MCHIP is the lead national policy advisor for the MOH an integrated comprehensive MNCH/RH package of services. MCHIP will support the MOH to address policies, guidelines and training health care workers in all aspects of an integrated MNCH/PMTCT, which ensures continuity with pediatric and adult HIV care and treatment packages. In addition, they will provide technical assistance to the MOH to print MNCH and PMTCT data recording tools, data reporting forms, and IEC materials. MCHIP project was awarded in April 2011 and not a part of expenditure analysis. MCHIP will participate in the next phase of the expenditure analysis. MCHIP will be concentrating its technical capacity support at the central level but to provincial level capacity to support district level implementation of best practices across the continuum of care. Due to the initial start date of April 2011, only $1,005,000 is being requested for FY 2012 to initiate new activities that were not previously covered in FY 2011. These additional funds in FY 2012 will be used to provide a dedicated short-term personnel support to the MOH to ensure the planning, coordination and timely execution of task-shifting of ART initiation by nurses and support the procurement of cervical cancer commodities. Purchased/leased under this mechanism from the start of the mechanism through COP11-9New requests in COP12-2 Total planned/purchased/leased vehicles for the life of this mechanisms-11 This is one per province. They are used for supervisory visits to health facilities and communities, as well as for transport of materials. Sub-contractor-10 motorcycles in 2012 for use for supervision of community work.

JHPIEGO/MCHIP will support the expansion of cervical cancer activities in the implementaion of the MOH's Action Plan to Strengthen and Scale-up Cevical Cancer Prevention and Control Services". On behalf of the MoH, JHPIEGO/MCHIP will train health facilities in the use of the single visit approach (SVA); providing technical assistance using a reasonably and accurate test to identify those in need to provide safe and effective treatment. The expansion of this training will include the purchasing of equipment and materials. JHPIEGO will support the MOH MCHIP to introduce a supervisory and learning system in real time, using electronic equipment to control the quality of services provided . From the peripheral level to the referral level.

Priorities in FY 2013 focus on USG coordination with the MOH at all levels for scale up of PMTCT services within an integrated MNCH system, support the implementation of option B+,strengthen all four prongs of PMTCT . National level TA to the MOH for policy development and dissemination will be critical for increasing access to PMTCT services. JHPIEGO/MCHIPs supports the MOH through district and provincial level in the model maternities, technical assistance, training, quality improvement, and support to M&E systems. Expanding capacity to deliver PMTCT interventions in MNCH settings, with high levels of service utilization by women, children, and families, will be critical for scaling up PMTCT. Funding in FY 2013 will specifically be used to provide support tothe MOH to ensure the planning, coordination and timely execution of option B+.

JHPIEGO/MCHIP will support policy and strategy development; health information system strengthening; human resources development through training, especially with the new Integrated Package of Services, and strengthening the quality improvement regime. will support adequateuse of the longitudinal MCH and PMTCT data recording tools, data reporting forms and systems, and support data analysis and use at the central. These national level efforts will be complemented by additional resources at the provincial level, including the placement of technical MCH nurses at the provincial level to strengthen HIV-related M&E systems including PMTCT using MCH funding. JHPIEGO/MCHIP will support the MoH to develop and use quality measures to improve routine, periodic, and accurate feedback to health care providers to identify challenges and acknowledge successes on data flow.

In FY13 PEPFAR will revitalize secondment of a MCH/PMTCT M&E technical specialist for improving national PMTCT data flow and quality which was established based on a joint USG and MOH Terms of Reference for M&E support. Continue to support MCH M&E support by leveraging MCH resources for a MCH/Reproductive M&E specialist to be seconded to the MOH Public Health Department, with focus on reproductive health section activities. Electronic patient tracking systems with mother-child pairs will be explored in higher level facilities, with attention to tracing exposed children at community level. For more peripheral facilities, simpler, paper based system will be put into place and linkages with organizations working at community level will be established to ensure active follow up of defaulter children.

JHPIEGO/MCHIP, in partnership with clinical partners, will work to improve linkages and referral between HIV longitudinal care and routine MCH/PMTCT and family planning services. This activity will ensure training for the implementation of positive prevention and support the establishment of HTC within family planning services, to prevent unintended pregnancies and future children from becoming HIV-infected or orphaned and improve counseling in family planning to assist HIV infected women who want to be pregnant in receiving accurate information about their family planning options and how to prevent vertical transmission. Through in-service training, this activity will reinforce the practice of retesting among pregnant women to assist with identification of incident cases during pregnancy and delivery of PMTCT services.

MCHIP will support the establishment of a epidemiological surveillance System for the screening and diagnosis and monitoring of birth defects. The Determination of the additional risk due to the use of EFV or other ARVS cannot be established without prospectively follow a large number of pregnancies, with and without the exposure of interest. To achieve this, MCHIP will support 3 Hospitals to establish a pregnancy registration system. In coordination with other efforts from treatment group will support the establishment and implementation of a pharmacovigilance System in ANC services , to support and encourage registration of drugs side effects in pregnant women, encourage standard procedures for ARV toxicity monitoring , as part of an effort to detect any sign of increased toxicity or birth defects related to ARVs. MCHIP will provide TOT to Implementing patners on: PMTCT and MCH/FP integration including Community package. This activity will be critical to ensuring delivery of critical MNCH services (appropriate diagnosis and treatment of complications in pregnancy (mother-baby pair follow-up) including ARV complications in pregnancy. Reinforce community engagement on PMTCT to strengthen all four prongs of PMTCT This is part of the integrated package of services,.

It will also be critical to ensuring specific activities under PMTCT and MCH, namely

CHTC - offering special services for couples.

Mother to Mother strategy including engaging community leaders to actively involving partners in HIV prevention efforts, including linkages between HF services and ANC

Strengthen Antenatal services and reduce lost follow-up, ensuring at least 4 visits during pregnancy, reduce lost follow up post partum.

Training on Quality improvement SBMR( MNCH/FP/PMTCT/) which is an integrated approach for HIVand MCH.