access and Support for Epidemic Control (CASE) project in 16
health facilities across 13 LGAs of Akwa Ibom with a collective caseload of 47,420. BLF’s main
point of contact, for the CASE projects, is Mr. Isaac Davies, the Executive director himself;
please email – Add Email Here.
The main objective of this project is to improve access to and uptake of quality health services
through collective action by community of people living with HIV towards improved service
delivery and client outcomes at the facility and community levels.
Akwa Ibom is the selected state for implementation based on its FY21 status as being among the
‘’ lower performing, large volume sites’’, based on their MER outcomes. 13 LGAs of the state
hosting 16 PEPFAR supported sites are slated for the Community-Led monitoring.

Organizational Capacity and Past Performance:

Brokline Foundation (BLF) is Community Based Organization established in June 2007 to
promote family health, mobilize resources for community development and alleviate poverty
through people-oriented programs including skills acquisition and empowerment for
marginalized populations such people living with HIV, adolescent and young people, key
population including orphans and vulnerable children. BLF is registered with the Akwa Ibom
Ministry of Women Affairs and Social Welfare and the Nigerian Corporate Affairs Commission
in 2015 with registration number IT/NO 78468.
With a vision to ensure a healthy society for every person, BLF’s core areas of interventions
includeCare and Support for Orphans & Vulnerable Children and PLWHA, HIV prevention
intervention for Most at risk population, (FSW, PWID, MSM), Household Economic Services
(HES).
BLF is governed by an active Board of Trustees (BOT) which comprise of 5 members (2
Females and 3 Males). The board meets once a year except for emergency situation to approve
policies and other strategic direction for the organization. The Executive Director reports to the
BOT and he alongside the Director of Finance and Administration and Program Manager
constitute the management team of the organization. The organization has a staff strength of 11
core staff, 7 office-based Volunteers and 98 Community Based Volunteers.

BLF in recent past has implemented third-party monitoring project for the Social Investment
program, HIV Stigma-Index Survey through CCCRN in the 31 LGAs of Akwa Ibom state. BLF
has also implemented the LOPIN 1 Project (ARFH) and STEER Project (Save the Children)
providing comprehensive OVC services including case findings and linkage to treatment in Ikot
Ekpene, Essien Udim, Ikot Abasi, Eastern Obollo and Abak.
In the last 9 years, BLF has implemented the Global Fund Round 9 and SIDHAS Project, Bill&
Melinda Gates Foundation project for Adolescent and Young Women (AYP Project) all in Akwa
Ibom State. BLF is reputable in Akwa Ibom state especially within the development space and
has a cordial working relationship with government at state and local levels. BLF has track
record of performance and accountability and is known for delivering high quality results and
achieving project targets.
BLF has implemented projects across various areas including OVC, Key Population, HIV
prevention, Governance and Civic engagements as well as Malaria programs and was awarded
one of the best performing organization using the Society Tackling Aids Through Rights (STAR)
model on the ENR project in 2011 to 2014.

Problem Statement:
Communities affected by HIV have been providing feedback on the quality of health service
provision since the early days of the HIV epidemic. Gathering, collating and using this
information, however, has not necessarily been systematic. Consequently, decision-makers often
lack data and analysis from the perspective of service users, and interventions may not accurately
respond to community priorities and experiences. This imbalance of knowledge and power in
service design and provision particularly penalizes minority and stigmatized groups. (UNAIDS
2021).

Akwa Ibom State has the highest burden of HIV/AIDS in Nigeria with a prevalence of 5.5% and
a viral load suppression rate of 36.9%. (NAIIS 2018).Although there is an estimated burden of
178,000 people living with HIV, and close to 120,000 unmet need for life-saving antiretroviral
therapy amongst other interventions, recent efforts by implementing partners in the state has seen
a surge in the number of persons placed on treatment. This success however creates a challenge
in managing the huge client burden in terms of quality services, waiting time and iterating
processes to ensure services are client centered.
The shape of the epidemic, vary across the various regions of the state with southern region
contributing 55% of new infections. Poor treatment coverage, adherence rates and loss to follow
up continues to contribute to AIDS related deaths. This is further ventilated by interruptions in
treatment (IIT) and ART drug supply for PLHIV will increase death thereby truncating the
efforts towards achieving the 95-95-95 goal.
Other factors include lack of basic transportation services in rural areas (that makes it difficult to
access HIV services), Lack of health care providers who specialize in providing care to patients
with HIV, close- knit social networks can be difficult for individuals to privately seek HIV
services and persists significant gaps in providing HIV treatment to all who are in need and
restricting to healthcare facilities will continue to perpetuate this gap in limited resource setting
thereby increasing the non-adherence to treatment by client and the quality of services provided
by the service providers in the targeted facilities.

