HOW DOES IT ALL WORK?
Recruiting a squad manager
The whole process starts with recruiting a squad manager, who is then responsible for recruiting, training, managing, motivating, monitoring, and supporting coaches in his designated district.
A good squad manager has a combination of leadership and management qualities, guiding and motivating his coaches and building strong relationships with clinic staff while also ensuring that project management and M&E tasks are properly performed.
Because the squad manager is involved in helping coaches to brainstorm solutions to barriers their men are facing, it is very helpful if not essential that he also be a man living with HIV.
“I’m never alone. I can phone other coaches for advice. We are on WhatsApp, in a group. And the Squad Manager helps if I have a problem at the clinic.”
The squad manager is responsible for:
Establish relationships with the clinics in his cluster
Providing his coaches with all necessary support in executing their duties
Gathering and sharing best practices among his coaches
Ensuring that his coaches submit all required data
Checking the quality of data reported by his coaches. Ensuring that all players provided by the coach are in the facility records i.e., the HPRS register, Headcount register and on TIER.Net
Capturing and sharing all weekly and monthly data reports with the relevant DSP staff
Monitoring and assessing coaches’ performance to ensure they are performing their duties satisfactorily, in close collaboration with clinic staff, operational managers, cluster team leads and professional nurses at the facility to which the coach is linked.
A squad manager is responsible for 20-30 coaches.
Training squad managers
The best way for a squad manager to become a competent trainer and manager of coaches is to understand what it feels like to be in the coach’s shoes. For this reason, squad managers undergo the same training as the coaches. Squad managers then receive additional training on management and M&E.
“Until I heard the other coaches sharing their story of HIV, I thought I was the only one who was experiencing those things. When I heard the problems they had I realised what I went through was nothing. From the first day when we shared our stories I realised what it meant to be a coach.”
— Coach Gert, Sibande District
Role playing, role playing, role playing. Explaining yourself to different people - that’s what makes the difference. Yes, knowing about HIV facts is also important but I can say 80% is about understanding men and others understanding us.”
— Coach, Ugu District
Downloads
Squad Manager Job Description
Squad Manager Sample Ad
Recruiting coaches
Each squad manager is responsible for leading the recruitment process for his team of coaches.
Squad managers often find it most productive to disseminate the coach job posting via PLHIV networks (formal or informal), adherence clubs, CCMDD distribution points, public health NGOs, clinics, and the district health team.
Clinic nurses may be particularly knowledgeable about which men under their care are doing well on treatment, are well respected in the community, and have the right temperament to function as a coach.
Once the program is operational in a district, existing coaches often become an additional source of referrals for new coaches.
Selecting coaches
First and foremost, a coach must be a man who is living with HIV and has been on treatment for at least 12 months with no treatment interruptions or lapses. (This can be confirmed from clinic records.)
In addition, there are certain personal characteristics that make for a good coach:
A man who is open and confident about his HIV status, rejecting any stigma or shame
A good communicator who is comfortable being visible in his community as the face and voice of men living with HIV and working to change the HIV narrative
A “people person” who enjoys helping people and feels connected to his community
A good listener who can tailor his advice and support to a man’s particular barriers and needs
A problem solver who can work collaboratively to generate practical and creative solutions
As a certain amount of data capturing is required, we recommend completion of matric as the minimum educational requirement.
The coach job description and psychographic assessment tool can be used to identify candidates with the highest likelihood of being effective:
Downloads
Coach Job Description
Coach Sample Advert
Coach Qualifier Tool
Linking to and working with the clinic
Each coach is based in his community but should also be linked to a clinic (or perhaps 2-3 clinics if geographically proximate and relatively low-volume), based on the implementing partner’s determination of where support is most needed.
Teams of 20-30 coaches should ideally be clustered geographically, so that squad managers are able to conduct in-person support and supervision.
Once coach/clinic assignments have been determined, the squad manager should initiate the relationship with the clinic, explaining the Coach Mpilo model and engaging with the relevant clinic staff, including nurses and data capturers.
Once that relationship has been established, the squad manager should introduce each coach to the clinic(s) to which he will be linked, ensuring that he is introduced to all relevant clinic staff as noted above and not simply to one or two individuals.
The squad manager should then continue to facilitate a positive and mutually respectful relationship between coaches and clinic staff by ensuring that clinic staff are satisfied with the service the coach is delivering, and any issues or concerns are promptly addressed and resolved.
“Nurses are busy, they can’t sit and talk to a man for 3, sometimes 4 hours. And a man, he is not going to phone the nurse to tell him his problems at whatever time. That’s how we [coaches] help.”
