ACCLAIM Toolkit: Scaling Up Community Involvement in Maternal and Child Health and Prevention of Mother-to-Child HIV Transmission

This toolkit offers a compilation of various tools (guidelines, standard operating procedures, presentations, job aids, and forms) used in the Advancing Community Level Action for Improving MCH/PMTCT (ACCLAIM) Project, which sought to enhance community involvement in maternal, neonatal, and child health (MNCH) and prevention of mother-to-child transmission (PMTCT) services among men, women and community leaders. Implemented by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) in Swaziland, Uganda, and Zimbabwe, the project used three distinct approaches which are supported by the toolkit: “community days”, peer group mentorship, and community leadership engagement.

Evaluation results of the various arms of the project (used in isolation or in combination with others) found that, “[C]ommunity days and peer-led health support group interventions slightly improved facility deliveries. Engagement with community leaders slightly improved male partner testing, while community days and peer groups improved infant ARV uptake.  All interventions improved percentage of attending ANC before 20 weeks gestational age, gestational age at first ANC by 2 weeks and maternal ARV uptake. The Community Leadership intervention had the largest effect on these indicators”.  By sharing this toolkit, EGPAF hopes the positive effects of ACCLAIM can be recreated in other settings.

The resource includes the following:

Community Leaders Tools

• Community Leader standard operating procedures (SOP) Manual - the purpose of the SOP Manual is to summarise the targets, purpose, and adaptation of each SOP intended for use by the community leaders. This manual first gives an overview of how to use each SOP, the activity they are for, and the corresponding forms and reports that should be used with them and then explains the purpose, roles and responsibilities, procedures, and resources of each in detail.
• Community Leader Refresher Training Guide -the refresher training is three-day course for community leaders aimed at improving their acknowledged difficulties with skills and topics, taken from quarterly reports and meetings with EGPAF staff. The refresher training guide provides the step-by-step procedures by which community leaders should engage in community action, advocacy, policies, constructing sustainable plans for change, and certain MNCH topics. The refresher training goes over modules on certain health topics complete with objectives and facilitation instructions.
• Community Leader Forms - these are designed to provide a resource, in which community leaders can give their feedback on the subjects, structure, preparation, and implementation of each Community Day.
• Module 0-8 Institute - this document provides the goals, key competencies, necessary materials, preparations, timetables, and outlines of each module. Each module is structured by subject and broken down into subsections which include health myths and realities, an overview of national health policies, and discussion questions.
• SOPs for Adapting the Community Leaders Institute -  this document provides a guideline for the adaptation and implementation of the community leaders institute curriculum. This SOP summarises the skills, training, support, and mentorship that EGPAF staff will provide to the community leaders to best serve their communities.

Community Day Tools

• Community Day SOPs - outlines how Community Days should be implemented and conducted both by EGPAF staff and local personnel.
• Community Day Forms - seek to establish a method to monitor the registration and attendance of participants and facilitators, agendas for the days, provided services, inventory of equipment, referrals, dialogue templates, exit interviews, and post-meeting plans.
• Male Youth Dialogue Guide - provides an outline for guiding discussions with male youth during Community Days. It is broken up into four subgroups: sex; healthy relationships and avoiding HIV; ANC attendance, labour and delivery; and postnatal care/child welfare. 
• Female Youth Dialogue Guide - provides an outline for guiding discussions with female youth during Community Days. It is broken up into four subgroups: sex; healthy relationships and avoiding HIV; health during pregnancy, labour and delivery; and postnatal care/child welfare. 
• Male Adult Dialogue Guide - provides an outline for guiding discussions with male adults  during Community Days.  It is broken up into three subgroups:  ANC attendance; labour and delivery; and postnatal care/child welfare.
• Mother-in-law Dialogue Guide - provides an outline for guiding discussions with mother-in-laws during Community Days. It is broken up into three subgroups: ANC attendance; labour and delivery; and postnatal care/child welfare.
• Women at Child-Bearing Age Dialogue Guide - provides an outline for guiding discussions with women of childbearing age during Community Days. It is broken up into three subgroups: ANC attendance; labour and delivery; and postnatal care/child welfare.

Peer Group Tools

• Peer Group Facilitator Standard Operating Procedures (SOPs) - provides a guideline for the roles and responsibilities of the peer group facilitators. This SOP summarizses the processes by which the peer group facilitator should structure participant recruitment, gathering informed consent, registration, meetings, referrals, withdrawals, and peer group close outs.
• EGPAF Staff Managing Peer Groups SOPs - outlines the procedures and processes by which the  MNCH and male peer groups should be implemented. Each peer group will have four different sections, on topics including MNCH, gender, PMTCT and their relation to the prevention of HIV and the sustainability of health. The document summarises the roles, responsibilities, and expectations of EGPAF staff that will ensure the peer facilitators are well-trained and receive the necessary support and mentorship. 
• Peer Group Forms -  holds all of the forms, surveys, reports, and template materials that will be needed in the peer groups.
• Peer Groups Manual - provides an outline of all the sessions that group members who join the groups will be taken through. The sessions aim to capacitate the group members with MCH and PMTCT knowledge so as to change their health behaviour so that better health outcomes will be attained. The MCH classes for women will be taken through the following topics: staying healthy during pregnancy, pregnancy and birth-planning, preparing for child birth delivery and immediate post natal care, and staying healthy after birth. The MCH classes for men will be taken through the following topics: strong informed powerful men as champions for health families, becoming a father, are you ready to be a father, and keeping your family healthy.