Sexual HIV Prevention Programme (SHIPP)
Futures Group International
Combining community-based organizations’
local knowledge, participatory and
GIS mapping approaches
to improve condom availability in
Gert Sibande District, South Africa
Lessons from a pilot intervention
July, 21 2014
Brent Matthysen, Phiwa Sondhlane, Babalwa Fede and John Imrie
Background
• Condom use remains a core sexual HIV prevention
intervention globally
• However, ensuring the quality, quantity, distribution
continuity & equity of freely-available condoms
presents substantial challenges
• Erratic & inequitable condom distribution,
particularly in poor rural & hard-to-reach areas,
results in poor uptake, inconsistent usage &
an unwillingness to adopt condoms as a primary HIV
prevention strategy
Policy Context
1) South African National Department of Health
is the main provider of freely-available
condoms in the country
69.6
69.3
Amajuba DM
63.7
uMgungundlovu DM
55.3
49.1
Umzinyathi DM
43.0
42.7
42.6
39.1
Cape Winelands DM
Central Karoo DM
30.8
27.9
27.0
25.2
25.2
24.7
24.6
24.3
23.2
23.1
22.5
19.8
19.3
19.1
18.3
18.2
18.1
17.6
17.5
16.9
16.8
16.1
15.9
15.9
15.5
15.1
15.1
14.9
14.6
14.4
13.8
12.8
12.7
12.6
12.2
11.8
9.9
9.0
8.9
7.1
6.3
5.6
5.5
Ehlanzeni DM
Mopani DM
Xhariep DM
Zululand DM
Sisonke DM
O Tambo DM
Gert
Sibande
T Mofutsanyane DM
19.1
Final target: 50
Male Condom
Distribution
Rates by District
(2012-13)
and
Scale-up Targets
19
Uthungulu DM
West Rand DM
Nkangala DM
RS Mompati DM
Namakwa DM
Umkhanyakude DM
A Nzo DM
Mid target: 36
2) Condom
distribution has
been variable &
erratic
Current average: 22 condoms
Amathole DM
Dr K Kaunda DM
Cacadu DM
eThekwini MM
Johannesburg MM
Ekurhuleni MM
J T Gaetsewe DM
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
Source: Health Systems Trust, 2013. District Health Barometer
80.0
Policy Context (cont.)
•
South African NDoH is the main
provider of freely-available condoms
•
Condom distribution across the
country has been variable & erratic
•
3) National plan aims to supply
1 billion condoms annually
50 male condoms per male aged
≥15 years
Mpumalanga Province (South Africa)
.
.
PRETORIA
Johannesburg
. Durban
. Cape Town
Pilot Site - Gert Sibande District
Methodology
Methodology – Step 1
Geospatial analysis of antenatal HIV rates
prevalence, 2011
Methodology – Step 2
• Collaborative systems review of condom supply,
management & distribution system
– Poor:
• condom supply
• distribution coverage
• monitoring (data recording)
• data flow
• reporting (NOT feeding the DHIS)
• data analyses
• information sharing
Methodology – Step 3
Capacity-building workshops
with SAG partners
– District & Local Municipalities
& CBOs
1. Know Your Epidemic &
Response
2. Drawing of maps by hand:
• mapping of infrastructure
& services
(107 CBOs & 242 persons)
• plotting of hot spots &
primary & secondary
condom distribution points
Methodology – Step 4
 Plotting of sites using Global Positioning System
hand-held devices
Mapped & Plotted Potential Hot Spots & SCDPs
Hot Spots
Social, Health, Safety, Security &
Civil Services Infrastructure
Tuck Shops, Stores, Supermarkets & Markets Public Primary & Secondary Health Facilities
Taverns, Bars & Shebeens (unlicensed)
CBOs (nonSHIPP-funded)
Hair Salons
Police Stations
Industry, Mines, Farms & Timber Sidings
Libraries, Community & Information Centers
Gas Stations
Municipal Offices
Truck Inns, Truck Stops & Taxi Ranks
Social Development Services Offices
Informal Settlements
Other Government Department Offices
Telecommunication Booths
Post Offices
Lodges, Guest Houses, Hotels & Inns
Condom Warehouses / Depots
Living Compounds & Hostels
Car Wash Sites (informal)
Brothels
(all are illegal)
Prisons
Power Stations
1,800 sites mapped & plotted
Methodology – Step 5
 Creation of electronic maps using:
− stored GPS coordinates
− freeware Geographic Information Systems (GIS)
software applications
 Collaborative amendment of condom
distribution data collection tool used by the
condom warehouse & other primary distribution
points
− auto-aggregation by week, month & quarter
using MS Excel formulas
Combining community-based
organizations’ local knowledge
and GIS mapping activities to
improve condom availability
Methodology – Step 6
 Dissemination of e-maps to stakeholders for use
in condom distribution scale-up planning &
distribution activities
Gert Sibande Condom Distribution Rates
(Number of male condoms per male aged ≥15 years)
2013-14
60
53.8
50
40
40
34.7
28.3
30
20
10
0
19.4
25.1 25.8 27
32.2
28.2 27.6
25.7 27.1
25.6
Lessons Learned
• Participatory approaches ensure CBOs acquire indepth understanding of mapping that is easily
replicable without need of advanced additional
technical support
• Combining participatory approaches, GIS
technology & CBOs’ indigenous knowledge can
fast-track equitable condom distribution &
coverage, & reach key populations such as rural
communities
Thank You
www.futuresgroup_shipp.com
The Sexual HIV Prevention Programme (SHIPP) is a United States Agency for
International Development (USAID) – PEPFAR funded initiative in South Africa (SA)
to galvanize and support combination HIV prevention activities. •Implementing partners
include Futures Group, the Centre for AIDS Development, Research, and Evaluation,
EngenderHealth, and Futures Institute.