The Network of People Living with HIV/AIDS in Nigeria (NEPWHAN) implements Community-Led Monitoring (CLM) under the Global Fund to Fight AIDS, Tuberculosis and Malaria GC7 N-THRIP grant, with support from Institute of Human Virology Nigeria (IHVN) and national stakeholders.

CLM places communities at the center of monitoring HIV, TB, malaria, and integrated health services, ensuring that the experiences of service users directly inform decision-making, advocacy, and health system improvement.

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What Is Community-Led Monitoring?

Community-Led Monitoring is a routine, structured, and evidence-driven process through which people who use health services systematically assess how those services are delivered. Rather than relying only on facility or administrative data, CLM captures real-time community experiences related to access, quality, dignity, and accountability.

Through CLM, communities generate credible evidence on what is working, what is not, and why. This evidence is then used to engage health providers, government institutions, and development partners to resolve bottlenecks, improve service quality, and strengthen health outcomes.

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Why CLM Matters

Despite major investments in HIV, TB, and malaria programmes, many service users continue to face barriers such as stigma, stock-outs, poor service quality, informal fees, and rights violations. These challenges often remain invisible without community-generated evidence.

CLM ensures that:

• • Service users are heard and represented
  • Gaps in service delivery are identified early
  • Health systems are responsive and accountable
  • Policies and investments are guided by lived realities

By grounding monitoring in human rights and community leadership, CLM strengthens trust between communities and health systems and contributes to better health outcomes for all.

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Our CLM Approach

NEPWHAN’s CLM approach is built on four interconnected pillars: Education, Evidence, Advocacy, and Engagement.

Education: CLM begins with empowering communities with knowledge. People living with HIV, key populations, and other vulnerable groups are educated on their rights, standards of care, and available services. This knowledge enables communities to recognize gaps, demand quality services, and participate meaningfully in monitoring processes.

Evidence: Trained community data collectors routinely gather quantitative and qualitative data from health facilities and communities. Using standardized tools and digital platforms such as Community iMonitor, data is collected on service access, quality, stigma, discrimination, commodity availability, and client satisfaction.

Advocacy: Evidence generated through CLM is transformed into actionable advocacy. Findings are analyzed, validated, and presented to facility managers, state and national health authorities, and policymakers to drive corrective actions and system improvements.

Engagement: CLM promotes continuous engagement with decision-makers. Through consultative meetings, dialogue forums, and dissemination sessions, communities and authorities co-create solutions and track progress over time.

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What We Monitor

NEPWHAN’s CLM tracks key service delivery and rights indicators, including:

• • Access to HIV, TB, malaria, and integrated services
  • Quality of care and client satisfaction
  • Availability of medicines and commodities
  • Health worker conduct and respect for human rights
  • Stigma, discrimination, and gender-related barriers

Monitoring is conducted across public, private, faith-based, and community service delivery points to ensure a comprehensive picture of service delivery.

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Where We Work

Under the Global Fund GC7 N-THRIP programme, NEPWHAN implements CLM in 13 high-burden states: Abia, Akwa Ibom, Bauchi, Borno, Benue, Edo, Imo, Kogi, Ondo, Nasarawa, Oyo, Kebbi, and Sokoto.

Facilities and communities are selected based on HIV burden, service volume, and geographic spread to ensure equitable representation.

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Our Impact

CLM turns lived experience into evidence and action. Every month, a network of trained data collectors captures tens of thousands of client perceptions and facility observations so that community feedback becomes the basis for service improvement. The programme’s design targets comprehensive coverage: each state team aims to interview hundreds to thousands of service users monthly and to conduct focused quarterly FGDs that represent PLHIV, KPs, adolescents and other vulnerable groups. Those data are validated locally, visualized in real time on dashboards, and used in state-level dissemination meetings and national advocacy briefs. As a result, CLM has driven concrete outcomes — from reduced commodity stock-outs at specific sites to changes in clinic hours, strengthened referral pathways, and improved respectful care practices following facility feedback. By documenting recurring problems and demonstrating corrective actions, CLM strengthens trust in services and helps increase uptake, retention and overall treatment outcomes.

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Ethics, Data Protection & Accountability

Ethics and confidentiality are central to CLM. Participation is voluntary, and all respondents provide informed consent; interviews are conducted in private and in participants’ preferred language. To protect participants, personal identifiers are separated from survey data, and electronic submissions are encrypted and managed through secure servers with restricted access. Data collectors receive training on confidentiality, harassment prevention, and how to refer participants who need psychosocial, legal or clinical support. The CLM protocol also includes procedures for minimizing risks — for example, how to handle distress during interviews and how to escalate urgent safeguarding concerns. NEPWHAN retains ownership governance over CLM data in line with the SR/PR agreement and shares aggregated, de-identified findings for advocacy and service improvement while safeguarding individual privacy. These safeguards ensure that communities can safely speak about problems without fear of reprisal.

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Partnerships & Governance

CLM is inherently collaborative. NEPWHAN leads implementation but works through multi-stakeholder governance structures that include State and National Steering Committees, CBO partners, the Key Population Secretariat, and government partners such as NACA, NASCP and NCDC. Technical partners (WHO, UNAIDS, IHVN, etc.) provide methodological support, while development partners and donors support scale and sustainability. At the state level, three CBOs implement CLM with dedicated program, M&E and finance staff and a team of community data collectors drawn from the populations served (PLHIV, KPs, AYP and general community). This governance model ensures that community evidence is reviewed jointly with facility managers, state health authorities and donors, enabling coordinated action plans, resource allocation, and policy engagement. By embedding CLM within existing coordination forums and forming clear escalation pathways, NEPWHAN ensures findings move from community voice to institutional response.

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Monitoring & Accountability

NEPWHAN’s CLM uses a rigorous monitoring and learning cycle to guarantee quality and follow-through. Data collectors are recruited and trained to standardized criteria; monthly quantitative collection is complemented by quarterly FGDs and KIIs. All incoming data are pre-processed, standardized and verified through spot checks, multi-source cross-checks and validation visits before results are published. State and national validation meetings review findings, prioritize issues, and agree corrective actions with facility managers and health authorities. Follow-up is tracked so that remediation is documented and reported back to communities. NEPWHAN also publishes periodic CLM reports and policy briefs, presents findings at stakeholder fora, and uses the Community iMonitor dashboard for real-time visualization — turning monitoring into accountability and continuous improvement. These systems reinforce that CLM is not an academic exercise but a practical mechanism for measurable service change.