PLUS UP FUNDING: This new activity links to the following PMTCT service delivery activities: IntraHealth, Columbia, JHPIEGO. There is very low uptake of prenatal services in Ethiopia; only 25% percent of pregnant women make at least one prenatal clinic visit and home delivery remains the norm, with only 6% of Ethiopian mothers delivering in a health facility. Currently, only 46-53% of positive mothers accept Nevirapine after post test counseling. These patterns have important implications for the design and execution of PMTCT interventions. EngenderHealth will introduce different quality improvement (QI) approaches such as the COPE model (Client-Oriented, Provider-Efficient), facilitative supervision, and other QI approaches that foster client orientation in developing strategies to improve quality of services. EngenderHealth will assist in reaching more women through community outreach and referral by traditional birth attendants (TBAs).

"The intervention aims to achieve the following: 1) Improve quality and use of ANC, PMTCT, and FP services in supported sites; 2) Increase access to ANC/PMTCT/FP information and services; and 3) Increase counseling in family planning, HIV/STI prevention and treatment services. During the first year, EngenderHealth will pilot activities in 20 health centers and four hospitals in Amahra and Oromia regions in high prevalence communities. Sites will be selected through a rapid assessment process, looking at counseling and testing, ANC and PMTCT service data, existing community referral networks and trained TBAs/HEWs, etc. The vast majority of Ethiopian women don't access health services during pregnancy and childbirth. In the 2005 DHS, distance from health facility (68%), need to take transportation (72%), anxiety there might not be a female provider (73%) and concern that there may not be any provider (80%) were the major reasons women gave for not attending health facilities even when sick.

" This partner will explore these challenges using a formative assessment to identify how to address reasons for low ANC and PMTCT utilization and loss-to-follow-up in the specific pilot sites. The results will be used to help create a communication strategy to reach both women and men: EngenderHealth will adapt its PMTCT COPE handbook successfully implemented in Cameroon, Kenya and Tanzania since 2004. The second step will be to coordinate training of trainers on Quality Improvement (QI) and Facilitative Supervision (FS). This is a theoretical and practical training for medical directors from the pilot facilities, woredas and regional health bureaus. The training has theoretical knowledge on QI tools including COPE, Quality measurement tool (QMT), as well as practical sessions where COPE exercises will be conducted in a pilot site. Each participant will develop action plans to introduce COPE into their respective facilities. Two such trainings will take place for the 24 sites - with 12-14 participants per training. COPE facilitators from EngenderHealth will work with each trained participant to introduce COPE into all 24 facilities. During the three-day COPE introduction, all PMTCT and ANC providers will meet to discuss their existing services, identify bottlenecks and issues of quality, analyzing root causes in order to develop their own recommendations. The providers will use the COPE self-assessment tools specifically adapted to PMTCT, as well as client interview and site visit forms. Community members, mothers and TBAs will be involved to help the facility reach recommendations. During the last day of the introduction, the facilitators will introduce QMT to help document baseline information to analyse the results after implementing the recommendations. The health facility will form a QI committee comprised of PMTCT and FP counselors, the medical director, matron and woreda head etc. to follow up the action plan. The aim of the COPE methodology is to enhance local capacity to implement quality improvements and conduct supervisory follow-up visits. It will be important to consider the role of TBAs as sources of information within these communities. The partner will train TBAs to improve their communication skills in HIV counseling and testing, family planning, stigma, etc. Another strategy will be the use of community-based Reproductive Health Agents as key community promoters of family planning and ANC services. They are already trained to go house to house to talk to people, so they are well positioned to identify pregnant women and advise them about available services. The Amhara Development Association and the Oromia Development Association have over 5,000 CBRHAs which this project will mobilize for outreach. After a facility has implemented COPE, then the Community COPE tool will be introduced to assist health facilities in engaging community members in dialogue regarding quality of services and client needs. It will be useful to strengthen the relationship between community members and facility providers.

EngenderHealth aims to reach over 4,000 pregnant women and their partners with integrated SRH services. The targets will be counted by PEPFAR partners reporting in each of the health facilities. This activity will increase the quality of PMTCT and ANC services provided while raising community awareness of the benefits of available services .