To mitigate these problems, BLF will engage community of people living with and affected by
HIV/AIDS, collate their experiences to inform a wide range of services that affect community
health and well-being, particularly of marginalized and underserved people. The project will
develop local models to identifying gaps and barriers and enhance the capacity of the
beneficiaries to lead discussions and decisions relating to their health.

Project goal: the goal of this project is to improve access to and uptake of quality health services
through collective action by community of people living with HIV towards improved service
delivery and client outcomes at the facility and community levels.
Project Strategic Objectives:
 Improve access to HIV services uptake or initiation - To assess barriers to HIV service
access and uptake from the client’s perspectives, that is, people living with HIV;

 Increase client’s retention in Care and Treatment - To evaluate gaps in delivery,

which negatively impacts treatment adherence, from the client’s perspective;

 Integrate CLM solution models for improved Health delivery systems - To identify
actionable recommendations and deploy remedy for gaps identified.

 Increased participation of clients in decision making - To enhance capacity of

communities for ownership, accountability and inclusion in design and decisions
regarding their health

Implementation Strategies/Approaches:
This project implementation will significantly adopt participatory approaches to data gathering
and client-centered service delivery at two levels: (1) Community approach and (2) Facility level
approach. The table below shows achievable results for the project cross-matched with the
relevant activities to accomplish the expected results.

Project Objectives with activities

Intervention Area Activities
Strategic objective 1: Improved access to HIV services uptake or initiation
Stakeholders engagement ● Stakeholders meetings at Facility level (Implementing Partners and
Key drivers at LGA and State); Community level (Network groups
and Community based organizations)
● Quarterly/monthly coordination meetings on data demand and use.
Addressing Stigma and ● Targeted outreaches at community, LGA and State
Discrimination ● Partnership with Network groups
Use of social media support ● Utilize social media platforms e.g. WhatsApp, Telegram,
system Instagram, Facebook
● Trainings and logistics support
Strengthening Support Group ● Snowballing approach
(Peer Mentoring approach) ● Peer- to- Peer tracking system
Strategic objective 2: Increased client’s retention in Care and Treatment
In-depth Survey of Client’s ● In-depth Survey of client’s perception on quality of Facility’s
perception on quality of health services
Facility’s health services ● In-depth survey on Pill-burden and proposed solutions
● Improve Client reminder system for drug intake,
Eliminate lengthy Waiting- ● Pilot test the use of Digital Health System
time at the Facility and ● Digital health system for drug ordering from the home. Through
Improving the ease of ART USSD
collection and/or ordering ● Strengthen 3PL to start ART Home dispensing
Use of Logistics ● Collaborate with NEPWHAN and HCWs trained as Index Testing
(IT) champions
● Elicitation of targeted contacts of index clients, high risk men
Strategic objective 3: Integrate CLM solution models for improved Health delivery systems
Data Analysis &Visualization ● Daily multi-channel tracking of facility service delivery, follow-up
for Decision Making on developed action plans
Strengthen Bi-directional ● Facility imbedded Monitors should provide updates weekly and
Reporting monthly
Enhance Capacity of Human ● Trained Service providers, Network or Peers providing supportive
Resource counseling to Defaulters and Client’s Lost-to-follow up
● Monitor and report gaps to facility key persons and collect
immediate remediation plans
Data use ● Data driven pursuit of saturation by age and sex
● Advanced predictive data analytics for program decision making
● Hold monthly and/or periodic coordination meetings to review
implementation strategies, learning and address gaps.
 Geographical scope: BLF will implement this project in 16 health facilities across 13 LGAs
of Akwa Ibom with a collective caseload of 47,420.

