Improving client-centered HIV services through community-led monitoring in Nepal

BACKGROUND: To achieve and sustain HIV epidemic control, services must be differentiated to respond to the preferences and needs of underserved populations facing the greatest HIV infection risks. With support from the U.S. President''s Emergency Plan for AIDS Relief (PEPFAR) and the United States Agency for International Development (USAID), the Meeting Targets and Maintaining Epidemic Control (EpiC) Project in Nepal supports community-led monitoring (CLM) to ensure that services are continuously accountable to clients.
DESCRIPTION: In October of 2020, the EpiC team introduced community scorecards and an electronic client feedback system to implement CLM in Nepal. Scorecards are generated from a structured quantitative questionnaire with rating scale and qualitative interviews. The client feedback system, called LINK, is promoted through service sites and push messaging to clients, and can be anonymously accessed by scanning posted QR codes or clicking embedded weblinks. Both the community scorecard and LINK results guide project-facilitated quality improvement consultations that engage program managers, site-level staff, and community members in the development of action plans.
LESSONS LEARNED: From October 2020 to September 2021, clients submitted feedback 3,512 times through LINK, with 90% of entries expressing service satisfaction. Complaints were registered in only 212 entries, and clients provided constructive suggestions about more convenient service operating hours; expanded availability of sexually transmitted infection services; improving the quality of counseling; ensuring client confidentiality; and clinic cleanliness. Scorecards were generated from assessments at 26 sites. Sites scored an average rating of 83 out of 100 on the quantitative assessment tool, but this average varied across sites for specific service components. Clients gave index testing services the lowest average score (74%) and gave the highest average score (87%) to components focused on commodity access and on reducing stigma and discrimination.
CONCLUSIONS: CLM identified specific opportunities to improve and differentiate services to be more responsive to clients while providing a platform for both community members and providers to develop and advance improvements. Virtually all sites implemented actions in response to CLM results. Going forward, sustained engagement in CLM should help to evaluate the potential impact of these improvement efforts.

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