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Table 2 Comparison of the planned and implemented activities (fidelity)

From: Feasibility, acceptability and potential sustainability of a ‘diagonal’ approach to health services for female sex workers in Mozambique

  Planned activities Progress by the end of the project
Targeted peer outreach and community mobilisation Expand No. of FSW peer educators (PE) from 15 to 30 Partially done. The PE cadre was expanded to 18.
Orient PEs through a comprehensive training program that comprises the essential information on all SRH components, techniques on how to provide peer education services, and how to use monitoring tools Mostly done. Two trainings were conducted, one on human rights and empowerment, and one on refreshment of peer education and mobilisation strategies. In addition, 10 new peer educators were trained.
PEs will be paid a stipend of 1500 MZN (USD35) per month working daily from 4 pm to 10 pm operating from the Night Clinic Done
PEs will:  • provide essential IEC on all key SRH aspects  • distribute free male and female condoms and lubricants  • provide information and sensitisation on a correct use of SRH services  • implement a system of referral slips  • track FSWs who dropped out of certain services, such as HIV care  • provide IEC on substance/alcohol abuse and mental health services Mostly done. Tracking of HIV care defaulters not done.
PEs will mobilize the community at large to sensitise them about the needs of sex workers to reduce stigma and discrimination Mostly Done. ICRH-Mozambique conducted sensitisation activities, with involvement of peer educators.
ICRH-Mozambique will facilitate the creation of a local sex worker association and build capacity among FSWs through workshops and other means Mostly done. An informal association was created. Capacity was built through exchange visits in India, Malawi and elsewhere in Mozambique.
Support groups and safe spaces will be encouraged by the project to provide an opportunity and platform for sex workers to discuss and share experiences Mostly done. The Night Clinic functions as a sort of safe place, a Vulnerable Women’s Support Group was created.
Targeted clinical services The package of services at the Night Clinic will be expanded to include:  • IEC on all sexual and reproductive health topics  • Provision of male and female condoms and lubricants  • Syphilis screening  • HIV Testing & Counselling  • Free contraception, including long-lasting methods, such as implants, and emergency contraception  • Care for incomplete abortions, and support to women with unwanted pregnancies  • Sexual and gender-based violence (SGBV) counselling  • initiate HIV care, including antiretroviral therapy Partially done. Female condoms and lubricants were added to the package, emergency contraception is offered, implants are offered but with frequent stock-outs, care for incomplete abortions and the initiation of HIV care were not done, and the SGBV services were only provided for part of the intervention period.
Memoranda of Understanding will be developed with the district health departments that will describe the responsibilities of each Done
In addition to the current Night Clinic in Moatize, a second Night Clinic will be constructed within the City of Tete, offering the same services Not done. Was replaced by organising mobile clinical outreach.
FSWs will be invited for routine clinic visits for regular HIV and syphilis testing, genital exams and counselling around e condom use and risk reduction Done, but limited effectiveness because very few FSWs returned for their follow-up visits.
HIV+ FSWs will be linked to ART adherence support groups Not done
Improve access to the general health services Workshops with health facility managers and key SRH providers of 4 selected public health facilities Done. But late in the project.
Appointment of FSW points of contact at 4 selected public health facilities Done. But late in the project.
Assess whether data on the number of FSW attending the services can be collected in a confidential manner Done. But late in the project.
The project will evaluate with the provincial and district health departments if FSWs can be targeted through existing organised outreach activities, such as HIV testing & counselling Partially done. No FSW-targeted outreach was done by the government, but outreach was done by NGO instead.
The project will coordinate with the provincial and district health departments and MSF how ART adherence support groups can be further expanded. The support groups will be linked to the Night Clinic and the community mobilisation activities Not done
Linkages and referral systems Identifying 2 focal persons at each of the 4 health facilities who will be the point of contact Done. But late in the project.
Regular meetings between members of the FSW community, the focal persons and health managers of the 4 selected public health facilities, the Night Clinic staff and ICRH-Mozambique Partially done. There were 7 meetings between all points of contact, the ICRH-Mozambique staff and the peer educators, but no health facility specific meetings between the points of contact and FSW representatives
Referral and counter-referral systems between the Night Clinics, the 4 health centres and the provincial hospital Done
Referral and counter-referral systems between the PEs and the health services Done
Tracking of defaulters by PEs Not done
Monitoring systems The monitoring tools for peer outreach will be adapted and expanded Done. But late in the project.
The daily registers will be replaced by an electronic FSW individual monitoring system Done. But late in the project.
A system will be developed to monitor attendance by FSWs at the 4 public health facilities Done. But late in the project.