SUMMARY:

AED will use FY 2008 PEPFAR funding to continue to support integration of maternal nutrition and Infant

and Young Child Feeding (IYCF) in the context of HIV policy into healthcare and community services

through three components: training of healthcare providers and community health workers from all nine

provinces; assistance for implementation of integrated IYCF and PMTCT model in two districts of KwaZulu-

Natal and one district each in North West, Mpumalanga and Eastern Cape; and support to enhance public

awareness of the importance of maternal nutrition and IYCF in PMTCT.

BACKGROUND:

This is an ongoing AED project, initiated in FY 2004 with PEPFAR funding. The first activity was

development of guidelines on nutrition for pregnant and lactating women and IYCF in the context of HIV and

AIDS. AED has been working in collaboration with the South African National Department of Health (NDOH)

nutrition directorate and local NGOs to build health workers' capacity to integrate maternal nutrition and

IYCF into existing healthcare and community services based on these guidelines. This will continue with FY

2008 funding. In addition, AED will continue to support efforts to enhance public awareness of the

importance of improved nutrition for HIV-infected women in general and pregnant and lactating women in

particular, as well as the importance of IYCF counseling as an aspect of PMTCT. Furthermore, AED will

provide technical assistance to the National, Provincial and District Departments of Health and selected

NGOs and FBOs to enhance male involvement to address gender issues in PMTCT. AED will also provide

technical assistance to ensure sustainability through continuing support and monitoring of PMTCT data.

AED will also provide technical assistance to provincial DOH staff to encourage expansion to other sub-

districts in the provinces and promote greater sustainability.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Technical Assistance to NDOH, NGOs and FBOs

Building on the development of Maternal Nutrition Guidelines in collaboration with the NDOH, further

technical assistance will be provided to National, Provincial and District Departments of Health and selected

NGOs and FBOs. This technical assistance will increase Human Capacity Development (HCD) by training

health workers to integrate counseling on maternal nutrition and IYCF in the context of HIV into existing

healthcare and community services. AED will provide technical assistance to the targeted provincial

Departments of Health in the implementation of the guidelines. In addition, following earlier successful

training of lecturers from universities and schools of nursing in the integrated model, AED will provide

technical assistance to develop capacity to include the integrated program into existing professional

development curricula of nurses and dieticians' pre-service orientation. Additional trainers from these

institutions in the nine provinces will be trained at the national level as well as provincial level in Gauteng,

Limpopo, Northern Cape, Western Cape and Free State provinces. Healthcare providers from each of the

five target provinces will be trained to provide direct integrated services to clients in their respective districts.

Policies and guidelines on pregnant and lactating mothers and IYCF in the context of HIV will continue to be

disseminated and implemented. Technical assistance will continue to be provided to Mpumalanga, Eastern

Cape and North West provinces to conduct needs assessments at clinics and community services in three

sub-districts, and will be followed by mentorship and supervision in view of implementing integrated PMTCT

and nutrition for pregnant and lactating women and IYCF into service outlets. Facilities where AED is

currently working will continue to receive support, mentorship and in-service training around issues not fully

addressed during the initial implementation of the program, such as stigma and family planning. Program

managers working with women and children (on integrated management of childhood illnesses, PMTCT,

CT, Maternal, Child and Women's Health, and Health Promotion) will be mobilized on the promotion of the

Baby Friendly Community Initiative in the context of HIV.

ACTIVITY 2: Quality Assurance

Building on the activities of FY 2006 and 2007 in the four sub-districts (Kagisano Molopo, North West;

Qaukeni, Eastern Cape; Umzumbe, KwaZulu-Natal; and Kabokweni, Mpumalanga), AED will support

existing facilities to increase the provision of quality care by supporting the provision of refresher courses for

performance and quality improvement in the integration of nutrition to the basic PMTCT package. AED will

provide technical assistance for the integration of safe-feeding practices in PMTCT into antenatal, labor and

delivery practices, as well as post-natal care. Quality assurance and supervision will be provided using the

trained Baby Friendly Hospital Initiative assessors to conduct internal and external assessments.

ACTIVITY 3: Family-Centered Community Care

Technical assistance will be provided to three sub-districts to implement the "Family-Centered Community

Care" approach, with clear follow-up and referral system for mothers and infants. CBOs, NGOs and FBOs

will contribute to community mobilization. Technical assistance will be provided to health care workers and

community volunteers to address stigma and discrimination, including gender issues. In addition, key

community members, leaders, and religious leaders will be trained to organize behavior change

communication activities on male involvement and people living with HIV in each of the three target

facilities. AED will support development of linkages and referrals to existing services such as family

planning, TB treatment, and care and support for HIV-infected mothers and families. AED will strengthen

linkages between facility interventions and community services for follow-up, couple counseling, family-

based counseling and testing, specifically involving men in PMTCT activities, and will also encourage and

facilitate public-private partnerships.

ACTIVITY 4: Integrated IYCF/PMTCT expansion to Northern Cape

With FY 2007 funding, AED expanded to the Northern Cape Province. FY 2008 funding will be used to

continue activities with FHI and JPHEIGO to harmonize the PMTCT provincial guidelines and monitoring

systems. FY 2008 funding will be used for expansion of the integrated IYCF/PMTCT model in the Western

Cape, Gauteng, Limpopo and Free State provinces.

ACTIVITY 5: Expansion

Activity Narrative:

FY 2008 funds will continue to support the roll-out of and training on the new NDOH PMTCT guidelines with

the integration of maternal nutrition and Infant and Young Child Feeding practices. This will include capacity

development of non-governmental organizations and community health care workers in existing provinces

so they will be able to play a key role in achieving project targets, strengthening referrals and linkages, and

improving monitoring and evaluation to ensure program sustainability within the selected provinces. Funds

also will be used to expand the program by providing onsite support to other service outlets within the

existing districts. In the existing districts, FY 2008 activities will include emphasis/addition of HIV counseling

and testing and ARV prophylaxis in the integrated training on maternal nutrition and IYCF in the context of

PMTCT. This will be based on the national PMTCT guidelines, in line with the National HIV and AIDS

Strategic Plan.

These activities will directly contribute to the seven million infections averted component of the 2-7-10

objective of PEPFAR by training additional health workers on safe infant feeding practices, hence reducing

the risk of transmission via mixed feeding. AED will contribute to the PEPFAR vision outlined in the five-year

strategy for South Africa by expanding access to PMTCT services and by improving PMTCT related

counseling of mothers.