PLUS UP FUNDING: EngenderHealth's Men As Partners (MAP) Program, established in 1996, works with men to promote gender equity and health in their families and communities. EngenderHealth will adapt its experiences from South Africa, Kenya and India to the Ethiopian context. This funding will also build on EngenderHealth's planned work through the PEPFAR-supported Male Norms Initiative by providing more technical assistance and resources to local NGOs and PEPFAR partners to address issues of male engagement, gender-based violence, and other social norms that exacerbate gender inequalities and negative health behaviors. The objectives of this activity are to provide MAP tools and technical assistance to local partners and communities, especially to men and young boys, with messages about the links between HIV/AIDS, STI, alcohol, ‘Khat' chewing, gender-based violence, and male norms. EngenderHealth will work with two local NGOs - Hiwot Ethiopia and Integrated Family Services Organization (IFSO) - to reach the general community as well as vulnerable at-risk groups in Addis Ababa. The target geographical areas will be seven kebeles in Addis Ababa around the Mercato and Kazanechis neighborhoods. EngenderHealth will develop communication materials and tools for local partners to use with men and young boys. There are several local NGOs working to support victims of domestic violence and rape and to prosecute the perpetrators. However, there is very little being done to discuss the underlying social and economic issues. There is a need for peer counseling materials for men - to discuss domestic violence, rape, gender inequality and their role in protecting the health of their family. EngenderHealth will conduct several 3-day MAP workshops with community leaders, NGOs, and youth. Topics will include creating me"At the end of the workshop, it is expected that the influential group of leaders and youth will have an individual commitment to make personal changes and to raise awareness of these issues. Further more, they will develop action plans for follow up activities with their peers. There will be pre and post workshop tests to assess knowledge gain. The post-MAP workshop activities will include the peer educators meeting weekly to discuss their changes, challenges and learn from each other. Discussions will be around personal changes and activities to engage their own peers and close friends. Each member is encouraged to bring interested friends to the meetings. The meetings will be in the Kebele buildings or compounds. The peer educators will be facilitating the discussion and documenting progress that are seen within the groups. By the end of the first month, the program will be reaching 250-350 men through the MAP methodology. " By the third month, the opinion leaders and youth will be graduating to be MAP advocates and they will be ready to conduct their own mobilization with assistance from the peer educators. An estimated 50% of the leaders (25-35/per Kebele) will be ready to mobilize at least 10 of their friends with personal stories, information and influence. Each MAP advocate will have person to person discussion with 10 of his friends per month. The program also plans to reach 3000 street youth enrolled in informal education with the local NGO named Forum for Street Children. Currently, 3000 street youth in Addis Ababa are getting informal education through the Forum for Street Children. The trained MAP advocates will be used to come and talk with the young people about gender norms, HIV/AIDS prevention, etc. There will be pre and post workshop knowledge assessments for the youth. The MAP Advocates will also be employed to reach young people through other local organizations, youth and boys clubs. Activities addressing youth will provide age-appropriate information.

PLUS UP FUNDING: EngenderHealth's Men As Partners (MAP) Program, established in 1996, works with men to promote gender equity and health in their families and communities. EngenderHealth will adapt its experiences from South Africa, Kenya and India to the Ethiopian context. This funding will also build on EngenderHealth's planned work through the PEPFAR-supported Male Norms Initiative by providing more technical assistance and resources to local NGOs and PEPFAR partners to address issues of male engagement, gender-based violence, and other social norms that exacerbate gender inequalities and negative health behaviors. The objectives of this activity are to provide MAP tools and technical assistance to local partners and communities, especially men and young boys, with messages about links between HIV/AIDS, STI, alcohol, ‘Khat' chewing, gender-based violence, and male norms. EngenderHealth will work with two local NGOs - Hiwot Ethiopia and Integrated Family Services Organization (IFSO) - to reach the general community as well as vulnerable at-risk groups in Addis Ababa. The target geographical areas will be seven kebeles in Addis Ababa around the Mercato and Kazanechis neighborhoods. EngenderHealth will develop communication materials and tools for local partners to use with men and young boys. There are several local NGOs working to support victims of domestic violence and rape and to prosecute the perpetrators. However, very little is being done to discuss underlying social and economic issues. There is a need for peer counseling materials for men - to discuss domestic violence, rape, gender inequality and their role in protecting the health of their family. EngenderHealth will conduct several 3-day MAP workshops with community leaders, NGOs, and youth. Topics will include creating men's discussion groups, establishing "buddy' peer support networks etc. "By the end of the workshop, it is expected that the influential group of leaders and youth will have individual commitments to make personal changes and raise awareness of these issues. Furthermore, they will develop action plans for follow up activities with their peers. There will be pre and post workshop tests to assess knowledge gain. The post-MAP workshop activities will include a peer educators' weekly meeting to discuss their changes, challenges and learn from one another. Discussions will focus on personal changes and activities to engage peers and close friends. Members are encouraged to bring interested friends to meetings, which will be held in kebele buildings or compounds. The peer educators will facilitate the discussion and documenting progress within the groups. By the end of the first month, the program will be reaching 250-350 men through the MAP methodology. " By the third month, the opinion leaders and youth will be graduating as MAP advocates and will be ready to conduct their own mobilization with assistance from the peer educators. An estimated 50% of the leaders, (25-35/per kebele), will be ready to mobilize at least ten friends with personal stories, information and influence; each MAP advocate will have person to person discussions with ten friends per month. The program also plans to reach 3000 street youth enrolled in informal education with the local NGO Forum for Street Children. Currently, 3000 street youth in Addis Ababa are receiving informal education through this organization. Trained MAP advocates will talk to young people about gender norms, HIV/AIDS prevention, etc. There will be pre and post workshop knowledge assessments for the youth. They will also be employed to reach young people through other local organizations, youth and boys' clubs. Activities addressing youth will provide age-appropriate information.