TX_CURR
VL Linkage
SN State LGA Facility Name
Coverage FY20
FY20
Akwa
1 Ibom ak Mbo Enwang Primary Health Centre 8832 102% 6238%
Akwa ak Ibiono
2 Ibom Ibom Ibiono Handmaids Hospital 4516 116% 3980%
Akwa ak Essien
3 Ibom Udim Ukana Cottage Hospital 4212 101% 2158%
Akwa
4 Ibom ak Oron Oron General Hospital (Iquita) 4028 93% 100%
Akwa
5 Ibom ak Uruan Ituk Mbang Methodist General Hospital 3738 91% 1349%
Akwa ak Ibesikpo
6 Ibom Asutan Nung Udoe Primary Health Centre 3342 95% 4771%
Akwa ak Ikot
7 Ibom Ekpene Ikot Ekpene General Hospital 2837 97% 101%
Akwa
8 Ibom ak Itu Mbiabong Itam Health Center 2752 141% 64100%
Akwa ak Etim
9 Ibom Ekpo Etim Ekpo General Hospital 2555 96% 735%
Akwa ak Ikot
10 Ibom Ekpene Ikot Ekpene Primary Health Centre 2317 103% 2298%
Akwa ak Obot Nto Edino Comprehensive Health
11 Ibom Akara Centre 2002 106% 3241%
Akwa
12 Ibom ak Ikono Ikono General Hospital 1983 112% 973%
Akwa
13 Ibom ak Ini Ikpe Ikot Nkon General Hospital 1600 121% 4272%
Akwa
14 Ibom ak Ika Urua Inyang Primary Health Centre 968 99% 1989%
Akwa ak Ikot Ikot Ekpene Infectious Disease
15 Ibom Ekpene Hospital 871 100% 95%
Akwa
16 Ibom ak Itu West Itam Primary Health Center 867 88% 96%

47,420

 Program Methods and Design:

PROJECT DESCRIPTION QUANTITATIVE

AND/OR QUALITATIVE
INDICATORS AND
MEANS OF
VERIFICATION
Goal (Overall To improve access to and uptake of quality health
Objective) services through collective action by community of
people living with HIV towards improved service
 delivery and client outcomes at the facility and
community levels
Specific - Improved access to HIV services uptake or initiation
Objectives - Increased Client’s retention in Care and Treatment
- Integrate CLM solution models to Service delivery
sites
Results/Outcomes R 1.1 –Stakeholders engagement Indicators:
R 1.2 –Addressing Stigma and discrimination - Number of CLM visits
R 1.3 – Use of Social media support system conducted
R 1.4 – Strengthening Support Group (Peer mentoring - Number of Sites visited
Approach)

R 2.1 – In-depth surveys ((i)Facility Service Quality; - Number of Patients

(ii) Pill-burden) reached/interviewed
R 2.2 – Tackling Waiting-time at the Facility - Number of Training
R 2.3 – Improving ease of ART collection/ ordering conducted
R 2.4 – Use of Logistics support

R 3.1 – Data Analysis and visualization for decision

making - Number of
R 3.2 – Strengthening Bi-directional Reporting and recommendation plans
Action taking developed
R 3.3 – Enhance Capacity of Human Resources - Number of follow-up on
R 3.4 – Data Use recommendations

Activities/Outputs A.1.1 - Stakeholders meetings at Facility level (IPs Facilitators/HR, writing

and Key drivers at LGA and State); materials, PA Systems,
Community level (Network groups and CBO) refreshments, transport
A.1.2 - Targeted outreaches at community, LGA and reimbursement,
State to address stigma hall/meeting venue,
A.1.3 - Utilize social media platforms e.g. WhatsApp,
Telegram
Training and logistics support
A.1.4 - Peer- to- Peer tracking system to reach People
living with HIV and not on ART
A.2.1 - In-depth Survey of client’s perception on
quality of Facility’s health services
A.2.2- In-depth survey on Pill-burden and proposed
solutions
A.2.3 - Improve Client reminder system for ART
intake
A.2.4 - Digital health system for drug ordering from
the home. Through USSD
A.2.5 - Strengthen 3PL to start ART Home dispensing
A.3.1 - Trained Service providers, Network or Peers
providing supportive counseling to Defaulters and
 Client’s Lost-to-follow up
A.3.2 - Routine monitoring of positive yield across
facilities
A.3.3 - Monitor and report gaps to facility key persons
and collect immediate remediation plans
A.3.4 - Hold monthly and/or periodic coordination
meetings to review implementation based on
experiential learning from best practices and address
gaps.

