A sustainable approach to providing HIV services and information at the community level a longitudinal exploration of female community health entrepreneurs' performances Robert A.J. Borst Sociologist of science in training, epidemiologist & radiology technician

Performance in practice hard to maintain and ‘impact’ unclear What is the problem? Community health workers play a key role in providing sexual and reproductive healthcare in rural areas. Performance in practice hard to maintain and ‘impact’ unclear (let alone quantify). We focussed on ‘community health entrepreneurship’ as potentially more sustainable approach (see also Beentjes et al.). Our aim: obtain richer understanding of community health entrepreneurs’ performances in order to contribute to the construction of a sustainable primary sexual and reproductive healthcare model

What did we do? Initiated a mixed-methods project Observations & interviews Tablet-based surveys What reflects community health entrepreneurs’ functioning and actions? Availability of essential medicines* Availability of key products* Income (in USD) Self-esteem (by means of Rosenberg’s) We used general and generalized linear mixed-models to compare changes between groups after six-months. List with potential entrepreneurs Random sample 1 (n=150) Remaining group (n=350) Randomised over two groups Trained directly (n=56) Trained > 6 months (n=77)

What are the results? Community health entrepreneurs had: a higher availability of essential medicines* OR: 3.39, 95%-CI: 2.03; 5.65 a moderately higher availability of key equipment* OR: 1.87, 95%-CI: 1.03; 3.37 a slightly higher Rosenberg’s self-esteem score 1.24 points higher difference, 95%-CI: 0.09; 2.39 a higher average weekly-income $8.96, 95%-CI: $3.59; $14.32

What do the results mean? 1) Community health entrepreneurs can be key actors in providing more sustainable sexual and reproductive healthcare 2) Higher self-esteem among entrepreneurs reduces risk-taking behavior 3) Community health entrepreneurship allowed for economic empowerment of women that became entrepreneur But: This was after six months… how will the situation be after 12, 24, longer? To what extent do these four proxies reflect ‘performance(s)’? First qualitative findings point at flexibility and resilience of the model

Thank you, webale muno, webale nnyo, merci beaucoup, grazie, gracias, Спасибо, danke schön, bedankt, obrigado/a, terima kasih Poster presented here as well: Beentjes et al. – Healthy Entrepreneurs: Using a business model to build sustainable community health systems, improving access to health products and HIV knowledge for adolescent girls and young women in rural Uganda * =