Written by: mothers2mothers
As mothers2mothers (m2m) begins to wrap up their Active Client Follow-Up (ACFU) pilots for scale up, both quantitative and qualitative collection of pilot data is being collected for analysis to identify the successes and challenges of using ACFU to encourage women to continue accessing health care through mobile phones and home visits. Nearly all of our feedback is coming from those who know our program best – our Site Coordinators (SCs) and Mentor Mothers (MMs) who run our program in the facilities and are conducting ACFU activities on a daily basis.
The perspectives in this post come from the experiences of SC Nthati Mpopo and MM Mamosito Lerama, who have graciously shared their experiences with ACFU at the site level. These interviews provide a peek into an innovation that will help m2m actively encourage client retention, influence specific targeted PMTCT outcomes, and, importantly, provide the opportunity to improve organizational data use and data quality.
Mamosito’s interview was conducted in Sesotho and translated to English. Some additional information has been added in brackets to provide context for the quotes.
What are your overall feelings about your experience with ACFU?
Nthati: “[ACFU has been] doing a very wonderful job, it has helped us to improve the data quality reporting in the logbooks, …improved relationships with clients [but also with] facility staff because they know if something has been missed, they can come to m2m. [ACFU] shows that m2m is important to facilities…ACFU has also reduced cost of following up clients and allows m2m staff to focus on their obligations at the facility, as the use of mobile phones reduces the number of home visits that need to be conducted, and means that MMs and SCs can be “available for work by doing it on the facility premises…instead of going out.”
Mamosito: I have had a very good experience with ACFU. We have been able to successfully follow clients and they have been coming back to the facility to access services.
Can you tell us about your daily ACFU activities?
Mamosito: When a client misses a priority PMTCT event, we send them an SMS asking them to come back to the facility, then if they don’t return to the facility we make a call, followed by two more calls, and finally a home visit to try to make contact with them and ensure they access the services they need.
Has ACFU improved clients’ access to PMTCT services?
Nthati: [ACFU] makes them more responsible, [and their retention in PMTCT services is] better than before. [It helps especially] in rural areas where most women work. If we phone them it is much easier to find them and help them access services.
Mamosito: Yes, a lot because clients are accessing all of the services they should be getting, for example testing their children and getting test results, and getting ARV refills. It also is improving male involvement, especially through home visits, as we can invite the spouse to come back to facility to access health services with their wife.
Can you share an ACFU success story with us?
Mamosito: There was a client who was not disclosing her status, so we sent an SMS to invite her back for PMTCT care, and when she came back to the facility, she brought her partner and finally managed to disclose to him at the health facility.
Are there challenges you see with ACFU?
Mamosito: There is a long period of SMS, waiting one week between SMS and call. While we are waiting to follow procedure, we sometimes lose some of the children [who test HIV+]. We have lost two infants while waiting to follow up clients for infant test results.
Nthati: What …is challenging about this, is that [the staggered timing of contacting clients] makes it take a long time [to actually make contact with clients who don’t answer the first SMS]. While we are waiting to follow the ACFU procedure, clients are missing important information that could help them access important services sooner. Like when a child tests HIV+ or a woman has a low CD4 count and it takes a long time [to tell them] because we wait to [follow them up after they miss an appointment] but the information is already in. It is also a challenge in urban areas where women aren’t actually exposed to cell phones yet and…we have to make a home visit right away.
Why do you think women don’t come back to access services in the first place?
Nthati: Often tests have to be sent out to a different facility that has the equipment or the CD4 count machines are out of order, and clients come back but results aren’t ready so they leave again and don’t know when to come back. Sometimes it’s about the work conditions [in the facility] and the administration of facility don’t tell them about their next appointment [so they don’t know when they are missing important services].
Mamosito: Most of them are working clients, so they don’t have time to come back. Others are living far away from the facility and it is difficult for them to get to the facility to access services.
We appreciate Nthati and Mamosito’s candid responses about their experiences with ACFU and look forward to getting continued feedback as we work to make ACFU an intervention that helps our staff and clients across the organization.