Community Health Observatory of Côte d'Ivoire

Sub-Saharan Africa is home to two-thirds (67%) of people living with HIV, and Côte d'Ivoire is among the most affected countries with an HIV prevalence among adults aged 15-64 of 2.9%: 4.1% among women and 1.7% among men (Spectrum 2022). This corresponds to about 390,000 people living with HIV.

The epidemic is however marked by widespread pockets that have much higher levels of vulnerability. HIV and AIDS disproportionately affect those who are least able to claim their rights – the most marginalized, the poorest and the least educated. Discrimination and stigma are fuelling the pandemic at all levels by reducing the accessibility of these groups to prevention and treatment services, to the assistance provided to people affected by the disease.

Among the most vulnerable groups are key populations. Together with their partners, they account for 65% of new HIV infections (2022-global-aids-update-summary_fr.).  Since the beginning of the AIDS epidemic, stigma and discrimination have fuelled  HIV transmission for these groups and have greatly exacerbated the negative impact of the epidemic.   Studies indicate that there is a causal relationship between human rights violations and the HIV epidemic among populations with the highest prevalence rates of HIV infection. These violations are major obstacles to preventing new infections, mitigating impact and providing adequate care, support and treatment. They concern all countries and regions of the world.  In Côte d'Ivoire, we actually find higher HIV prevalence rates within these groups: 23.6% among transgender people, 11.6% among MSM, 11.57% among FSW, 9.11% among drug users. That is 3 to 10 times the national prevalence.

In addition to these groups, there are marginalized groups such as persons with disabilities. In this population made particularly vulnerable to HIV, the growing link between HIV, AIDS and disability is a topical issue and a cause for international concern.  According to the World Report on Disability published in June 2011, more than one billion people with disabilities live in the world, and among them, 110 to 190 million, or nearly 15% of the world's population, face very significant difficulties. For example, UNAIDS in its guidance note on disability and HIV in 2009 found that people with disabilities are at as high or even higher risk of HIV infection as the rest of their community; for a variety of reasons: lack of access to information on sexual and reproductive health and HIV/AIDS, lack of access to medical care, including HIV/AIDS care services, poverty and marginalization, and a high rate of abuse and sexual violence. In addition, while studies have shown that people living with a disability are indeed at increased risk of exposure to HIV, it also appears that the person living with HIV or AIDS is also at risk of becoming permanently or episodicly disabled because of their condition (Disability and HIV": http://www.un.org/french/disabilities/default.asp?navid=39&pid=1567,       Retrieved 2017-05-30)

Unfortunately, HIV responses often forget about people with disabilities.  Yet they  are over-represented among people living in poverty and among key populations affected by HIV. They are less involved in social, economic and public life, and are less successful in economic, health and education.  About 453,000 people with disabilities were counted in Côte d'Ivoire with 90% physically disabled and 10% mentally disabled (RGPH 2014).  Since 2021, there is some data on their vulnerability factors (HIV prevalence of 2.9%) due to a weak promotion of HIV/AIDS prevention (lack of adapted tools), lack of resources (28.3%) and ignorance of the existence of services (22.6%), (CIV Alliance Report, Study for the identification of specific needs in terms of prevention and care for STI-HIV/AIDS among people with disabilities in       Abidjan – Ivory Coast, 2020).

Young people are also a particular target.  In Africa, according to UNAIDS, young people aged 15 to 24 account for 39% of new HIV infections among adults.   Astrong representativeness in all other vulnerable groups in  general: at least 60% of the population of the Ivory Coast (IC) is less 15-24 years old (RGPH 2021). For this population,  it is estimatedthat it is responsible for 67% of new infections, or 4 infections per day (SPECTRUM 2015).   Their needs are to be integrated in a general way into those of sexual and reproductive health.   In West and Central Africa,  sexual and reproductive health indicators remain a concern.   Adolescent girls' access to contraception would prevent 2.7 million non-consensual pregnancies per year in sub-Saharan Africa, according to a study by Sex Rights Africa Network. Globally, about 303,000 women die each year from pregnancy-related causes.  For young people and adolescents in particular, improving access to SRH services is a strategic issue.  In Côte d'Ivoire, theearly fertility rate remains high (39 per cent among uneducated girls and 14 per cent among others).

