The Strengthening Communities through Integrated Programming (SCIP) project is comprised of two results-oriented projects in Nampula, directed by Pathfinder International, and Zambézia, directed by World Vision, that aim to integrate health, HIV, water/sanitation, and rural enterprise program components to contribute to an overall objective of strengthening communities. The SCIP project aims to bring together, in conjunction with funds from other sectors, income growth, increased use of child survival and reproductive health services, community-based safe motherhood programs, and programs to reduce the transmission of HIV. The goals under this program are to implement new methodologies for collaboration with existing programs, avoiding duplication of efforts and ensuring maximum impact. The SCIP project aims to strengthen capacity of the public health system, NGOs, and CBOs to support facility-based services through improved service delivery and management and supervision systems

World Vision will carry out activities at the provincial, district, and community levels in16 districts of Zambézia in a coordinated, complementary manner with other USG funded development activities. World Vision, through the SCIP project, will build on its former HIV/AIDS prevention project, MozARK, which developed comprehensive strategiestailored to the epidemic in Zambezia province and grounded in evidence based individual behavior and social change theories. The prevention strategies target the main drivers of the epidemic including multiple concurrent partnerships, trans-generational and transactional sex and low condom use. SCIP World Vision provides excellent opportunities to warp-around other behavior change and prevention activities such as immunizations, TB, malaria, FP/RH, water, sanitation and hygiene (WASH). Addtionally, World Vision will support community activities to encourage the increase of Counseling and Testing efforts.

SCIP World Vision will support PMTCT programming at the community level, linking mothers and newborns with services for FP/RH and Maternal Child Health services. World Vision will also work with Community Health Councils to help them strengthen social protection systems. Moreover, the project provides a comprehensive and quality package of services for OVC and their families. The project will assess and encourage an array of bankable activities by community based organizations that will improve health in communities, including those that increase income to allow households to procure nutrition and health services and those that increase availability of services in the communities.

SCIP World Vision aims to increase young women's risk perception about engaging in age-disparate relationships by linking them with ongoing programs such as: (i) life skills education; (ii) training in income-generation; and (iii) identification of peer 'role models'/peer educators who will work with these young women and refer them to services for FP/RH as needed. Community Health Volunteers (CHV's) will also be trained to reach out to men, often the primary decision-makers in the traditional family. The project will use the model "Men as Part of the Solution" as conducted by MozARK, to promote changes in male behavior that can reduce HIV infection and increase their responsibility in regard to the family well- being. In addition, male-friendly environments will be facilitated at antenatal care, PMTCT, intra-partum, and newborn care services.

The SCIP program will support achievement of goals outlined in the Partnership Framework by strengthening both the clinical and community-based capacity of health care workers to deliver services; strengthening linkages between services to working towards comprehensive health care for PLHIV and OVC; strengthening organizational and technical capacity of civl society to improve local and community level response; and decentralization and strengthening of health systems. The Project Team will work closely with Zambezia Provincial Government officials including the Health Directorate and the DPS to improve the quality of services and to implement an integrated community-based approach. These packages are designed to horizontally and synergistically integrate project activities across geographic regions and technical sectors, providing coordinated, efficient implementation, complete with stakeholder engagement.

World Vision has field data collection tools, volunteers trained in data collection and use, and decentralized systems for data entry, storage, retrieval, and analysis. Monitoring & evaluation activities will be based on collective lessons learned. Data collection tools and systems will be redesigned to accommodate needs for data integration. All partners will use the same field tools. Existing data collection systems will be evaluated for ease of use, data quality features, and suitability to integrate into a data

warehouse. A baseline survey will be conducted during the first two months with a mid-term evaluation and an impact evaluation to follow.

