Pathfinder International works together with Botswana Ministry of Health and local NGOs to provide education and psychosocial support to pregnant women and mothers living with HIV, to prevent mother to child transmission of HIV (PMTCT) and promote maternal health and child survival.

While pregnant HIV positive women in Botswana have the advantage of greater access to PMTCT services than their counterparts in other African countries, many of their other needs remain unmet. Psychosocial support and counseling services are still lacking in many instances. Clinical staff is overburdened and unable to offer the necessary support, and family members who could be taking over this important role tend to hold traditional and cultural beliefs that contradict PMTCT practices. To prevent overall HIV transmission and improve maternal and child health gender norms, attitudes and behaviors must change. In FY 2012 Pathfinder will develop and implement innovative approaches to improve project efficiency in Francistown, Serowe, Palapye, Boteti and Chobe districts. The funding will also be used to build local and organizational capacity of Botswana Council of Churches (the current implementing local NGO) to expand and strengthen delivery of strategic, sustainable, integrated, evidence based, and high quality PMTCT services at the community level. In order to promote sustainability, Pathfinder will work to build their capacity and skills to fundraise, build private sector partnerships, and identify viable income generating activities. In addition Pathfinder will advocate for the integration of the peer mothers program into existing maternal, neonatal, and child health (MNCH) services in all public health facilities.

The successes of the Botswana PMTCT program in preventing transmission of HIV from mother to child are well known. However, along with CDC/Botswana, Pathfinder has identified gaps that currently exist within the PMTCT program that negate some of these successes. As such, while the PMTCT activities will be a continuation of those that have been implemented since September 2009, during FY 2012 the focus will shift to focus more on increasing access to postnatal care and family planning, reducing serocoversion among pregnant women initially testing negative and ensuring HIV free survival of infants by promoting safe infant feeding practices, early infant diagnosis and treatment. Additional emphasis will be placed on ensuring that HIV positive mothers access CD4 count testing , that HIV exposed infants access PCR testing and linkage to care in a timely manner, and that male partners of pregnant women are reached through education and prevention counseling. It is believed that this shift will largely contribute towards better maternal, paternal, and child health outcomes

During FY 2012, program strategies will include peer counseling, clinic talks, support groups, and outreach activities including home visits. Daily activities for trained Peer Mothers will include identification of PMTCT clients accessing antenatal services, and registering them into the peer mother model. Registration process involves conducting risk assessment profiling and identifying clients gaps in information, behaviors and skills. The identified issues are then used to jointly come up with a plan that will guide service provision. Service is provided in the facility and/or home setting depending on the clients preference. The aim is to reach a minimum package of care which includes counseling and education on 80% of the planned sessions. Those reached with minimum package will continue to access services through support group meetings. Existing materials are used to re enforce messages and these materials will be reviewed regularly to ensure appropriateness.

During the implementation process, Pathfinders performance monitoring system that provides standardized tools to assess progress against work plan targets will be strengthened through quarterly reviews. Pathfinder will also build local and organisational capacity of Botswana Council of Churches to expand and strengthen delivery of strategic, sustainable, integrated, evidence based and high quality PMTCT services at community level. The long term plan is for the program to be eventually absorbed by the Government of Botswana. This year, a new evaluation and mentoring partnership with the Mothers to Mothers (M2M) program of South Africa will be initiated. Along with M2M, Pathfinder will develop a program enhancement plan to improve efficiencies and impact. By the end of the COAG, an exit strategy will be developed which aligns this community program to existing health systems. Such programs will include maternal and child health programs, sexual reproductive health, and others, In this way BCC and its local structures will play their role as per their mandate under the guidance, support and coordination of the Ministry of Health which is in line with the national strategic plan and country ownership.