An integrated approach to community health service delivery in Samoa

November 9, 2020

A group of young people take part in a group exercise during an activity organized by the Ministry of Health under its Integrated Community Health Awareness Programme. Photo: Ministry of Health.

An integrated approach to deliver health services in Samoa is proving to be an effective and sustainable way to respond to health care challenges and reach vulnerable communities. The approach is now also being replicated in other countries in the Western Pacific.

Samoa’s Integrated Community Health Approach Programme (ICHAP) was launched in 2017 by the HIV, Sexually Transmitted Infections (STIs) and TB National Programme and the Health Education and Promotion team at the Ministry of Health in cooperation with a range of partners, and with support from the Global Fund and the United Nations Development Programme (UNDP) through the Multi-Country Western Pacific Integrated HIV/TB Programme.

The goal is to boost awareness on prevention measures for HIV and STIs among the general population, with an emphasis on young and at-risk people, and to bring health promotion to local communities who were often not adequately reached by conventional service delivery.

A group of women hold up signs for the Ministry of Health’s T3 campaign aimed at addressing HIV and STIs in Samoa. Photo: Ministry of Health.

Health workers test people for STIs using the SD Duo point-of-care test kit on the sidelines of a health education seminar for youth, 2019. Photo: Ministry of Health.

Over the years the programme has evolved to incorporate other high priority health issues. This year, it focused on HIV, STIs, TB, infection control and health care waste management to strengthen preparedness and response to the COVID-19 pandemic. Previous years have covered other infectious diseases, noncommunicable diseases (NCDs), climate change resilience, maternal and child health and family wellness.

Another key aspect has been the collection and analysis of data on behaviour and knowledge of health issues, particularly among people from rural and remote communities, youth and key populations (men who have sex with men, transgender people, people who use drugs, sex workers, seafarers and prisoners). In 2018, a survey was conducted with over 500 respondents and captured baseline health information, helping to improve health surveillance across multiple indicators, and to inform policy and programme design.

Seminars are often held during ICHAP activities, providing opportunities to share knowledge and openly discuss the health issues facing local communities. Photo: Ministry of Health.

“All of the areas of health are integrated into one programme to overcome the challenges posed by cultural and religious stigma of sensitive health issues,” said Bobby Carney, Research, Monitoring and Evaluation Officer, HIV, AIDS, STIs and TB at the Ministry of Health Samoa. “If these are delivered alone, they will not be received as effectively by communities.”

“To deliver the strategy, we engage communities directly and involve traditional village leadership to deliver critical health messages and prevention awareness,” he continued. “It has been a very successful approach in reaching out to rural communities and vulnerable groups. It compliments the UN mission to ‘leave no one behind’ and is aligned with multiple Ministry of Health initiatives that promote a community centered approach to improving population health.”

The programme aims to respond to a number of challenges facing health care in Samoa, including the need to end the silo approach to health service delivery, improving overall health of the population, overcoming resource constraints, increasing coverage and establishing a more sustainable and resilient health system. Health communication, public health and clinical services are delivered holistically in this approach.

Serafi Moa, Senior Nurse Specialist of the Communicable Disease Clinic, and a junior nurse take an attendee’s blood pressure and blood glucose as part of an integrated screening activity for STIs, TB and NCDs, 2017. Photo: Ministry of Health.

Each year, the programme identifies a new set of priority health issues to focus on, and targets a new set of communities. Based on this, relevant partners are gathered to contribute their own unique expertise to carry out the activities.

Typically, campaigns are organized every year for about five days in communities on the islands of Savai’I and Upolu. At the sites, multi-purpose service points are set up with a range of services provided to the local population at one convenient location.

The outreach activities have so far reached more than 30 villages, 25 primary schools and colleges, 2 prison facilities and 2 youth organizations, reaching upwards of 1,400 community members and 2,500 school students.

Due to the COVID-19 pandemic, only a single campaign was organized this year, with restricted participation. It was held at the Ministry of Health conference room on Upolu from 13-17 July, and invited young people in particular to participate. The Ministry of Health partners were given the opportunity to utilize their networks to bring in young people.  A total of 260 people took part in a series of workshops. Booths were also set up offering a range of services, from point-of-care testing for HIV and STIs to screening for NCD risk factors.

Examples of some of the COVID-19 information materials distributed to those in attendance at this year’s ICHAP activities.

The organizing partners were the Samoa Red Cross Society, Fa’ataua le Ola (psychosocial support), Nuanua o le Alofa (people with disabilities), Samoa Family Health Association, Young Women Christian Association, Samoa National Youth Council and the Samoa Faafafine Association (transgender community).

“UNDP’s support to building resilient and sustainable health systems does not stop at the clinical or facility level, but rather it runs deeper into communities and reaches those who are vulnerable and marginalized in society,” said Gayane Tovmasyan, Regional Programme Manager, UNDP. “Our experience shows that health responses that involve the community produce strong results, whether it be for HIV, TB and malaria, or in responding to the COVID-19 crisis. This is why we focus on supporting community-level solutions and place community-level involvement as the foundation of our interventions.”

The topics covered in this year’s ICHAP activities were heavily influenced by the ongoing pandemic, which has so far spared Samoa – there have been no confirmed cases in the country (as of the publishing date). Nonetheless, preparation is a high priority in the eventuality that an outbreak occurs. Therefore, in addition to sexual and reproductive health issues and TB, which are covered in each ICHAP campaign, the workshops included awareness raising sessions on COVID-19, including modes of transmission, people who are most at risk and home-based prevention measures.

A local tattoo artist receives supplies for proper disposal of hazardous waste after attending a training session by the Ministry of Health, Health Care Waste Section, 2020. Photo: Ministry of Health.

A local tattoo artist receives supplies for proper disposal of hazardous waste after attending a training session by the Ministry of Health, Health Care Waste Section, 2020. Photo: Ministry of Health.

The Ministry of Health also offered a specialized training for tattooists and hairdressers to strengthen prevention measures for HIV and TB and health care waste management, covering proper hand washing, use of personal protection equipment and sterilization of tools and equipment.  

The Samoa Faafafine Association has been an important partner in the annual activities, taking advantage of the opportunity presented to deliver sexual health services to marginalized transgender communities.

The faafafine and faatama community coming together in a group activity in one of the workshops organized by the Ministry of Health, 2020. Photo: Ministry of Health.

The faafafine and faatama community coming together in a group activity in one of the workshops organized by the Ministry of Health, 2020. Photo: Ministry of Health.

“The programme has not only enabled the outreach of testing and condom/lubes distribution to the faafafine and faatama community, but it has also enabled SFA to create transgender clubs in rural villages, amplifying the outreach in a more collaborative close relationship with the village councils and church leaders,” said Alex Su’a, President, Samoa Faafafine Association. “This is an outstanding achievement for SFA and its advocacy.”

Given its success, the integrated community-based health services and awareness raising approach is now being replicated by other countries in the region, with support from UNDP and the Samoa Ministry of Health. Niue has adopted the approach and has implemented their first campaign this past June, with another scheduled for October, while Cook Islands is currently trialing the concept.