For all these groups, access to care is marked by obstacles throughout the chain of service provision (community and clinical): (i) Limited coverage of the service offer;   (ii) thevery low community involvement of existing identity associations that are very poorly equipped for community actions and for advocacy and insufficiently represented in decision-making bodies;   (iii) The overall unfavourable socio-cultural context in relation to the definition of "acceptable" standards that limit freedoms and integration, even in the healthcare environment.

The outbreak of the COVID-19 epidemic has exacerbated these problems and led to many difficulties in maintaining services in general and particularly with regard to the most vulnerable groups.   The consequences have been significant: a decrease in new cases identified and treated, an increase in lost HIV and TB, their greater isolation and an increase in their vulnerability.

The diagnosis during this period revealed: (i) a lack of involvement of community actors in the implementation of strategies to maintain access to and offer of services to populations; (ii) insufficient measures for the prevention of GBV and human rights violations in the response, particularly among minors and adolescents;  and (iii) the lack of a mechanism to monitor the impact of epidemics on vulnerabilities in access to services.

It is to address these gaps that our solution is proposed. This is an extension phase, focusing on people with disabilities and adolescents and young people (15-24 years).

Community actions are essential in raising awareness and engaging policymakers in the implementation and financing of national responses and also ensure that beneficiaries at the last mile of the health goods and services distribution chain effectively receive the necessary and sufficient information and services. Community-led Monitoring (CLM) positions communities as major players in the health system, able to collaborate with civil society stakeholders, affected groups and other entities involved in the community, to collect quantitative and qualitative data on service delivery in a structured, systematic and regular manner. Our solution is a model of CLM on the offer and access to clinical services of HIV/AIDS, and tuberculosis.

Implemented since 2019, it helps reduce these barriers by providing evidence-based information on access to care issues for the most vulnerable groups.

Our model is particularly interested in incidents related to:

• Availability of services, drugs and inputs
• Violation of free measures relating to certain services
• The quality of services
• Human rights violations including gender-based violence in clinical and community settings
• The appearance of serious side effects as a result of treatments.
• Community ownership of measures to prevent potential epidemic diseases

And it is thus 40 indicators related to the provision of services and human rights that are informed on a routine basis, with a quarterly report.  These indicators are not reported by the national health information system.

Our model is presented in the form of a monitoring and alerting platform, documentation, guidance, and response, to various incidents that hinder access to health services for the most vulnerable groups.

To do this, a system for collecting and analysing data in the community and at the level of health centres has been installed. It relies on nearly 400 collectors in the 113 health districts and 114 clinical sites. These collectors are community health workers, peer educators from target groups or monitoring committees bringing together representatives of the population (community leaders, members of community-based organizations, patients, etc.). All have been trained for incident notification and documentation.

The collection is done via tablets or computer during interviews or focus groups.  During this collection,measures are taken to ensure respect for the dignity of individuals, the anonymity of participants or victims and the confidentiality of data.  Thetools put in place as part of data collection and management are also useful for quality control and security of data and participants or victims.

Similarly, no names or personal information are collected during the activities of the community Health Observatory (CHO).  Computers/tablets are encrypted and password protected. The files containing the data are transferred daily to a central server that is also encrypted. Once transferred to the central server, the data on the tablet is no longer available at the collection agent level to minimize risk and increase privacy.

In addition to all anonymously reported data, we are vigilant in ensuring that any contextual information that could identify a particular individual is not included in any publication or report that we transmit to the various parties on a quarterly basis.

Each reported case is then investigated and submitted for validation to a committee that decides on the type of incidents and its admissibility before consolidation at the central level.

In addition to the control parameters during the entry, the monitoring of the quality of the data is also done during missions of supervision or validation of the data from the central to the local level carried out quarterly. In addition, all actors at the local level are coached by supervisors who monitor their work and ensure compliance with ethical considerations.

The analysis after clearance of the data collected by a team of monitoring and evaluation officers follows a plan developed to inform the desired indicators.

The data generated is analyzed monthly for feedback to the Monitoring Committees for action at the local level, such as advocacy, mobilization, denunciation, awareness of the population for the appropriation of prevention measures etc.  This analysis is also conducted on a quarterly basis and results in the production of quarterly and annual reports.  This report presents the levels of occurrence of incidents by target, sex, age... that have been documented and validated and responses taken where appropriate.