 Proposed Program Schedule and Timeline: The proposed timeline for the program
activities. Include the dates, times, and locations of planned activities and events
Work Plan
S/N Activity Months in Year 1
1 2 3 4 5 6 7 8 9 10 11 12
A.1.1 - Stakeholders meetings at Facility
level (IPs and Key drivers at LGA and
State); Community level (Network
groups and CBO)
A.1.2 - Targeted outreaches at community,
LGA and State to address stigma
A.1.3 - Utilize social media platforms e.g.
WhatsApp, Telegram
Training and logistics support
A.1.4 - Peer- to- Peer tracking system to
reach PLHIV and PL not-on-ART
A.1.5 - PEPFAR-led training for successful
grant applicants
A.2.1 - In-depth Survey of client’s perception
on quality of Facility’s health services
A.2.2 - In-depth survey on Pill-burden and
proposed solutions
A.2.3 - Improve Client reminder system for
PL drug intake
A.2.4 - Digital health system for drug
ordering from the home through USSD
A.2.5 - Strengthen 3PL to start ART Home
dispensing
A.3.1 - Train Service providers, Network or
Peers providing supportive counseling
to Defaulters and Clients Lost-to-
follow up
A.3.2 - Routine monitoring of positive yield
across facilities
A.3.3 - Monitor and report gaps to facility
 key persons and collect immediate
remediation plans
A.3.4 - Hold monthly and/or periodic
coordination meetings to review,
evaluation and learn best practices

 Key Personnel:
BLF has a team of highly qualified and competent staff across the major component of the
program implementation namely Program, Finance & Administration, Strategic
information.
Executive Director (ED): Mr Isaac Davies will provide overarching leadership and strategic
direction for the project. He will be responsible for governance issues and lead advocacies as
well as external engagement. He supervises the project management team which is led by the
Program Manager.

Program Manager (PM) Austine Edet Udoh: He has a Degree in Project Management in
Global Health, University of Washington, degree in Microbiology and MSc. in Public Health
with over 5 years of experience and involvement in community development work, technical
support, management, administration and leadership. He will be responsible for program
decisions, coordination and leadership.The day to day implementation of the project.

Finance & Admin Manager (FAM) Blessing Friday Noah: She possess a degree in
Accounting with 5 years’ experience in managing donor funds and related project. She is
responsible for operations and management of project funds, financial accountability and
reporting including human resource. She establishes and maintains financial and management
procedures for the organization and implementing Partners. The FAM ensures compliance with
all regulatory requirements as it relates to donor. She ensures that all finances are properly
administered and monitored; advise on the proper allocation of resources; ensure that
appropriate financial regulations and controls are in place and in use at all times. She prepares
and review detailed budgets for approval by the Executive Director and Implementing Partners.
She makes regular reports to BLF and partners on income, expenditure and any variations from
budgets. The Strategic Information team is led by the Strategic Information Officer (S.I.O)
Edidiong Ini Udobong: She holds a degree in Mathematics with over 7 years’ experience in
research, data and knowledge management.She is responsible for research, data and knowledge
management, monitoring, evaluation, reporting and learning. This unit will play a critical role in
curating the lessons learned from implementation and build it into a body of knowledge.