— Coach Gert, Sibande District
Coaches support clinics by:
Helping men who have been newly diagnosed with HIV to cope with their diagnosis
Helping men who have experienced a treatment interruption to return to care
Helping men to understand the importance and benefits of adherence
Identifying alternate arrangements for collection of meds when a regular clinic visit is a barrier
Clinics support Coaches by:
Providing contact details for men who need support (whether newly diagnosed or LTFU)
Advising on referral for support on issues outside the coach’s scope, such as clinical care, mental health, substance abuse, etc.
Problem-solving with the coach on alternate arrangements for men who cannot access their treatment at the clinic
Ensuring that men returning to care are treated with dignity and respect
Orienting the coach on clinic staffing structure and relevant processes and protocols
Where applicable, coaches should coordinate with facility case managers to ensure that support is aligned and not duplicative.
Coach should generally check in at the clinic in person once or twice a week to collect any new referrals and to provide feedback on the status of men already enrolled. Further contact by phone or WhatsApp may also be helpful as issues and needs arise.
“When the clinic and the nurses understand how we are working, and they have respect for us, we can work together, we can be a good team.”
— Coach, Ehlanzeni
Enrolling men
A Coach reaches men living with HIV in two ways:
Using leads provided by his clinic
For newly diagnosed men, the clinic should be oriented on using a referral register and consent form to capture each man’s contact information and whether he consents to be contacted by a Coach.
For men experiencing a treatment interruption, the clinic should provide contact details to the coach so that he can follow up directly with the man to identify and help to address any barriers that he may be experiencing.
Coaches are trained to respect privacy and exercise discretion in reaching out to men, and in fact do this intuitively as they understand first-hand the fear and anxiety that a man can feel around stigma and disclosure.
Coaches should also consider participating in the clinic’s early morning health education sessions, as an opportunity to introduce their services to men waiting in the clinic queue.
Coach Mpilo Clinic Consent Form Template
Marketing his services directly to the community
Using posters, flyers and a community networking guide, each coach should also aim to create awareness of his existence and availability within the community. His work cell phone number should be included on all marketing materials.
The community networking guide helps the coach to identify possible demand creation platforms in his community, such as churches, sports groups, community events, etc.
As part of their training, coaches are taught how to present and promote themselves to their communities in person and via other accessible communication platforms—social media, community radio, etc.
Supporting men
A coach supports each of his players in whatever way is needed; there is no cookie-cutter approach to how or how often a coach should engage.
Some men will prefer to meet with their coach in person; others will prefer contact by phone call or WhatsApp. Some men may need their coach for an entire day, particularly early in their journey, while others may only need a periodic ten-minute check-in.
Coaches should be encouraged to tailor their approach to each player’s needs and preferences, keeping in mind the ultimate goal of overcoming barriers to treatment and achieving adherence and viral suppression.
We have found that men often need intensive support in the first 1-2 months, that support generally becomes ‘lighter-touch’ after 3-4 months, and that a coach can start to ‘let go’ of a man after 6 months, though there is no formal exit or graduation and he always remains available as needed.
A coach should be able to support approximately 50 new players per quarter, though in piloting this varied from 30 to 100, depending on the extent of their barriers and where they are in their journey. As their players become stable, coaches should be encouraged to take on additional players, with an aim of supporting approximately 200 men per year.
In my community, I am up there. My family, my friends - in their eyes i have become someone they can look up to. It’s that I am not scared to say who I am, that I am helping other men. The community supports me. Taxi drivers even offer me free lifts.”
— Coach, Ugu District
Downloads
Coach Mpilo - Clinic Interface Protocol
Coach Mpilo Community Networking Guide
Coach Mpilo Poster and Flyer Templates
Coach Player Contract
Supporting and supervising coaches
Squad managers should be in frequent contact with each of their coaches—in person, by phone and by WhatsApp—to understand how each coach is doing in working with his players, identify any issues or concerns in their interactions with the clinic, assist in problem-solving as needed, and generally ensure that coaches receive the necessary guidance and support to perform their work.
The squad manager reporting template allows each squad manager to monitor their coaches’ performance and identify any coaches who appear to be underperforming. They should then follow up with those coaches to provide any needed guidance and support and ensure that any issues or challenges are resolved.
“The impact that Coaches are making in the community, especially with other men, is bigger than we think.”
— Dr Chrispopher Mawhire, Broadreach HealthCare
Monitoring & evaluation
Coaches report the following to their Squad Managers:
Weekly
Update on all new men they enrol for support
Challenges each man is facing and any solutions identified
Monthly
Update on the treatment status of every man they are supporting
Challenges and opportunities in working with their communities
Challenges and opportunities in working with the clinic