They are also being treated urgently for an immediate response when it comes to human rights incidents and service/input/drug disruptions. In this context, theresponse given is of different types and depending on the incident:

• Holistic care (medical, psychological, psychosocial...)  For victims of DH violations (including rape and physical assault)
• Legal assistance to victims
• Conduct of advocacy or concerted actions with authorities at the local level on issues of availability of inputs, services,

At the central level, the observatory's data support the actions of civil society through the Community Advisory Group to support policy and legal reforms to improve access to services for the most vulnerable groups.

This request relates to the strengthening of CHO to extend the services it offers to new targets: people with disabilities and adolescents and young people and to a new public health issue including sexual and reproductive health aspects.

CHO targets are the most vulnerable groups with reduced access to health care provision. For the pathologies currently covered (HIV and TB), these most vulnerable groups are found among key populations (MSM, transgender people, drug users, sex workers), young girls’ victims of sexual exploitation, PLHIV, tuberculosis patients and women and minors for rape cases.

In 2021, 687 human rights incidents were reported, 636 validated, including 405 cases of violence against women. 100% of the victims received care.

Regarding the availability of inputs, 1302 cases of ruptures were reported in 2021, of which 66% (852/1302) were related to HIV, 13% (174/1302) tuberculosis and 21% (276/1302) malaria. The actions carried out were able to allow responses for HIV, at a satisfaction rate of 23%, 34% for TB and 44% for malaria.

The action ofu CHO thus makes it possible to remove certain barriers that hinder access to care (screening, CCC and care), to keep patients in care and to systematize the care of victims.

In addition, the mobilization of civil society actors and their involvement in the animation of the Observatory required capacity building on the CLM, and on advocacy. This makes it possible more generally to strengthen the associative capacities of young identity organizations, to give them visibility and to strengthen their participation in advocacy actions and decision-making bodies.

Since 2019, associations of young people and people with disabilities have presented the need to be able to work within the observatory to highlight the problems of access to care affecting their communities.

With regard to people with disabilities, the problems of access to health services arise in a particular way because, despite the more than obvious risk factors, the specificity of disability is not taken into account in policies and programmes to combat HIV and AIDS.  The population of persons with disabilities in Côte d'Ivoire is estimated at Three Million, if we apply the estimated proportions of the United Nations (15%).  Of these, 60 to 65% are unemployed.

While efforts are being made to improve the integration of people with disabilities into working life in the fields of education, employment and sport, few initiatives are being carried out at the health level. The general observation is that thehealth system is not adapted to the needs of the disabled, and the staff still do not have the technicality to accommodate and provide care for the disabled. Free medical care exists in some urban medical centres, but information for patients and transport to these reception centres for people with disabilities (PWD) remain uncertain as long as they are not integrated into a major public policy (Organizational and operational capabilities of specialist centres for children with psychomotor disability in Abidjan Annals of Physical and rehabilitation Medicine, vol. 52, 2009).

In the context of the fight against AIDS, the findings are the same on prevention and care programs that are not adapted to the situation of disability:

•  existing prevention tools do not take into account the hearing impaired, deaf and blind.
•  Counselling and screening strategies have not yet been adapted to clients with "conventional" communication difficulties.
• From a gender perspective, PWD women are exposed to physical and sexual violence but are also not specified in GBV management documents.
• Access to health services is difficult as in most national public buildings and does not have an access ramp.
• The lack of data on the situation of PWDs in general and in particular with regard to HIV and STIs. Important studies such as the EDS or CIPHIA make no mention of the PWD situation.

 The observatory wants to highlight these problems of access to health services by producing evidence to upgrade the guidelines. It also wants to address cases of human rights violations suffered by this target and provide victims with systematic remedies.

Data on SRH needs show that for young people, especially girls, cultural and social norms are a barrier to access to services, while sexual behaviours have changed significantly: 23% of girls aged 15-19 are already mothers or pregnant (7%).  Because of these norms, young people are far from prevention services: 62% of girls and 75% of boys have never been tested for HIV; 33% of women aged 20-24 have unmet family planning (FP) needs. Only 16% of women and 25% of men aged 15-24 have a "thorough" knowledge of HIV/AIDS (much higher in urban areas). In particular, efforts need to be made for adolescents living with HIV. The transition to adulthood is not without problems, linked to the weariness vis-à-vis a chronic treatment, the discovery of sexuality. In addition to the difficulties of therapeutic and psychological care at this age, there is the problem of the transition to adult services, which does not facilitate the maintenance of care for these young patients because of a lack of close collaboration between pediatric and adult structures.

