Unite Health Systems With Community-led Health Services To Deliver On UHC
Despite mounting evidence of how key population or community-led health services have bridged the gap between public health system and those unreached, we are yet to optimally integrate community-led health service delivery model into public health system effectively, said Dr Nittaya Phanuphak.
Dr Nittaya Phanuphak is the Executive Director of Institute for HIV Research and Innovation (IHRI), Governing Council member of International AIDS Society (IAS), and Convener of 2nd Asia Pacific Conference on Point-of-Care Diagnostics for Infectious Diseases.
Sterling examples of high impact key population or community-led health service deliver models come from the land of smiles – Thailand. HIV key populations continue to play a major role in delivering Pre-Exposure Prophylaxis (PrEP for HIV prevention) to those who are at a heightened risk of HIV acquisition. Thailand has the largest PrEP rollout in Asia Pacific region, 80% of people using PrEP in Thailand receive it from a clinic led and staffed by members of the community that it serves. Key populations are groups of people who are disproportionately affected by HIV (which includes gay men and other men who have sex with men, transgender women and sex workers).
'On the ground, despite successes, we have faced challenges too over the last decade in our efforts to integrate community-led health service delivery model into the national public health system in Thailand. Key population lay providers are still the main providers and carers who are initiating and maintaining key population clients in PrEP services,' said Dr Phanuphak.
Over two years ago, Thai government changed regulations which adversely impacted the community-led health services. For example, due to these regulatory changes by the government, PrEP medications were not allowed to be stocked at the clinics run by key populations. Key population service providers were only allowed to give PrEP if it was prescribed by government doctors (and not NGO doctors).
'These regulations are still there but, on the ground, we are upholding our core values of delivering health services in a people-centred way. Many public hospitals work closely with key population led clinics since more than a decade now. These hospitals have seen the impact of key population led health services at the provincial level. They too feel that the best way forward is to continue and maintain the original flow of having client come to the key population led clinics, get tested for HIV by lay providers, and then have the PrEP prescription made through TeleHealth by a government doctor. PrEP can be given out to the client within an hour of entering the clinic,' said Dr Phanuphak.
Funding cuts have made community-led services even more vital
Trump's decisions have snapped funding majorly to a range of health-related projects in the Global South. Dr Nittaya opines that with limited resources it becomes even more critical to ensure we are serving those most in need and most likely to be left behind.
'We need to continue integrating key population led health services into country's healthcare system and make sure that key population led clinics are receiving their reimbursements from the government in a fair way. We also need to ensure that the cadres of lay providers are recognised and endorsed at the country level,' said Dr Nittaya Phanuphak.
Community-led services are not just limited to HIV
'Key population or community-led health services is not only limited to HIV services. It can also be expanded to services for sexually transmitted infections (STIs), mental health, harm reduction, among others. This would be a real game changer for public health in Thailand,' said Dr Phanuphak.
Other countries in southeast Asian and western pacific region such as the Philippines, Viet Nam, Myanmar, and Laos, are also following Thailand-model by adapting community-led health services in their own unique in-country contexts and realities.
Communities and countries need to learn from each other too, says Dr Nittaya Phanuphak. 'We learn from the Philippines that there are members of key populations within the healthcare providers including medical professionals. In Viet Nam, we are seeing a good role of private sector in developing key population led clinics – many of which are social enterprise models too.'
End delays in translating scientific breakthroughs into public health impact
Among the biggest breakthrough scientific announcements in 2024 was lenacapavir - a medicine (twice yearly injections) that showed 100% protection against HIV among women who took part in the study. The study called PURPOSE-1 had cisgender women as participants and lenacapavir demonstrated 100% efficacy in preventing HIV infection. PURPOSE-2 study enrolled a more diverse population of cisgender men, transgender men, transgender women and non-binary individuals who have sex with partners assigned male at birth. PURPOSE-2 study results showed that twice-yearly lenacapavir cut HIV incidence by 96%.
Dr Nittaya Phanuphak shares her disappointment because when the HIV prevention medicine lenacapavir was announced last year, she was rightly hoping for a rapid rollout to protect many more people from HIV acquisition. But it has not happened so far.
