Tonata in collaboration with Okalongo Health Clinic held a Consultative Meeting with Ombandja Traditional Authority regarding community based HIV medicine distribution


Namibia is making great strides in making access to HIV medication a reality. Decentralisation of anti-retroviral (ARVs) drug distribution from health facilities to communities is one of the models of Antiretroviral Therapy (ART) service delivery outlined by the Ministry of Health and Social Services. There is a need to raise awareness and mobilise communities to ensure people have access to available ART services according to their needs. Traditional authorities plays an important role in community mobilisation effort. Tonata in collaboration with the MoHSS-Okalongo Health Centre engaged the traditional authority (TA) of Ombandja to discuss the available ARVs drug distribution approaches and how the TA could assist in ensuring that their communities receive the services they deserve.

Meeting with Ombandja Traditional Authority
Chief Walaula of Ombandja Traditional Authority (second from left) with Tonata and MoHSS staff 


Tonata PLHIV network is funded by PEPFAR through USAID to scale-up Community Adherence Group (CAG) refill groups approach to ART service delivery in eight health districts of Oshikuku, Engela, Onandjokwe, Omuthiya, Tsumeb, Grootfontein, Nyangana and Andara in collaboration with the Ministry of Health and Social Services (MoHSS). 

Tonata Oshikuku District in collaboration with Okalongo Health Centre organised a consultation meeting with Ombandja Traditional Authority (OTA) held on 19 July 2019. The purpose of the consultation meeting was to introduce ART Differentiated Services Delivery models stipulated in the National Guidelines on Antiretroviral Therapy (2016) issued by the MoHSS. Particularly, the aim was to sensitise OTA leadership on Community Adherence Group (CAG) model part of Community ART Service Delivery so that they could mobilise Ombandja traditional community to embrace opportunities and benefits of CAG.

The meeting was held with Chief Walaula and his Ombandja Traditional Authority council and all village headmen. The council comprised of Senior Traditional Councillors, Traditional Councillors, and Secretary of the Traditional Authority. In Namibia, especially in the North Central regions such as Omusati Region, traditional authorities, which are the custodians of traditional customs, norms, values, language, culture, and customary laws, remain the centrepiece of community life. The traditional authorities guide and teach on moral and ethical conduct of their subjects. They are responsible for decisions regarding the collective welfare of the traditional community and can have decisive impact on activities taking place in that community, especially if the programs are initiated from outside the local community. Members of OTA council derives their leadership and authorities from the Chief in line with customary laws and relevant national legislations. The Chief is a figure of great reverence and respect in the traditional community.

Due to the significance of the Chief and his OTA in community cohesion, influencing mind-set changes within their traditional community’s jurisdiction, Tonata in collaboration with MoHSS – Okalongo Health Centre have made it a priority to engage them to promote and publicise Community Adherence Groups.
The meeting was officially opened by Chief Matias Walaula and chaired by Mr. Olavi, Senior Traditional Councillor. Mr. Shekundja, Counselor at Okalongo Health Centre, gave a presentation on the aims and objectives of the meeting, followed by Mr. Shoolongela, Tonata Oshikuku District Coordinator and Mr. Iita, Tonata Communication and Advocacy Officer, who presented on the definition and formation of support groups (SGs)and the importance of Community Adherence Groups, respectively.
“SG members on ART who are stable on their medication can form a Community Adherence Group (CAG) which elects one or two members to collect the group’s ARVs medicines at the nearest health facility and distribute their ARVs among themselves at their meeting point in their own community” said Mr. Shoolongela. On his part, Mr. Iita stressed that with only one elected CAG refill group member collecting the group’s ARVs at the clinic on behalf of other members, it reduce time spent and direct and indirect costs associated with collecting ARVs, and reduce congestion and work overload at health facilities. “In addition, the CAGs are empowered to ensure proper adherence to treatment and retention into care, deal with stigma, and provides support (e.g. economic, psychosocial, spiritual, etc.) to its members” he emphasised.

The meeting sparked OTA’s interest in the rationale and implementation strategy of CAG, with lively discussions which covered the evolution, decentralisation, task shifting and accessibility of ART service delivery to PLHIV in Namibia in general, and Ombandja community in particular. At first, ART was only accessible in the capital Windhoek before it was decentralised to Oshakati intermediate hospital, then Oshikuku (and later Outapi) hospitals, then Okalongo Health Centre, later to other clinics and outreach points in Ombandja, and now to organised CAG members in their own communities.


Ms. Aupindi, a Registered Nurse at Okalongo Health Centre, gave a presentation on the eligibility criteria for CAG members. She indicated that one must be 18 years or older; should have been on ART for 12 consecutive months, their Viral Load should be less than 50, no opportunistic infections (OIs) such as TB that require clinical care, and must not be pregnant or breastfeeding to be eligible to join a CAG. However, she reiterated that those who were not eligible are encouraged to adhere to their clinical guidance in order to be stable on their medication and therefore becoming eligible. “If one adhere to ARVs medication and the Viral Load becomes suppressed to 50 or below or their OIs are treated, or a person reached 18 years, then they become eligible. Also, if one stop breastfeeding then they become eligible for enrolment into CAG again. But if one does not adhere to ARVs medication and their Viral Load increase above 50 or they develop OIs, then they become ineligible” she highlighted.

Mr. Shimooshili, Tonata Community ART Coordinator, gave a presentation on the movement of patients care book (PCB) from one facility to another in respect of joining a CAG. He also touched on appropriate things that maybe discussed during CAG meetings. He explained that it was easy to move a patient care book between health facilities within a district. However, if the patient PCB was at another district s/he must ask for a transfer letter that they will take to their nearest health facility. He also indicated that ART patients should ensure that they have enough stock before moving to outside their communities, especially those who go to cattle posts or look for employment elsewhere. He advised that if a person wish to move outside the community s/he must obtain a transfer letter from the health facility to take it with to wherever they are going.

Mr. Shekundja closed the presentation that PLHIV on ART interested in joining existing CAGs or forming new CAGs should contact their nearest health facility or Tonata district team. The meeting was well received, with Traditional Authority members engaged and asking relevant questions of the presenters. The discussions, questions, comments and answers session was facilitated by Mr. Olavi. They specifically wanted to know how community members will distribute ARVs medication among themselves, who guide them, what measures are in place to ensure safety and quality assurance. To the satisfaction of the meeting attendants, Ms. Aupindi, assisted by Mr. Shimooshili and Shekundja, responded to all questions by clarifying all relevant points raised.

OTA leadership in turn expressed their appreciation of the Government’s policy response aimed at meeting the plights and needs of PLHIV, especially access to ART and promised to engage, sensitise and mobilise their communities. OTA leadership also indicated that they will hold community meetings in their respective communities, as well usage of other existing platforms of information communications, in collaboration with Community Health Workers, health care workers, CACOC Coordinator at the Constituency Office, and/or Tonata staff to send the message across. They indicated the importance of forging partnership with the health authorities to ensure the health of their communities.


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