The integration of these new targets and sexual and reproductive health as a surveillance area will:

At the local level:

• Better visibility on the needs related to the specificity of the targets
• The availability of data on the occurrence of incidents in relation to the fields covered by the observatory
• The systematic availability of recourse for these new targets in the event of incidents
• Better follow-up of patients and maintenance in care
• Better knowledge of their rights
• The implementation of corrective measures at the level of health centres.

At the national level:

• Upgrading strategies and policies
• In the long term, areduction in cases of human rights violations in the community and at the level of health centres towards PWDs and young people, due to the prosecution of perpetrators and a better knowledge of their rights by the beneficiaries,
• A better political and social environment ensuring better access to health services for the most vulnerable groups

The CHO was born from the human rights observatory set up since 2017, with a focus at the start on human rights issues. The observatory's main target was key populations, sexually exploited girls and people living with HIV. In 2019, it expanded to 39 districts and integrated service availability monitoring. In 2020 it affected all 113 health districts.

In 2022, it was subsequently strengthened in the wake of the COVID-19 pandemic to cover new targets such as TB patients, orphans and children made vulnerable by HIV, children and women victims of rape. It has also extended its surveillance fields to quality of services and COVID prevention measures to become a more comprehensive CLM model integrating all existing community-based surveillance initiatives at the national level hence the name of the Community Health Observatory.   

The coordination team has therefore been active since 2017. Its members come mainly from our two organizations: NGO Alliance Côte d'Ivoire principal recipient of the Global Fund for community service offer and Enda santé, sub-recipient for the human rights program and then CLM of the Global Fund. Other civil society organizations have joined us and participate at the central or district level in the animation of the CHO: the National Federation of Civil Society Organizations Engaged in Health (FENOSCI), the Platform of Networks of Organizations Engaged in the Fight against HIV, Malaria and Tuberculosis (bringing together 10 networks of organizations),  the network of people living with HIV (RIP+), the NGO Ruban Rouge, responsible through its line 106 for promoting the observatory and the remedies it offers.

The Coordination team therefore has a good command of the national context and local realities. It is also capable of mobilizing actors and communities through all these community-based structures. Finally, the team has the necessary technical capacity to implement the interventions carried out within the framework of the CLM and is engaged in a process of ongoing capacity building of its members. It includes public health experts, statisticians, pharmacists, lawyers, sociologists, computer developers, data managers, specialists in social mobilization, operational research.

For this phase of extension of these services, the CHO will be enriched by the participation of organizations representing the new targets: Confederation of Organizations of Persons with Disabilities of Côte d'Ivoire, Ivorian Youth Network (RIJES) etc.

These organizationsand their members will be involved as for the others in all phases of implementation:

•  Identification of specific indicators to be entered,
• Data analysis through the recruitment of resource persons within the observatory's data management unit, who are also members of the pool of national trainers on the CLM
• Definition of data usage procedures,
• Data collection entrusted to peer educators and community health workers from the new target groups,
• Their integration into monitoring committees, their leadership in conducting responses to incidents affecting them at the local level and within the community advisory group responsible at the most strategic level for environmental monitoring and support for legal and political reforms.

The goal for us is to be able to meet the needs of as many beneficiaries as possible. Unfortunately, the available funding does not cover these New Targets.

In the long term, we hope that the availability of data concerning them will allow donors and public authorities to make a commitment to them.

In addition,our model presents a gap for the financing of responses at the local level by communities within the Monitoring Committees. This proposal also aims to be able to respond to this financial gap.

The Community Led Monitoring model implemented by our organizations is a recent initiative and the first at this scale, at the national level and in the West African region.

It is a step forward in the involvement and commitment of community-based organisations in theconstruction of a strong and resilient health system. The data provided are of an exceptional nature because they come from the users of the services and differ completely from those produced by the national system which serves to provide information on traditional indicators such as prevalence, the number of people screened, the number of people benefiting from services etc. Data that do not shed light on the specific needs of beneficiaries, on the quality of the services offered, their availability and the assessment of beneficiaries on these services, any factor that contributes to the maintenance in patient care.

It is also a tool for monitoring and citizen control of the State's commitments at local and national level. The available data thus make it possible to shed comprehensive light on the barriers to access to health services for these marginalized groups but above all to offer an immediate and systematic response.