"Despite the progress over the last 2-3 decades in HIV response, we still had 1.3 million people who were newly diagnosed with HIV in 2023 worldwide. Around a quarter of these new infections occurred in Asia Pacific region. We have HIV prevention tools in our region but pace at which these are being rolled out is not acceptable. No one needs to get newly infected with HIV because we have the science-based tools to prevent the transmission. For example, PrEP rollout is barely 2% of the target rollout for 2025 (target was to ensure that at least 8.2 million people have used PrEP at least once in a year by end of 2025). This is a huge gap," she said.
Unless all science-based new and old HIV prevention tools would not be offered to people to choose from, we would not be able to protect everyone from the virus.
"When research and development of these new health technologies have taken place in our countries in the Global South so that we can have enough scientific evidence for approvals from US FDA or European Medicine Agency, then why cannot people of our own countries access these approved products?" asks Dr Phanuphak. "This is not fair."
Deploying health technologies developed by the Global South equitably at the point-of-need
Dr Phanuphak calls for uniting our community power in the Global South and leverage upon our regional purchasing power to negotiate lowest possible prices for quality assured screening and diagnostic tools and generic medicines - especially those developed in the Global South. She also underlines the importance of taking services for multiple diseases and health conditions to the communities in people-centred and rights-based manner.
She says that when a health technology is approved by the regulators, it should be developed and made accessible to the people in the Global South without any delay. Not doing so, is not acceptable.
1st Asia Pacific Conference on Point-of-Care Diagnostics for Infectious Diseases was held in Australia. Dr Phanuphak was among those who worked hard to bring the 2nd POC 2025 to Thailand which will be held during 19-21 June 2025 with her being its convener.
She rightly calls for deploying scientifically validated point-of-care health tools closer to the communities to strengthen multiple disease responses, such as for TB, HIV, STIs, vector-borne diseases like malaria or dengue, hepatitis, HPV, among others.
She calls for accelerating innovations in developing more health technologies to serve the most-in-need communities in a rights-based, gender transformative and people-centred manner. "Point-of-care technologies is not only limited to testing for example, but also point-of-care sample collection tools too, so that sample collection not only gets enhanced but also it can be done in a way that it becomes self-care. We should not have to rely on people going to healthcare facilities for sample collection by healthcare providers, but if science-based tools become available, then sample collection can perhaps be done by the clients themselves and sent to the nearest testing centre."
"We cannot talk about new point-of-care technologies without talking about game-changing health financing, policies and political commitment too. At the POC 2025, I hope that we can bring all these aspects together so that we can not only transition in deploying point-of-care health technologies where they are needed most in people-centred manner, but also how can we sustain the implementation," she said.
Integration may not mean the same for everyone
Dr Phanuphak reflects that integration may have different meanings for different people. "A programme manager may think of integrating services together, such as those for TB and HIV. For grant managers it may mean integrating testing platforms, such as those for TB and HIV. We have seen on the ground already that community-led clinics have naturally integrated HIV, hepatitis and STIs services to serve people better. Lay providers have also gone beyond the laboratory integration by integrating mental health, harm reduction, social and legal services."
She calls for reimagining integration in a people-centred way so that we can deliver on WHO Multi-Disease Elimination Approach at the local level and scale up those that have demonstrated impact.
Shobha Shukla – CNS (Citizen News Service)
(Shobha Shukla is the award-winning founding Managing Editor and Executive Director of CNS (Citizen News Service) and is a feminist, health and development justice advocate. She is a former senior Physics faculty of prestigious Loreto Convent College and current Coordinator of Asia Pacific Regional Media Alliance for Health and Development (APCAT Media) and Chairperson of Global AMR Media Alliance (GAMA received AMR One Health Emerging Leaders and Outstanding Talents Award 2024). She also coordinates SHE & Rights initiative (Sexual health with equity & rights). Follow her on Twitter @shobha1shukla or read her writings here www.bit.ly/ShobhaShukla)
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
NZ Herald
2 days ago
- NZ Herald
Thai royal update: Princess Bajrakitiyabha battles severe infection
The Thai King's eldest daughter, who has been gravely ill in hospital for more than two years, has suffered a 'severe' blood infection, the palace said on Friday. Princess Bajrakitiyabha Mahidol has been unconscious in hospital since falling ill with a heart condition in December 2022 during a military dog
