June 13, 2016

Drop-in centers make health services safe and accessible to sex workers in Malawi

Written by Grace Kumwenda-Pakachere, BAH, MA IHDC Program Manager

This post originally appeared in the LINKAGES newsletter, The Link.

Drop-in-centers (DICs) are stigma-free spaces where female sex workers (FSWs) can access basic health care services; HIV counseling and testing; STI screening and treatment; family planning information; and some contraceptive methods, including condoms, oral contraceptives, DeproProvera, and implants. Just as importantly, the centers also offer a safe place for FSWs to gather, socialize, and receive potentially life-saving information from trained peers.

In March 2016, LINKAGES Malawi-based partner Pakachere Institute for Health and Development Communications opened its first of five DICs. LINKAGES will have a total of 17 DICs in Malawi — four will serve MSM and will be run by another implementing partner, CEDEP; six will be run by the Family Planning Association of Malawi (FPAM); and the last two by Youth Net and Counseling Organization (YONECO). Pakachere’s DIC in Mangochi is located near several rest houses where FSWs rent rooms and is also close to “hotspots,” or areas that are frequented by male patrons. Just 600 meters away lies the district hospital, where FSWs are sometimes referred for services that are not provided at the DIC.

One key factor in the success of DICs as a service delivery model has been the meaningful engagement of the key populations they serve. While a DIC manager with a clinical background is responsible for the provision of health care services and the facility’s routine administrative tasks, the manager is supported by outreach workers, who are predominantly FSWs. Outreach workers create demand for the center’s services and encourage their peers to attend. Trained FSW peer educators hold monthly sessions to discuss health and safety issues, and FSWs serve on the committee responsible for the center’s ongoing operations. The DIC’s clients determine their priorities for use of the space. As a result, the DIC has been home to activities as varied as dance classes; discussions on genderbased violence; movie showings; and meetings about the FSWs’ economic empowerment activities such as village savings and loans, where they pool money and borrow from the fund.

In the coming months, Pakachere will focus on further increasing the number of FSWs using the DICs. Pakachere plans to encourage FSW clients to refer their peers to the center and also to link the center’s activities with those of community-based peer educators.

Simon Sikwese, Pakachere’s executive director, credits the Ministry of Health for its role in the establishment and growth of the DICs. “The partnership we have with MOH through the district health offices has been key for our success in setting up these DICs,” he says. “The district health officers in Blantyre and Mangochi have supported the DICs’ operations by providing all necessary medical supplies and technical staffing support. We’re so grateful that they have truly embraced the aim of the LINKAGES project.”

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