Network Coordination Services

The complex needs of Persons living with HIV & AIDS (PLHA) in resource constrained environments like Nigeria has made it impossible for one facility or organization alone to provide all services. Nation-wide interventions for HIV prevention, treatment, care and support in the last decade have resulted in increased awareness, case finding and access to treatment with antiretroviral drugs plus a concomitant increase in demand for support services for PLHAs and their families. In a difficult service environment with limited and disjointed health and social services networks, routing clients and families through various service points is an uphill task that further hampers quality care provision. Many clients become frustrated and abandon referrals and sometimes fall out of care. Efficient coordination of facility based HIV services integrated with community based services is critical for easy access by clients and their families. Such attempts at making services "client focused" go a long way to improve quality of care, client satisfaction, reduce loss to follow up and ultimately improve patient outcomes.

To ensure smooth client flow through these complex systems, Institute of Human Virology Nigeria ACTION-Project in 2009 developed a more robust case management approach by putting in place Network Coordination services to complement care & support services; provide coordinated synergy between services within facilities; between facilities; and between facilities and communities. The goal is to strengthen supported facilities to establish "functional" linkages that supports client access to services with minimal discomfort, tracks referrals through active feedback mechanisms and enhance relationship between service providers in and outside of the facilities. This strategy was implemented through financial support for health facilities to employ Network Coordinators who could be nurses with community or public health background, social workers, community health extension workers with knowledgeable about HIV service provision and trained on networking and linkages.

Network Coordinators work in conjunction with the facility and community services providers to coordinate all care and support initiatives. They are responsible for developing service directories, streamlining and strengthening referral and linkage of clients, and ensuring a functional feedback process between the various referral units within the facility as well as catchment communities. Network Coordinators spend 50% of their time in facilities participating in clinic flow and patient access to care activities, while 50% is spent in the community on network creation, advocacy, community resource identification and service evaluation activities. The Network Coordination services is ultimately strengthening retention in care as most patients access services within facility and community catchment areas with less stress. This significantly contributes to reduction in the number of patients lost to follow up.

Despite available financial support and benefits of Network Coordination services, a few supported health facilities are yet to employ and/or release staff for Network Coordination. Surprisingly the anticipate challenge regarding risks involved with poor transport systems for the community component of the network development, has so far not deterred any of the network coordinators from doing their work. However, majority of the facilities that have bought into the concept have begun to reap the complementary benefits of improved case management in HIV care. There is ongoing advocacy with facility administrators to ensure sustainability. Hopefully, as Network Coordination strengthens referral and linkage systems at all service points, hospital administrators can use the concept to further develop social worker roles within the health system.

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