Scoop
07-08-2025
- Scoop
Birds In Auckland Study Sang Fewer, Simpler Songs After Disturbed Sleep
Birds that missed out on sleep changed the way they communicated in a study by scientists at Waipapa Taumata Rau, University of Auckland. The research, led by Dr Juli Gaviraghi Mussoi, of the School of Biological Sciences, found that common mynas sang fewer and simpler songs after a single night of disturbed sleep. Their calls also changed in pitch and duration – the sounds were longer and lower – potentially affecting how they interact socially. 'We've all had days where we feel flat and unmotivated after a rough night,' says Mussoi. 'What we're seeing is that birds have those days too.' Bird vocalisations serve a range of purposes, from attracting mates to warning of danger and maintaining group cohesion. Producing these sounds requires precise timing and coordination between the brain, lungs and throat muscles. For birds of many species, a poor-quality song could be a threat to reproduction and survival. The researchers tested the mynas after different types of sleep disruption: a full night, the first half of the night, or the second half. All types affected the birds' behaviour the next day, though a full night of disruption had the strongest impact. 'We also noticed the birds rested more during the day, suggesting they were trying to recover' says Mussoi. She cautioned this was the first study of how sleep disruption affected birdsong complexity, with more studies needed for firm conclusions. While common mynas are highly adaptable and thrive in urban settings, the findings raise concerns about native species that may be more vulnerable to ongoing light and noise pollution. 'This research shows that even short-term sleep loss changes how birds communicate,' Mussoi says. 'In cities, these disruptions aren't rare. They're constant.' Mussoi conducted the research for her PhD and has since become a lecturer at the University of Waikato. Associate Professor Kristal Cain and Professor Margaret Stanley were also part of the study. The project had one other outcome: Mussoi's sixth bird tattoo to commemorate a research project. The picture of mynas adds to images representing studies of Australian magpies (sleep deprivation), pīwakawaka or fantails (song and reproductive success), budgies (visual acuity), great tits (cognition and problem solving) and Southern Lapwings (effects of human presence on behaviour). Where did she get her great interest in birds? 'I grew up in a small city in southern Brazil, and as a child, I spent nearly every day at my grandmother's farm,' she says. 'I'd spend hours with the animals, playing with frogs and watching birds – that's where my love for birds began.' Later, at university, she discovered the incredible diversity of bird species and was captivated by their behaviours, especially the colours and elaborate courtship dances of Birds-of-paradise. 'That mix of early experiences and scientific curiosity is what keeps me so fascinated by birds.' Learn more about the use of animals in research and teaching at the University of Auckland
Scoop
03-08-2025
- Scoop
Prevention Revolution And Policy Harmonisation Are Critical To End AIDS
SHOBHA SHUKLA – CNS Despite having science-based tools for HIV combination prevention, there were 1.3 million people who A collage of people with text AI-generated content may be newly diagnosed with HIV in 2023 - and also in 2024 - hardly any decline between the two years. Despite having science-backed lifesaving antiretroviral therapy to help every person living with HIV healthy and well (and virally suppressed - which also ensures there is zero risk of HIV transmission because treatment works as prevention), 630,000 people died of AIDS-related illnesses in 2023 - and also in 2024 - hardly any decline between the two years. We clearly need a prevention revolution to drastically bring down new HIV infections as well as a lot more needs to be done to reduce AIDS-related deaths. 'Business as usual' is clearly not an option. In sub-Saharan Africa, one in four (~25%) of new HIV infections occur among key populations, but in Asia Pacific region, four in five (79%) of new HIV infections occur among key populations (such as men who have sex with men, sex workers, transgender people, persons who inject drugs, among others). In 2024 alone, there were an estimated 800,000 new HIV infections in sub-Saharan Africa, and women and girls accounted for 63% of them. Adolescent girls and young women aged 15-24 are more than twice as likely to acquire HIV as their male peers. These numbers remind us that HIV remains a public health crisis. But HIV is not just a medical or health issue—it is deeply intertwined with social, economic, and legal factors. To truly end HIV as a public health threat, we must look beyond the virus itself and address the broader context in which it thrives," said Letlhogonolo Mokgoroane, Legal Representative and Head of Strategic Litigation and Research, OurEquity, South Africa; member of Johannesburg Society of Advocates. "Sexual and reproductive health, rights and justice (SRHRJ) is about more than access