Combining community-based organizations’ local knowledge, participatory and

GIS mapping approachesto improve condom availability in

Gert Sibande District, South Africa -

Lessons from a pilot intervention

Brent Matthysen, Phiwa Sondhlane, Babalwa Fede and John Imrie

July, 21 2014

Sexual HIV Prevention Programme (SHIPP) Futures Group International

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 Context1) South African National Department of Health is the main provider of freely-available condoms in the country

Male Condom Distribution

Rates by District (2012-13)

and Scale-up Targets

J T Gaetsewe DMFrances Baard DM

Ekurhuleni MMSiyanda DM

Johannesburg MMBuffalo City MM

eThekwini MMPixley ka Seme DM

Cacadu DMTshwane MM

Dr K Kaunda DMMangaung MM

Amathole DMN Mandela Bay MM

A Nzo DMVhembe DM

Umkhanyakude DMiLembe DM

Namakwa DMBojanala Platinum DM

RS Mompati DMSedibeng DMNkangala DM

Ugu DMWest Rand DM

Joe Gqabi DMUthungulu DM

Fezile Dabi DMT Mofutsanyane DM

G Sibande DMO Tambo DM

Gr Sekhukhune DMSisonke DM

Capricorn DMZululand DM

C Hani DMXhariep DM

Waterberg DMMopani DM

Lejweleputswa DMEhlanzeni DM

Ngaka Modiri Molema DMCentral Karoo DM

Overberg DMCape Winelands DM

Eden DMUmzinyathi DMWest Coast DM

uMgungundlovu DMCape Town MM

Amajuba DMUthukela DM

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.05.55.66.37.1

8.99.0

9.911.812.212.612.712.8

13.814.414.614.915.115.115.515.915.916.116.816.917.517.618.118.218.319.119.319.8

22.523.123.2

24.324.624.725.225.2

27.027.9

30.839.1

42.642.743.0

49.155.3

63.769.369.6

Current average: 22 condoms

Mid target: 36

Final target: 50

Gert Sibande

19.1

2) Condom distribution has been variable &

erratic

Source: Health Systems Trust, 2013. District Health Barometer

19

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.

. Cape Town

. Durban

Johannesburg .

Pilot Site - Gert Sibande District

Methodology

Methodology – Step 1Geospatial 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 3Capacity-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 & SCDPsHot Spots Social, Health, Safety, Security &

Civil Services InfrastructureTuck Shops, Stores, Supermarkets & Markets Public Primary & Secondary Health FacilitiesTaverns, Bars & Shebeens (unlicensed) CBOs (nonSHIPP-funded)Hair Salons Police StationsIndustry, Mines, Farms & Timber Sidings Libraries, Community & Information CentersGas Stations Municipal OfficesTruck Inns, Truck Stops & Taxi Ranks Social Development Services OfficesInformal Settlements Other Government Department OfficesTelecommunication Booths Post Offices

Lodges, Guest Houses, Hotels & Inns Condom Warehouses / DepotsLiving Compounds & HostelsCar Wash Sites (informal) 1,800 sites mapped & plottedBrothels (all are illegal)PrisonsPower Stations

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

Apr-13

May-13

Jun-13Jul-1

3

Aug-13

Sep-13

Oct-13

Nov-13

Dec-13

Jan-14

Feb-14

Mar-14

Apr-14

May-14

0

10

20

30

40

50

60

19.4

28.325.1 25.8 27

40

53.8

34.7 32.2

25.7 27.1 28.2 27.6 25.6

• Participatory approaches ensure CBOs acquire in-depth 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

Lessons Learned

Thank Youwww.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.