FP/MCH Program

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

Substantive changes were made in the COP 08 narrative and are as follows: This is a wrap around program

and a continuing activity from FY 08. The program activities began in September 2008.

Ethiopia has adopted the four-pronged PMTCT strategy as a key entry point to HIV care for women, men,

and families. The 4-prongs are: primary prevention of HIV infection; prevention of unintended pregnancies

among HIV-positive women; prevention of HIV transmission from infected women to their infants; and

treatment, care, and support of HIV-positive women, their infants, and their families. To support

implementation of this strategy, the new family planning/maternal-child health (FP/MCH) program will aim to

integrate FP and MCH with HIV services.

USAID's Population Program support to the national FP program has contributed greatly to an increase in

the contraceptive prevalence rate (CPR) from 6% to 14% over the past five years. The backbone of the

program consists of over 10,000 community-based reproductive health agents (CBRHA) in rural, semi-

urban, and urban areas. Over the past five years, USAID (through Pathfinder International and its

community network) referred over 1.5 million mothers for different maternal care including antenatal care

(ANC), delivery services, and postnatal care. In addition, through the CBRHA, it was possible to confirm

referrals for 40,000 clients for voluntary counseling and testing services and 70,000 people with suspected

sexually transmitted infections (STI) for diagnosis and treatment. About 75% of the referral sites for

Pathfinder International (health centers and hospitals) are in urban and semi-urban areas, where the HIV

epidemic is concentrated.

In 2004, USAID introduced the integration of FP into VCT sites through training of providers, and provision

of teaching aids and contraceptives. VCT service providers were trained in family planning counseling and

service provision. In addition, through collaborative efforts of partners a training curriculum, participant

manual and service protocol for the integrated service has been developed. Currently FP is integrated into

VCT service in 139 facilities (30 in Tigray, 25 in Oromiya, 42 in Amhara, and 42 in SNNP regions). The

funding source for the trainings was from USAID FP/RH program. Contraceptives made available for the

VCT clients are part of USAID's procurement, which costs, on average, $ 6 million for the whole FP/RH

program area. Integrating FP/RH with existing HIV services will support the national PMTCT strategy's

primary prevention of HIV infection and prevention of unintended pregnancy among HIV-positive women. In

addition, sexually active men, women, couples, and youth attending the different HIV/AIDS related services,

regardless of their sero-status, need to make proper planning for the future through the different FP/RH

information provided at the service sites.

A new five-year program will support FP/RH/child survival services and also cover safe-motherhood and

neonatal health. This program was awarded to Pathfinder International in July 2008 and will have the

support of all three teams with USAID's Office of Health, AIDS, Population and Nutrition, i.e. PEPFAR;

Health, Population and Nutrition and PMI.

The ultimate goal of PMTCT is to improve overall maternal and child survival. PEPFAR will use this award

to employ the social ties and status that CBRHA have in their communities for sensitizing the community at

large about the importance of ANC, skilled attendance at delivery, postnatal care, and PMTCT. They can

identify the pregnant women through targeted house-to-house visits to encourage and refer them for ANC

and postnatal care. They will continue to follow up with the pregnant women for subsequent visits and

referral for delivery within health facilities. CBRHA will also follow up with home visits for postpartum women

and their newborns to address the issue of postnatal drop-out to ensure HIV-exposed infants receive NVP,

immunization, and cotrimoxazole. They will also counsel mothers about exclusive breastfeeding, clean cord

care, insecticide-treated bed nets, and clean water. The CBRHA are also experienced in couples

counseling for family planning and will enhance male involvement in ANC and PMTCT.

This activity will be carried out in selected areas in Oromiya, Amhara, SNNP and Tigray Regions, and Addis

Ababa, where the CBRHA program is within a catchment area for 108 health centers offering PMTCT

services. This activity will support the linking of FP and HIV services in 200 new health centers and will

continue support in the existing 139 facilities already providing integrated FP and HIV services. FP

providers will be trained in counseling and testing for HIV so that they can do pre-counseling and link clients

to VCT services in the same facility. VCT, PMTCT and ART providers will be trained on FP counseling and

basic service provision to ensure that clients have access to voluntary and age-appropriate family planning

options. All clients will be offered family planning services and those interested will be given appropriate

counseling. Clients may be started on short-term methods such as condoms, pills or injectibles, or

lactational amenorrhea method or referred for long-term and permanent methods. Contraceptive

commodities procured with USAID health funding or other donor funding will be made available in health

facilities supported for ART to ensure that HIV-positive women have access to their choice of family

planning methods.