At the macro, medium and long-term level, they will be used to strengthen policies and strategies and to improve the socio-cultural environment.

Efforts to intensify and make accessible health services are thus strengthened through the CLM by providing insights into the implementation of differentiated and human-based approaches.

Human rights data have thus strengthened advocacy for reform of the Drug Use and Possession Act, thus providing an opportunity for drug users to benefit from a harm reduction programme rather than being systematically convicted.

In terms of impact, we expect better access to services by reducing barriers in the community and in health centres, greater coverage of the supply of services in quantity and quality and a reduction in the number of people lost to follow-up and therefore greater adherence to treatment.

The overall objective within five (5) years is to improve access to health services for the most vulnerable groups.

The following impact objectives are specifically targeted:

- Reducing vulnerability to HIV, tuberculosis and sexual and reproductive health issues

- Reducing stigma and discrimination against target groups in clinical and community settings 

- Improving the coverage of the quality of the services offered 

 In the short/medium term we expect: 

- Improving the legal context, policies and strategies for access to health services for the most marginalized groups

- Better knowledge of targets on their rights and increased use of the services offered 

- Greater participation of civil society organizations and identity organizations in decision-making  

To achieve them, the following interventions are implemented within the framework of the CLM program.

To measure impact objectives, programmatic mapping studies, bio-behavioural studies, assessments of stigma and discrimination (Index stigma), review of national strategic plans (fight against AIDS, sexual and reproductive health, tuberculosis), evaluation of the legal framework and policies and strategies, monitoring the socio-cultural environment, assessments on community engagement and participation in national public health objectives, as well as CRG (Community Right Gender) studies.

Some examples of indicators:

• Number of new HIV infections in key groups
• Incidence of tuberculosis in key groups
• Proportion of girls and adolescent girls using modern contraceptive methods
• Adolescent birth rate
• Coverage of essential health services
• Proportion of vulnerable populations who report experiencing stigma and discrimination in the care setting
• Presence of a legal framework to promote, enforce and monitor the application of the principles of non-discrimination on grounds of sex
• Proportion of girls and women aged 15-49 who have undergone genital mutilation
• Proportion of target groups victims of physical, psychological, or sexual violence in the past 12 months
• Proportion of victims who used justice services

Technology plays an important role in our system.

At the first level of collection, we combine the use of the ONA online platform and the Open Data Kit (ODK) collection system. The information is sent to the ONA server which is a data aggregation and processing platform on which we have a secure private account. The data is entered using the Geo-ODK application, which allows you to manage and apply questionnaires on a smartphone or tablet

This system eliminates errors due to the transfer of data between investigators and data entry officers. It also makes it possible to identify errors in real time during the investigation, and thus correct them immediately.

Data collected in different formats according to our needs: Excel spreadsheet, Access databases, WinDev type application...

We also use different solutions for data processing such as Stata, Sphynx or R, Excel

When it comes to emergency data: breakage of an essential product or cases of human rights violations such as physical or sexual assault, this method of notification is reinforced by SMS and or call.

Computer SMS messages are also used forcommunication with targets (relating to the promotion of the observatory and its remedies). The SMS information system allows automatic storage of beneficiaries' numbers in differentiated databases (according to profiles) for specific information adapted to needs.

With the ClickSend SMS gateway, nous can also track the delivery of the message, to ensure that the recipients receive nos messages.

Finally, for the reporting of side effects of drugs, the observatory is based on the national mobile application Med Safety.

In the future, we are thinking of other types of mobile applications allowing notifications by the beneficiaries themselves and the use of the Rights – Evidence – ACTion or REAct software  (DHIS 2 Interface)

The data is collected by collectors from the community and is representative of our beneficiaries: sex workers, MSM, drug users etc.:

- The referent ASCs:

They are peer educators who are responsible for screening, monitoring patients in the community and raising awareness. They are not actors dedicated to CLM but they play the role of monitoring and reporting incidents in the community. They do this through physical tools and by SMS to the zone supervisor (ASC Paralegal Coach)

- ASC coach community advisors

The 114 ASC Community Counsellors are responsible for the routine follow-up of patients within the health centres and focus on the provision of services, compliance with free measures and the availability of inputs. They also inform about the occurrence of serious side effects. Their action is essential for the maintenance of targets in care. It is made available to them internet and communication credit.