to contraception or maternal care. It is about the right of every individual to make informed decisions about their bodies, free from violence, coercion, or discrimination. When people - especially women and girls - are denied these rights, they become more vulnerable to HIV and other health risks. For example, only 40% of young women in sub-Saharan Africa have comprehensive knowledge about HIV prevention. In some countries, less than 50% of women have access to modern contraception. Gender-based violence remains alarmingly prevalent: in South Africa, a woman is killed every three hours, and one in three women has experienced intimate partner violence," said Letlhognolo. Letlhogonolo was speaking in SHE & Rights (Sexual Health with Equity & Rights) session co-hosted by Global Center for Health Diplomacy and Inclusion (CeHDI), International Conference on Family Planning (ICFP 2025), Family Planning News Network (FPNN), International Planned Parenthood Federation (IPPF), Asian-Pacific Resource and Research Centre for Women (ARROW), Women's Global Network for Reproductive Rights (WGNRR), Asia Pacific Media Alliance for Health and Development (APCAT Media) and CNS. Survivors of violence are at a 50% higher risk of acquiring HIV "Criminalisation of same-sex relationships and sex work drives key populations underground, away from essential health services. In 31 African countries, same-sex relationships are still criminalised, making it difficult for LGBTQIA+ individuals to access HIV prevention and care. Sex workers, who are 13 times more likely to be living with HIV than the general population, often face harassment and violence, further increasing their vulnerability. Justice is central to this conversation. Laws and policies that discriminate against people living with HIV, LGBTQIA+ individuals, sex workers, and other marginalised groups, not only violate human rights but also fuel the epidemic," said Letlhogonolo. "For example, in Nigeria, the Same Sex Marriage (Prohibition) Act has led to a 41% decrease in access to HIV services among men who have sex with men. Justice means ensuring that everyone—regardless of who they are or whom they love—can access the information, services, and support they need to live healthy, fulfilling lives," added Letlhogonolo. If HIV funding is not fully restored, new infections and AIDS deaths can increase alarmingly "Recent global funding cuts could send the world back to levels of HIV infections and AIDS-related deaths not seen since the early 2000s. Next 5-years projection show that new HIV infections and AIDS-related deaths globally can dangerously rise if the lost funding (both this year and in recent years) does not return. Many countries have reduced their investments and domestic funding is often inadequate to fully fund the AIDS response – which has been relying on external support," said Eamonn Murphy, UNAIDS Regional Director for Asia Pacific, and Central Asia and Eastern Europe. 'Nine countries in Asia and the Pacific region have rising new HIV infection rates. 9 countries in the region have too low coverage of lifesaving antiretroviral treatments. Moreover, the region has been hit with funding crisis – and – overall HIV prevention crisis too. Between 2010 to 2024, there were 9 countries in Asia Pacific which reported an increase in newly diagnosed people with HIV. Fiji has the world's fastest growing epidemic, new HIV infections increased by over 3091% in Fiji,' said Murphy. 'Along with Fiji, other countries in Asia Pacific where there was an upswing in the number of people newly diagnosed with HIV between 2010-2024 are: 562% rise in Philippines; 187% rise in Afghanistan; 84% rise in Papua New Guinea; 67% rise in Bhutan; 48% rise in Sri Lanka; 42% rise in Timor-Leste; 33% rise in Bangladesh; and 16% rise in Lao PDR. Between 2010-2024, there were 9 countries in Asia Pacific which are also treating less than half of the people living with HIV, such as Afghanistan (11%), Pakistan (16%), Fiji (24%), Philippines (40%), Bangladesh (41%), Indonesia (41%), Mongolia (41%), PNG (46%), and Maldives (48%),' said Murphy of UNAIDS. Between 2010-2024, there were 9 countries in Asia Pacific which are also treating less than half of the people living with HIV, such as Afghanistan (11%), Pakistan (16%), Fiji (24%), Philippines (40%), Bangladesh (41%), Indonesia (41%), Mongolia (41%), PNG (46%), and Maldives (48%). 'Compared to the decline in the number of people newly diagnosed with HIV between 2010-2024 worldwide (40%), the decline in Asia Pacific is far behind (17%),' said Eamonn of UNAIDS. In Eastern and Southern Africa, new HIV infections declined by 57% during the same period. Pam Ntshekula calls for rights and safety of sex workers "Our mission is clear: sex workers deserve dignity, protection, and full recognition of their human rights. We are calling for the full decriminalisation of sex work because sex workers deserve to work in safe, free, and dignified spaces. Right now, criminalisation puts sex workers at risk - it makes them more vulnerable to violence, police abuse, stigma, and poor health access. Decriminalisation would mean sex workers can report crimes without fear, access healthcare without judgment, and work without hiding. It is not just a legal issue —it is