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BHASO’s CHASA project proving to be a huge success in Masvingo Province
Batanai HIV & AIDS Service Organisation
March 05, 2013

HIV positive Chemedzai sets off to the local clinic to fetch her ARVs. At the clinic she is warmly welcomed by Rangarirai who is also HIV positive and has been on ART for the past four years. Rangarirai is a Community HIV and AIDS Support Agent or CHASA, to cut a whole mouthful short. Chemedzai is quite at home as she is made to feel comfortable by someone who is also HIV positive. She is happy that she was finally able to get enough courage to get tested after being counseled by Rangarirai. She needs more ongoing counseling on ART adherence and information on nutrition. Rangarirai is already getting ready for a counseling session. The Sister In Charge smiles as she hurries past to attend to a sick patient who has just been brought to the clinic in an ox drawn scotch cart. Batsirai, another CHASA is helping with some paper work and directing patients. After a long day’s heavy work tired Chemedzai completes her paper work and walks home. As she trudges home she is worried about Chikonzero and mbuya Vhangi who did not turn up to collect their ARVs. She decides to visit them the following day. Such is the day of a CHASA.

Who is a CHASA? What does he or she do and where? In 2009 Masvingo based Batanai HIV and AIDS Service Organisation (BHASO) picked the concept from the three years Networks Project that was being implemented by the International HIV/AIDS Alliance in Uganda between July 2006 and July 2009 after getting hold of the end of project report. The project was funded by the President’s Emergency Plan for AIDS Relief through USAID to the tune of US$7.6 million and was run in more than 40 districts. After realizing the potential of Ugandan Networks Project BHASO decided to replicate it in its operational areas.

BHASO is working with Switzerland based Solidarmed in the rural districts of Zaka and Bikita in support of its ART programme by facilitating the formation, training and coordination of support groups of people living with HIV and AIDS. There was great need for ongoing counselling, ART literacy and adherence, follow ups on defaulters and some assistance to health clinic staff that was already overloaded by day to day duties. The introduction of a new cadre who could offer supporting services at health institutions was seen as a sustainable solution. In Uganda they call this cadre Network Support Agent (NSA). We later learnt that the Zambia HIV and AIDS Prevention, Care and Treatment (ZPCT) partnership is actually implementing a similar project in five provinces while working closely with the Zambian Ministry of Health at national, provincial and district levels. The project is also funded by the US President’s Emergency Plan for AIDS Relief through USAID. In Zambia the cadre is called Adherence Support Worker (ASW). At BHASO we decided to call the cadre Community HIV and AIDS Support Agent or CHASA. Solidarmed was supportive and the first CHASAs were selected and trained.

The CHASA cadre belongs to the community, is based in the community and works for the community. He or she is there to offer support in HIV and AIDS related work that has to be done in the community. Two male and female support group members are selected by support group members from a number of support groups belonging to a cluster. A cluster is an area that is being serviced by a health centre. The two need to live publicly with HIV and on ART for at least two years and should be literate. Confidentiality is of great importance here. The two should be committed enough to volunteer and work at the health centre two days in week. After five days of training the CHASAs should be able to perform their duties that include receiving clients when they come to the clinic, counseling clients on drug adherence and positive living, providing clients with information on relevant HIV and AIDS issues, facilitating clients’ easy access to HIV-related services, following up on ART clients who are defaulting, ensuring proper documentation of relevant transactions and carrying out any other duties assigned by health staff.

The CHASA concept brings with it a number of advantages. Being HIV positive and on ART themselves, CHASAs understand the problems and issues faced by people living with HIV and AIDS. It then becomes easier for people living with HIV and AIDS to open up to CHASAs as they would be confident that their situations would be understood. Birds of the same feather flock together. Living in the same community CHASAs can make follow ups on defaulters and visit the sick. They can also make arrangements for collection of drugs for clients who are too weak to travel to health centres. CHASAs also help to relieve the heavy burden on already overloaded health staff thus freeing them for other pressing duties.

The CHASA concept is proving to be very successful where it is being implemented. There is improved drug uptake and reduced default rates. Disclosure has improved as more people feel free to come out in the open and join support groups. CHASAs are being instrumental in getting children tested and getting the support they need in order to take their medication faithfully. Overloaded health staff can rely on CHASAs for assistance in some duties that they can carry out at the health centre. CHASAs also offer support to local support groups in terms of training and information. There is greater meaningful participation of people living with HIV.

The issue of motivation for the CHASAs is a major challenge. Some form of appreciation for the two days they offer at the health centre would be in order. However due to resource constraints it is only in two districts that CHASAs receive some incentives in the form of bicycles and monthly allowances courtesy of the funding partner operating in the two districts. BHASO is not yet in a position to do the same in other districts. There is need for more resources to extend the concept to other districts and even to other provinces in the country.

To date BHASO is working with 191 CHASAs at 101 hospitals and clinics in the five districts of Bikita, Zaka, Gutu, Masvingo Rural and Masvingo Urban. Resources permitting the concept can be realised in the remaining Masvingo districts of Chivi, Mwenezi and Chiredzi. BHASO is eager to see more people living with HIV in the rest of Zimbabwe benefiting from the CHASA concept. BHASO is already working closely with the Ministry of Health and Child Welfare and other stakeholders at the grass root levels and is ready to discuss possibilities of operationlising the CHASA concept on a national level. If they did it in Uganda and Zambia, we can also do it in Zimbabwe in a format that suits our conditions and capabilities.

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