This activity will increase access for all ANC clients to VCT and FP; increase access for all FP clients to

VCT; and increase access for VCT clients and HIV-positive women on ART to FP services. It will do so by:

(1) strengthening the integration of services in the existing 139 sites and expand to 200 more health

facilities providing FP and HIV services; (2) providing FP training for VCT, PMTCT, and ART service

providers using the standardized curriculum for FP counseling and basic service provision; (3) training FP

service providers in voluntary counseling and testing for HIV; and (4) ensuring that FP commodities are

available in the major ART sites through "wrap-around" programming using USG Population and other

donor funding.

The community-based ANC and postnatal care and delivery referral activity will be linked to facility-based

PMTCT activities by IntraHealth, EngenderHealth and other USG partners. It will also be linked to the

USAID FP/MCH and PMI activities, which will use the CBRHA for expanding access to family planning and

Activity Narrative: other reproductive health activities as well as ensuring access to quality malaria case management.

Additionally, focused ANC services will link with malaria and syphilis programs that have a major impact on

pregnancy outcomes.

This activity presents a unique opportunity to build on demonstrated success of linking FP and VCT

services, as well as linking efforts to improve access to PMTCT and improve maternal, newborn and child

survival. It will ensure the availability of FP choices to clients of HIV services and also make VCT available

to FP clients. The focus populations are pregnant women living in urban and semi-urban areas and their

husbands; women accessing VCT centers; PMTCT clients; HIV-positive women on ART for counseling on

FP, and FP clients for counseling and testing for HIV.

This activity will also incorporate Men as Partners (MAP) program in Ethiopia. The program, established in

1996, works with men to promote gender equity and health in their families and communities. The MAP

curriculum will be adapted from two MAP manuals that were developed in Kenya and South Africa - both of

which were PEPFAR funded and have a heavy emphasis on HIV prevention. The four workshop modules

are 1) gender, 2) HIV and AIDS, 3) relationships, and 4) gender-based violence. Each module constantly

examines issues related to HIV prevention, which will encompass an ABC approach. The MAP workshop

reaches participants with 15 hours of interaction on these topics. The objectives of this activity is to provide

tools and technical assistance related to MAP to local partners and to reach communities, especially men

and young boys, with messages about the links between HIV/AIDS, STI, alcohol and ‘khat' chewing, and

gender-based violence. The intervention will primarily target unmarried, out-of-school young men with

multiple partners. This high-risk population is particularly vulnerable to HIV infection/transmission. The MAP

intervention will also target other key beneficiaries including older men, community leaders, parents, and out

-of-school young women.

This activity will attempt to reach 20,000 pregnant women and refer them for ANC, delivery, and PNC

services. The actual number of women counseled for PMTCT, receiving test results and PMTCT services

will be counted and recorded by the USG partners implementing PMTCT at the respective facilities. VCT,

PMTCT, and ART service providers in 200 health centers will be given in-service training on FP counseling

and service. The same facilities will be given in-service training for counseling and testing.

Wrap around with other USAID/E HAPN activities

PMI. Pathfinder International is also being supported by the Presidents Malaria Initiative (PMI) to deliver

quality malaria case management at community level in Oromyia. Building on the partners' previous work at

community level, PMI will support comprehensive supervision of malaria case management at primary and

secondary health facility level as well as work with zonal and district health offices to ensure adequate

epidemic detection and response of malaria epidemic outbreaks. Further linkages of work under this activity

will be done through the MSH/SPS activity (i.e. ensuring effective management of anti-malarial drugs at

health facility level) and Columbia University's laboratory diagnosis strengthening activity (i.e. ensuring the

implementation of quality laboratory diagnosis of malaria at health facility level).

New/Continuing Activity: Continuing Activity

Continuing Activity: 18614

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

18614 18614.08 U.S. Agency for To Be Determined 7604 7604.08 Maternal and

International Child Health

Development Wraparound

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

* Increasing women's legal rights

* Reducing violence and coercion

Health-related Wraparound Programs

* Family Planning

* Malaria (PMI)

* Safe Motherhood

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.01: