Success Stories

This week, Jeff and I visited all of the Expert Clients in the 12 health centers around the district to distribute some needed supplies. Whenever we visit an Expert Client at their site, we always ask them what challenges they are facing, and work then with the Expert Client, relevant health center staff, and any other appropriate Ministry of Health or CHAI staff to try and address the issue. As we went around this week, we listened to and noted the persistent list of challenges faced by each Expert Client, such as stock outs of HIV test kits and medications, the limited capacity of HIV testing and counseling counselors to absorb the high volume of patients needing these services, and continued fear and stigma in the community towards HIV leading women to try and hide their HIV status from health center staff and Expert Clients. But amongst all the challenges, this week we were also so clearly reminded of all of the triumphs the Expert Clients create and experience everyday.

At the first ever “All Expert Client Meeting” held in December, Jeff and I asked the Expert Clients to share some of the “Success Stories” that they have experienced with their clients. Using the jargon of “Success Stories”, which I feel is a loved phrase in the public health and international development world, the Expert Clients at first gave us a bit of blank, confused stare. Once we started explaining the meaning of a “Success Story”, the Expert Clients started breaking off into their small working groups, buzzing with stories to share with one another. Six Expert Clients shared their stories with the larger group, but we asked the others to please write down one story to give to us when we next visited their site.

Honestly, we hadn’t followed-up on this since December and thought most Expert Clients had probably forgotten to write-up their story. But this week, after listening to a long list of challenges faced by one of our Expert Clients, we asked her, reluctantly, if she had remembered to write down any of success stories. Given all the challenges, I was even worried she might have been too discouraged to write anything for us. Of course I was wrong. She excitedly grabbed her notebook and showed us a story she had written on the first page. We were about to tear out the page to take with us when we realized that half of the book was full of stories of clients who she felt had been positively impacted, accessed services, or made a healthy changed since she started counseling them!

As we went from site to site throughout the week, the stories kept coming, and I saw within the Expert Clients a determination to continue to do their work, despite all of the challenges, because of the lives they see changing right before them, changing in ways they know and understand personally because they have once been there themselves! Jeff now has over 30 stories to translate for our records, and that isn’t even all of the stories!

As we are preparing for a 6-month evaluation of the Expert Client Initiative, we are designing the evaluation to contain both quantitative and qualitative data. While we will most certainly gather and critically analyze quantitative data from Expert Client records on clients and health facility records on figures surrounding HIV testing, ART enrollment, and other important health service uptake and outcome indicators in our evaluation, these numbers will reflect only part of the impact of the Expert Clients. When trying to evaluate the impact this program is having on the lives of women, children and families in Malawi, qualitative data like “Success Stories” from the Expert Clients, and the clients themselves, cannot be ignored.