HBC activists provide services to PLHIV that include: 1) palliative care, 2) referrals to treatment and care services, 3) promoting adherence to treatment for HIV/TB and OIs such as CTX, and 4) follow-up care. They also provide psychosocial and spiritual support, appropriate nutritional advice, emotional counseling, and referral for food assistance. Advocacy for CT, PMTCT, and referrals to TB/HIV treatment, and FP services are integral messages for all Community Health Councils (CHCs)/CHVs

visits. World Vision networks with community based organizations, nongovernmental organizations, and other USG partners to leverage access to prevention and treatment services and facilitate treatment adherence through groups, follow-up by Home Visitors (HVs), and other community members. World Vision will collaborate with PEPFAR clinical partners to strengthen referral services for PLHIV. The project implements a transport support service (using two vans located strategically in two districts) to help PLHIV access quality health care and antiretroviral therapy.

In addition, the project is strengthening the community-based and complementary health service support structure to improve access and quality of maternal, newborn, and child health (MNCH) and family planning services for PLHIV, while improving behavior and care seeking practices. Household level support utilizes an integrated approach, occurring in the context of multiple activities: 1) Timed and Targeted Counseling using the life cycle approach and registration; 2) Using Mother/Father Groups to reach groups of people in familiar circumstances, with peer support; 3) BCC activities to enhance uptake of services, prevent spread of diseases such as malaria, diarrhea, STI, HIV and increase use of long lasting insecticide treated nets (LLIN); 4) Home visits for HBC, OVC care, and combination HIV prevention activities; 5) Community mobilized adolescent support groups to improve knowledge and practice on reproductive health (RH), family planning (FP), and prevention of STIs and HIV.

During household interactions, Community Health Volunteers (CHVs) foster antenatal care (ANC) visits, including PMTCT, for HIV+ pregnant women, encourage skilled delivery, support CT participation, and educate families in the recognition of signs of illness and complications including when and how to access skilled health care.

The main model for OVC support is through Community Care Coalitions (CCC) in all 16 districts. The CCC network is a model for mobilizing and strengthening community-led care for OVC. It is multi- sectoral approach that incorporates health, social welfare, education and justice. The CCC network is embedded in the community and actively involves beneficiaries (PLHIV, OVC, and women). CCCs are the primary mechanism for providing care and support to OVC, PLHIV, and vulnerable households, as well as for referring people to reproductive health/family planning (FP), CT, PMTCT, ART, and malaria and TB testing and treatment, where available. CCCs are accountable to the Health Care Councils.

The project provides a comprehensive and quality package of services for OVC and their families. CCC-

led interventions focus on HIV care and support but are not exclusively addressing only HIV issues in the community. The project works with Community Care Councils (CHCs), CCCs, and Home Visitors (HVs) to strengthen social protection systems. All the seven major OVC services: food and nutritional support, shelter and care, protection, health care, age appropriate education and vocational training, economic opportunity/strengthening and psychosocial support, are provided to children determined by need. The project ensures provision of quality, comprehensive, multi-sectoral and coordinated community care strategies for the HIV-affected, OVCs, and their households.

The project will establish loan guarantee mechanisms generating income to support health related activities. Projects may target specific groups of OVC who will be assisted to register as formal, legally binding associations with the intention of beginning income-generating activities (IGAs). Training and assistance in business planning, management, market linkage, and technical knowledge will transform these initiatives into successful business activities. IGAs will be tailored to the context of each target community and include agriculture production or processing within the framework of the value chain analysis to be performed by the project. The income and some of the produce will be used to support the educational, financial, and nutritional needs of OVCs. This project will build on previous successful experiences of the seven implementing partners.

Activities will actively promote CT and advocate for the increased use of counseling and testing facilities

and ensure appropriate treatment linkages. World Vision will mobilize communities and District Health

Associations (DHAs) to increase the demand and use of CT services and coordinate with USG-supported

agencies to establish a two-way referral system of clients. Clients who test positive (including pregnant

women) will be counseled to seek PMTCT services, ART, and family planning (FP) counseling, care, and

support, referred to existing community volunteers, and made aware of existing support groups for

PLHIV. The project will also integrate CT services into the mobile brigade activities, promote a door-to-

door campaign, and increase community-based information, education and communication (IEC) (radio,

theater) activities. Peer educators/activist/volunteers will be trained in skills-based interpersonal

communication (IPC) implementation for HIV prevention and promotion of CT. At the district, health

facility and community levels, World Vision will support the promotion of all methods of family planning

and the importance of counseling and testing, including at adolescent health clinics. Finally, World Vision

will promote interpersonal communication and HIV counseling and testing activities aimed at couples.