 Program Partners:
BLF has functional partnership with stakeholders at various levels across the spectrum of the
various sectors in Akwa Ibom state. BLF will leverage on this collaboration to ensure smooth
implementation of this project.
Hospitals Management Board (HMB): This is the agency responsible for coordination and
oversight of all secondary health facilities in Akwa Ibom state including cottage hospitals. BLF
will partner with the board for access to facility records and resources.
Primary Health Care Development Agency (PHDA): The PHDA is one of the nascent agency
in the state established to coordinate primary health care delivery. The agency oversees all
Primary Health care centers in the state. BLF will both strengthen the capacity of the agency to
deliver on its core mandate while collaborating to deliver the expected results.
Ministry of Health (MOH): BLF will liaise with the office State HIV/AIDS Program
Coordinator specifically while interfacing with the Ministry as a whole for effective
implementation
Akwa Ibom State Agency for the Control of AIDS (AKSACA): The organization will nurture
the relationship with this agency to effectively galvanize relevant networks and groups for
coordination, inclusion and meaningful engagement.
Heal the land Initiative (Support Group): This support group is a leading umbrella platform
for People living with HIV across the LGA within Uyo Senatorial district.
Supporting Health Redemption Organization (Support Group): This support group is the
leading organization of people living with HIV/AIDS across LGAs in Ikot Ekpene district

 Management Plan:

The project will be implemented and managed by a team of committed and experience personnel
within the organization and will to recruit where necessary. BLF will leverage on its wide
network and social capital within the region and the state at large to impact on the project results
and goals. We will collaborate with other sister project and leverage from the public sector for
resources that are beyond the project scope. The Executive Director will provide overarching
leadership and strategic direction for the project. He will be responsible for governance issues
and lead advocacies as well as external engagement. He supervises the project management team
which is led by the Program Manager. The day to day implementation of the project will be the
responsibility of the Program Manager. A team of experienced young people will lead
implementation. The project will be coordinated from Ikot Ekpene LGA.
The project will be managed by a Project Management Team (PMT) which will comprise of a
Program Manager (100%), Project Officer - (100% LOE), Strategic Information Officer (100%
LOE), and the Finance and Compliance Officer (100% LOE. The Project Management Team
(PMT) will meet every week and to review implementation and performance. The Program
Manager will coordinate team meetings to review activities, set target and carry out project
activities in line with the plan.

The pool of trained Community Case Workers shall undertake the delivery of services to
beneficiaries under the auspices of the PMT, who shall be responsible for monitoring
implementation of the Project. This will make for efficiency and effectiveness in service delivery
while giving ample time to the organization to embark on implementation of its capacity building
and systems strengthening plan concurrently.
  Program Monitoring and Evaluation Plan:

BLF in-line with PEPFAR directive for the CLM project will make use of standardized CLM
tools, for our various Site visits and during data collection. Data source will be triangulate with
Facility Care and Treatment register, Pharmacy register, Laboratory Viral Load Registers, as
well as, Lafiya Management Information System (LAMIS) database.

The following factors should be considered for the monitoring and evaluation plan:
● The data collection process is discrete and less difficult
● Use of site level, evidence based reports and registers
● Proffer some internet and mobile phone surveys (using google forms)
● Provide some incentives or identity protection for those who participate during sampling of
perception of clients receiving services
● Provide disaggregation by sex, age, ART Start, Stop-Treatment, LTFU (3 to 12 months)

Data Collection Methods:

Data collection will be at Facility (using Client’s records, registers at the clinics, pharmacies and
the referral cards) disaggregated by age and sex. Further disaggregation by primary use or
secondary use to further ascertain who is using and gaps which will enable us follow-up and
provide additional assistance where needed. In-depth surveys at the community level to
determine client’s perception will be through individual questionnaire phone application format.

Indicators for CLM Project:

Brookline Foundation will provide Quarterly reporting on each indicator listed on the program
strategy logical framework. For the grant analysis, progress or impediments to each indicator
will be tracked based on targets and achievements.
Performance Indicator Target Actual
Q1 Q2 Q3 Q1 Q2 Q3
- Number of Patients interviewed/ reached 40% 40% 20%
- Number of CLM visits conducted 30% 30% 40%
- Number of Site visited 40% 40% 20%
- Number of training conducted 60% 40%
- Number of follow-up on recommendation 50% 50%

 Future Funding or Sustainability

BLF hope to increase collaboration with other sister project and leverage from the public sector
for resources that beyond the project scope.