Reproductive health services for populations at high risk of HIV: Performance of a night clinic in Tete province, MozambiqueReport as inadecuate

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BMC Health Services Research

, 10:144

First Online: 28 May 2010Received: 04 December 2009Accepted: 28 May 2010DOI: 10.1186-1472-6963-10-144

Cite this article as: Lafort, Y., Geelhoed, D., Cumba, L. et al. BMC Health Serv Res 2010 10: 144. doi:10.1186-1472-6963-10-144


BackgroundDifferent models exist to provide HIV-STI services for most-at-risk populations MARP. Along the Tete traffic corridor in Mozambique, linking Malawi and Zimbabwe, a night clinic opening between 4 and 10 PM was established targeting female sex workers FSW and long-distance truck drivers LDD. The clinic offers free individual education and counselling, condoms, STI care, HIV testing, contraceptive services and outreach peer education. To evaluate this clinic model, we assessed relevance, service utilisation, efficiency and sustainability.

MethodsIn 2007-2009, mapping and enumeration of FSW and LDD was conducted; 28 key informants were interviewed; 6 focus group discussions FGD were held with FSW from Mozambique and Zimbabwe, and LDD from Mozambique and Malawi. Clinic outputs and costs were analysed.

ResultsAn estimated 4,415 FSW work in the area, or 9% of women aged 15-49, and on average 66 trucks stay overnight near the clinic. Currently on average, 475 clients-month visit the clinic 43% for contraception, 24% for counselling and testing and 23% for STI care. The average clinic running cost is US$ 1408-month, mostly for human resources. All informants endorsed this clinic concept and the need to expand the services. FGD participants reported high satisfaction with the services and mentioned good reception by the health staff, short waiting times, proximity and free services as most important. Participants were in favour of expanding the range of services, the geographical coverage and the opening times.

ConclusionsSize of the target population, satisfaction of clients and endorsement by health policy makers justify maintaining a separate clinic for MARP. Cost-effectiveness may be enhanced by broadening the range of SRHR-HIV-AIDS services, adapting opening times, expanding geographical coverage and targeting additional MARP. Long-term sustainability remains challenging and requires private-public partnerships or continued project-based funding.

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Author: Yves Lafort - Diederike Geelhoed - Luisa Cumba - Carla das Dores Mosse Lázaro - Wim Delva - Stanley Luchters - Marleen 


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