Using secondary data and baseline Knowledge, Beliefs, Attitudes, Practices (KBAP) surveys, results

where knowledge and communication gaps are wide will be targeted for "doer/non-doer & barrier

analysis" survey to be able to design well-targeted behavior change activities. The project will build on

general community-level prevention outreach through the Community Health Councils (CHCs) and well-

established network of trained Home Visitors (HVs), HBC Activists, peer educators, youth and parent's

advisory groups, parent school committees, and district health associations (DHAs) to strengthen

community HIV prevention and social behavioral change. Training on prevention messaging for

Community Health Volunteers (CHVs) will continue and be oriented to reproductive health, abstinence,

being faithful, and delay of sexual debut. The project will give special attention to the 15-24 age group

(married and unmarried) where most new HIV infections are occurring, and prevent the 10-14 age group

from becoming infected. Men 25 to 40 years old, married and unmarried, will be especially targeted to

reduce new infections. In promoting "B" behaviors, MozARK will build upon positive and strengthen

African norms of sexual fidelity. Community outreach efforts will be reinforced by mass media which will

highlight sexual rights of women and portray negative consequences of age-disparate relationships in

order to change young women's aspirations and motivations to seek these types of relationships.

The project will achieve sustainable shifts to appropriate healthy behaviors at the individual and

community level through a combination of interpersonal communication, targeted training, outreach

education campaigns, and use of various media forums such as local radio. The project seeks to reduce

HIV transmission by encouraging the adoption or continuation of lower-risk sexual behaviors, focusing on

most-at-risk individuals and on changing societal-level norms to support risk reduction. Behaviors

promoted include correct and consistent condom use and partner reduction. Target groups will include

men and women engaged in concurrent partnerships and/or cross-generational relationships, and

populations living or working in districts along major transport corridors including commercial sex workers

and mobile-bridge populations. PLHIV are also a target for the combination prevention campaigns used

in SCIP.

Prevention of Mother to Child Transmission interventions are integrated with USAID funded child survival

(CS) and reproductive health (RH) programs, including family planning (FP), and within primary health care services. This approach will help to increase the uptake of services for HIV+ pregnant women and provide them with comprehensive care. These complementary services are therefore key areas of importance to increase the quality and availability of goods, services, and information, increasing demand for goods and services, and increasing the social infrastructure to support communities. Activities will include emphasis on primary prevention of HIV among women of childbearing age and access to quality FP services as a major strategy to reduce vertical transmission. World Vision will enhance the role of lay counselors in Zambezia to strengthen linkages with and enhance capacity of civil society groups involved in primary prevention. A strategy for male involvement in HIV+ women's RH/Maternal Child Health (MCH) needs will be promoted including couples' counseling and testing, promotion of male involvement in reproductive health decision and childcare, and the promotion of condom use during pregnancy. Furthermore, World Vision will enhance capacity of health workers to identify and counsel on RH needs of HIV-infected pregnant women and couples, including the implementation of provider initiated testing and counseling (PITC) within FP.

Wrap-around activities include improved maternal and child nutrition practices, especially for HIV- exposed infants, as major strategies to improve maternal survival (MS) and CS and reduce vertical transmission. World Vision will integrate the maternal & child nutrition module in PMTCT training and will provide nutrition counseling training to health staff. In addition, World Vision will conduct an assessment, in coordination with the government's district level health workers, on the availability of materials, training and supplies for quality facility-based care for HIV+ pregnant women and their newborns in order to increase district-wide facility-based capacity.