about human rights, health, and safety. Every sex worker deserves to be protected, respected, and free to choose how they live and work," said Pam Ntshekula is a dedicated advocate for the rights and safety of sex workers and Lobbyist Officer, Sex Workers Education and Advocacy Taskforce (SWEAT), South Africa. "Many sex workers avoid clinics due to stigma and mistreatment. Full decriminalisation ensures safe, respectful access to SRHR services. Criminalisation limits condom use, outreach, and health education. Decriminalisation creates safer environments for prevention and care. Constant fear of arrest, violence, and shame harms mental wellness. SDG3 includes mental health - sex workers deserve safety and peace of mind," Pam added. "Sex workers face high levels of rape, assault, and abuse - often from police or clients. Decriminalisation allows them to report violence and access justice. Gender equality means protecting all genders and identities. My message is: There is no health without rights. There is no equality without decriminalisation. Decriminalising sex work is the single most powerful move to remove legal barriers to health access, justice, and human dignity. It also lets peer educators and health organisations do their work without fear," said Pam. "We also need to tackle poverty and unemployment by linking sex workers to job training, housing support, and social grants if they choose to exit. Empowerment means choices, not pressure." SDG goals and targets are not standalone but interconnected "Each of SDG goals and targets are interconnected. For example, studies show that countries with higher gender equality have lower rates of HIV infection among women. In Botswana, legal reforms to protect women's property rights have led to increased economic independence and better health outcomes. We cannot achieve health without justice. We cannot achieve justice without upholding rights. And we cannot uphold rights without addressing the root causes of inequality and exclusion," said Letlhogonolo. "It means we must break down silos. HIV programmes cannot operate in isolation from broader sexual and reproductive health services. Legal reforms must go hand in hand with public health initiatives. We must listen to and empower those most affected—young people, women, LGBTQIA+ communities, and people living with HIV—to lead the way," they added. "It means investing in education, not just about HIV, but about consent, healthy relationships, and bodily autonomy. In Uganda, the DREAMS initiative, which combines HIV prevention with education and economic empowerment for adolescent girls, has reduced new HIV infections among participants by 25%. Supporting community-based organisations is crucial: in Kenya, peer-led outreach among sex workers has doubled the uptake of HIV testing and treatment. It means holding governments accountable for their commitments to human rights and the SDGs," stressed Letlhogonolo. "In 2023, out of 54 African countries, only 16 African countries had fully funded their national HIV responses. We must advocate for increased domestic investment and international solidarity. And it means recognising that justice is not just a legal concept—it is a lived reality. When a young woman can access contraception without fear, when a gay man can seek HIV testing without shame, when a sex worker can report violence without risking arrest, we are moving closer to justice," rightly said Letlhogonolo. "Essential health services must include sexual and reproductive health services - including safe abortion and post-abortion care, menstrual health hygiene, and mental health services, with particular attention to women, adolescent girls, persons with disability, indigenous peoples, gender diverse communities, older people, young people, migrant workers, refugees, people living with HIV, sex workers, people who use drugs, among others. They must also include all health and social support services for survivors of sexual and gender-based violence," said Shobha Shukla, Lead Discussant for SDG-3 at the United Nations High Level Political Forum 2025 (HLPF 2025) in New York. "We have to ensure that health responses are people-centred, gender transformative and rights-based for all, without any condition or exclusion." She rightly called upon the government leaders who had assembled at the UN: "With less than 5 and a half years left to deliver on SDG3, we appeal to governments to step up their actions on gender equality and right to health - where no one is left behind." Shobha Shukla – CNS (Citizen News Service) (Shobha Shukla is a feminist, health and development justice advocate, and an award-winning founding Managing Editor and Executive Director of CNS (Citizen News Service). She was also the Lead Discussant for SDG-3 at United Nations High Level Political Forum (HLPF 2025). She is a former senior Physics faculty of prestigious Loreto Convent College; current President of Asia Pacific Regional Media Alliance for Health and Development (APCAT Media); Chairperson of Global AMR Media Alliance (GAMA received AMR One Health Emerging Leaders and Outstanding Talents Award 2024); and coordinator of SHE & Rights (Sexual Health with Equity & Rights). Follow her on Twitter/X @shobha1shukla or read her writings here