- Community Health Agents Paralegal Coach

The 113 ASC Paralegal Coaches trained and dedicated to the investigation and documentation of cases of human rights violations and the accompaniment of victims in their care.

The collections for these two groups of actors are done on tablets. And they are re-listed as volunteers.

- 120 Monitoring Committees

They bring together at the local level representatives of the populations, targets of the program, religious leaders, local organizations etc.; They are responsible for making observations in the community. Their motivation is only of a moral nature and in connection with their commitment to their communities.

Observations are returned to area supervisors for digital entries.

- The 33 regional delegates

They ensure the qualitative collections and the supervision of the local collectors. They are dedicated to this task and renumbered for. Their collection is done on digital media

The observatory is an instrument for promoting and defending diversity. It aims to be a tool at the service of the communities and target groups it serves in order to fight against inequalities. Therefore, he wants to be an example of inclusion for all types of populations. To do this, beneficiaries are represented at all levels of process; from the definition of indicators, coordination to the use of the information produced, data collection and incident responses.

The choice of indicators thus integrates the specificities of each target group, including those related to gender, age or patient profile.

Target groups, including sexual and gender minorities included in the programme, are thus included in the coordination team. There are also as many men as women and transgender people. The pool of collectors is mainly composed of people from the target groups: PLHIV, FSW, MSM, OVC, drug users... and soon young people and people with disabilities with representation of all types of disabilities. At the local level, these actors have been integrated into monitoring committees to support local actions, including advocacy.

At the level of the governing bodies of our organizations, key populations and PHAs are well represented.

Five groups of beneficiaries/clients:

• People from target groups: young people and people with disabilities
• Communities
• Identity organizations and other civil society organizations
• The  national part
• Donors
• Recourse and assistance in the face of incidents on the service chain and in the community
• production of monitoring data on incidents related to service offer and rights for the last 4
• Capacity building for identity organizations and other civil society organizations to integrate the CLM into their areas of intervention and facilitate their access to funding in this area
• Human resources (reinforcement of the coordination team and collectors)
• Upgrading the data collection platform and tools
• Funding for the implementation of training, visibility and supervision activities

 The products supplied differ according to these targets:

 To do this, the following interventions will be carried out:

  In terms of surveillance:

•  Capacity building
• In terms of communication:
•  Incident Response

• Installation of notification terminals at fixed points for reporting by the targets themselves
• Recruitment and equipping of community health workers
• Focus group to shed light on certain findings
• Investigation and documentation of reported incidents
• Training of actors
• Supervision
• Dissemination of data
• Production of promotional materials
• Care of victims: medical, psychological, judicial, social mediation etc.
• Referencing to appropriate services
• Local advocacy by monitoring committees
• Communuty score card enters health centers with implementation of a corrective action plan
• Strengthening the Community Advisory Group

The resources to be committed to satisfy them are:

 The needs are relatively affordable. Stakeholders (other civil society organisations, donors and governments) are already aware of and interested in the products offered by the observatory.

The observatory is currently supported by the Global Fund through its Human Rights program. In 2022, funding is €  1,437,987.63  covering all aspects of capacity building, promotion of the observatory and initiation of responses. The Global Fund grant is guaranteed until the end of 2023. Another phase of 3 years is granted in advance.

People with disabilities and young people are not covered by this funding. This proposal will make it possible to take into account the needs of the new targets in 2024 in the next funding cycle of the Global Fund (2024-2027) on CLM and human rights with the provision of evidence. 

The observatory's data enabled Enda Santé to raise € 540,000 in 2021 to strengthen the offer of legal services to targets. Indeed, the observatory's data at the end of 2020 had highlighted a gap in the legal assistance of victims. Similarly, the Initiative has also provided the organization with €900,000 for the establishment of a capacity-building programme and the provision of community-based services adapted to transgender people. The project starts in October 2022 for 3 years.

At the national level, the issue of the CLM has also been popular thanks to this initiative with the implementation of new dedicated grants by PEPFAR via UNAIDS. This grant is expected to start in 2022 at PEPFAR-supported clinical sites. Our organizations are not beneficiaries but have participated indirectly through their initiative in the promotion of this strategy.

Finally, many identity organizations were able to capitalize on their participation in the animation of the observatory to mobilize funds to meet the needs of victims of human rights violations in their network.