TITLE: Child Support Wrap around -Comprehensive care for OVC Under 5 Support

Mechanism ID # New 034

Although the 2004/5 Demographic Health Survey showed decline in under-five and infant mortality by 24% and 31% respectively to 112 and 68 per 1,000 live births, these rates are still unacceptably high. Most deaths are due to preventable diseases: e.g. malaria, pneumonia, and diarrhea. Other factors contributing to high morbidity and mortality of children are poor quality of health services, poverty, ignorance and low utilization of services. The situation is even more challenging for the under five OVC often in the care of the elderly or in child headed households. According to national MVC data management system, about 11.6% of OVC are aged 0-5 but analysis of service data indicates little is done for them compared to school-age OVC. In the communities, strong referral linkages both to community and facility care are lacking and the under-five OVC are out of the loop in terms of accessing other services.

This (New# 034)'s goal is to provide technical assistance to all OVC service providers partners on how to provide quality and comprehensive care to the under five OVC. The IM is a response to the identified national OVC responses gaps in supporting the under five OVC. It was therefore recommended by GOT and other stakeholders that there is a need of the technical assistance and specific implementation strategies to support the under five OVC activities in order to ensure their needs are well addressed. The IM will support to develop the national under five OVC support strategy and to pilot a model for strengthened comprehensive community care. The emphasis will be on strengthening local GoT entities and the community based OVC care groups on case management, supportive supervision and provision of integrated management of the childhood illness (IMCI) skills to ensure household and community practices that promote child survival, growth, and development.

The pilot will be implemented in two regions: one in the lake zone and the other in a coastal region where there are few facility service outlets. The implementation will be done in collaboration with local government. In the lake zone, this activity will be linked to a proposed USAID health program on malaria diagnosis and fever management in children under five to ensure comprehensive support and functional referral with the facilities. In this region PEPFAR is already supporting a pediatric HIV care and treatment program and critical malaria interventions are being rolled out through the PMI.

Prior to implementation in these regions, there will be a mapping of the nutrition, health and social services provided to HIV+ pregnant/lactating women and OVC aged 0-5 in the community. The exercise will include a situational assessment of the under five OVC, the number and type of partners providing services to this group including food, water and hygiene, and information on infant and young child feeding practices.

Under this (New# 034), groups of 10-15 OVC households will be organized with a literate volunteer as the "Leader Mother" and a community volunteer (1 community volunteer for each 10-household care group). The community volunteer will work in collaboration with the MVCC and the village health workers providing MCH outreach services (i.e. growth monitoring) to build capacity of the Leader Mothers in the weighing of infants and young children, counseling on healthy feeding practices, and promoting community-Integrated Management of childhood Illnesses (C-IMCI) practices (e.g. immunization, Insecticide Treated Nets use, home management of diarrhea). These community volunteers will also monitor linkages between their Care Groups and programs providing sanitation, food security, and other social supports. Monthly Care Group meetings will provide a venue for assessing infant/child growth, nutritional status, and health. Based on these assessments, Leader Mothers will refer families as needed to services, e.g. community-based management of acute malnutrition, HIV testing, PMTCT, pediatric HIV services. The creation of an effective referral system will connect the community to facilities and vice versa.

Strong partnerships will be forged to ensure coordinated care with local government authorities from district to community level through implementing joint planning and reviews and other. At the community level, there will be intensive collaboration with ward committees and existing community-based service providers (e.g. agricultural extension workers, malaria volunteers, village health week volunteers, MVCC lay counselors, home-based care providers, and mother mentors).

The (New# 034) will contribute to one of the goals of the GoT/USG partnership framework wherein the two governments expect to reduce HIV/AIDS morbidity and mortality and improve the quality of life for those affected and infected.

The (New# 034) will be reported under the PEPFAR OVC indicator which is part of the umbrella care group "number of eligible adults and children provided with a minimum of one core care service disaggregated by age and sex" and "the number of eligible clients who received food and/or other nutritional services." The coordination will be done with OVC implementing partners at the selected regions to avoid duplication of reporting. At national level, the data will be reported to the national OVC Data management system. When the model pilot is developed, other indicators to assess the program will be developed and the model will be rolled out nationally.

1. Provide technical assistance to all OVC service providers partners on how to provide quality and comprehensive care to the under five OVC.

2. Support to develop the national under five OVC support strategy and to pilot a model for strengthened comprehensive community care

3. Strengthen local GoT entities and the community based OVC care groups on case management, supportive supervision and provision of integrated management of the childhood illness (IMCI) skills to ensure household and community practices that promote child survival, growth, and development