Zero Discrimination Day: LINKAGES uses SMS to collect feedback on health services for continuous program improvement

Written by Ben Eveslage, Technical Officer, LINKAGES

LINKAGES is working to increase key populations’ (KPs’) engagement and retention in the cascade of HIV services, thereby preventing new infections, increasing the quality of life for those living with HIV, and helping to meet UNAIDS 90-90-90 treatment targets.  However, stigma and discrimination at health facilities are among the most significant and persistent factors[1] that limit KPs’ access to and use of HIV services.


Figure 1: Taking the SMS survey on a phone 

[1] Stigma and discrimination of KPs at health facilities was listed as the top challenge to program performance across the cascade of HIV services, according to a survey of LINKAGES’ program managers in 19 countries in December 2016.

In 2016, LINKAGES developed a system for monitoring the quality of health services from the perspective of both KPs and health care workers. With the SMS Service Quality Monitoring System (SMS2), peer outreach workers send text messages to KPs who have attended health services, asking a few simple questions about their satisfaction with the care they received. Using this system, health care workers can also complete short SMS surveys quarterly to assess their own facility’s performance and their personal performance. See Figure 1 for an example of how the SMS survey is administered. LINKAGES field teams will use the resulting data, collected at the facility or regional level, to:

  • Target and track the outcomes of efforts such as health care worker trainings to improve service delivery
  • Initiate a feedback loop among clients, project staff/community based organizations, and providers to improve health services (because providers get real-time feedback from KPs on their performance)
  • Continuously engage providers and patients/clients through SMS to encourage both high-quality service provision and positive health behaviors

The system is customizable and can be administered by community members, health care providers, and through messaging campaigns (opt-in method). By building on ongoing community activities, using simple phones that people already have, and employing an expandable SMS platform, this system can produce high volumes of regularly-collected data that can be used to improve programs quickly and track changes over time. See illustrative examples of data use maps and graphs in figures 2.


Figure 2: Potential use of SMS2 data – Create maps of health facilities with KP ratings to identify facilities that require quality improvement interventions (data in map are only illustrative)



Potential use of SMS2 data – Track average ratings of health facilities over time and assess outcomes of quality improvement interventions (data in graph are only illustrative)


LINKAGES will be piloting the SMS2 system in Lilongwe, Malawi beginning in March 2017 among peer outreach workers and KP members. SMS2 is scheduled for roll out in Burundi, Haiti (see Figure 4), Cote d’Ivoire, and a few other countries from March to May 2017, and the programs will continue to use the system throughout the year.



Introducing the LINKAGES Blog: Making Services Meaningful for Key Populations

Denis Nzokia, Religious Relations Assistant at LGBT group GALCK

Photo Credit: © Nell Freeman for the Alliance. Subject: Denis Nzokia, Religious Relations Assistant at the LGBT group GALCK. He is one of Kenya’s few openly gay activists.

Written by Kevin Osborne, Project Director of LINKAGES

With this post, I am excited to launch the official blog of the LINKAGES project! Linkages Across the Continuum of Services for Key Populations Affected by HIV (LINKAGES) is a five-year project funded by the U.S. President’s Emergency Plan for AIDS Relief and the U.S. Agency for International Development and led by FHI 360 in partnership with IntraHealth International, Pact, and University of North Carolina at Chapel Hill. The project is dedicated to reducing HIV transmission and improving enrollment and retention in treatment and care among key populations (KPs) — sex workers, men who have sex with men, transgender people, and people who inject drugs — and their sex partners. To support our commitment to active engagement with KP stakeholders, we have purposefully constituted the LINKAGES Advisory Board (LAB) to provide strategic guidance to the project. The LAB, which includes a balance of representatives from both global key population constituency-led networks and technical bodies, provides a richness in the breadth and diversity in working with a range of key populations. You can see the full list of LAB members here.

LINKAGES  — which has been in operation for less than a year — is already currently active in a number of countries across Africa, Asia, Latin America, and the Caribbean. The project’s activities include, but aren’t limited to, supporting the delivery of KP-friendly services through drop-in centers, supporting government partners to develop and roll out KP-specific policies and strategies, conducting research on gender-based violence perpetrated against key populations, working with KP peer educators, building the capacity of local KP-led organizations, and tapping into the power of internet-based technology to reach KPs with HIV-related information and referrals. It’s clear that LINKAGES with its deliberate focus on sex workers, men who have sex with men, transgender people, and people who inject drugs is doing the right thing at the right time!

As these programs and operations gain traction, we look forward to sharing stories and lessons from our on-the-ground experience. We also hope to hear and learn from others working in HIV prevention, care, and treatment for KPs. Through this blog, we will highlight evidence-informed and rights-based HIV programming for KPs and well as relevant research and resources. We will invite guest bloggers from around the world to share their experience working to promote, protect, and secure the health and human rights of KPs. We hope that this blog will serve as a platform for networking, knowledge exchange, and thought-provoking dialogue among members of KP communities, advocates, program implementers, scientists, and others working with KP groups.

Over the next five years, LINKAGES will play its part to ensure that sex workers, men who have sex with men, transgender people, and people who inject drugs receive the high-quality, stigma-free rights orientated HIV prevention, care, and treatment services they need and deserve. For the link between HIV and human rights is inextricable. We hope that you will contribute to this work by sharing your perspectives, lessons learned, and stories with us. If you wish to guest blog on Making Services Meaningful for Key Populations, please let us know by writing to Nicole Ippoliti ( There are several other ways to stay connected to LINKAGES. You can follow the project on Twitter and Facebook, and subscribe to our newsletter and blog. Together, we can advance the work of supporting key populations.