Connecting remote populations to HIV services: Lay counselors in Zambia

Issues: Lay counselors providing voluntary counseling and testing (VCT) services are now working in a few rural districts in Zambia to help scale up VCT services, given long distances from health facilities and limited Ministry of Health (MOH) personnel trained in VCT. The lay counselors are male and female volunteers selected by traditional leaders and the community. A major issue is how to keep the volunteer lay counselors actively engaged to make this a sustainable service.

Description: The lay counselors are given a t-shirt, cap, bicycle, and small stipend each month, but it was observed that more was needed to sustain the initiative. Therefore, stronger accountability to the traditional leaders and the community was put into place. Traditional leaders are oriented to the program and assist in supervision. Awards are given to high performers. They get high visibility in traditional celebrations and World AIDS Day. Meetings are planned to regularly bring together all counselors in a district to discuss problems and lessen isolation.

Lessons Learned: Forty lay counselors cover two remote districts, Namwala and Luangwa. After five months of implementation, 10,583 people have been sensitized to HIV/AIDS; 4,683 people have undergone counseling and testing and received their results. Out of these, 506 (11%) tested positive and were referred to the nearest health center for HIV management. Only three counselors have left service.

Recommendations: Successful use of lay counselors requires integrated participation of traditional leaders, MOH officials, project staff, and lay counselors plus strategic use of monetary and non-monetary incentives.