Detailed Mechanism Funding and Narrative

Years of mechanism: 2010 2011 2012 2013 2014

Details for Mechanism ID: 10546
Country/Region: Ethiopia
Year: 2011
Main Partner: IntraHealth International, Inc.
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $5,656,666

The goals of the program are to build the capacity of regional health bureaus, zonal and woreda health offices and Community Based Organizations (CBO), and to support and manage community-based PMTCT services. The specific objectives are to:

1) Increase access to Maternal and Child Health and Prevention of Mother to Child Transmission (MCH/PMTCT) services through providing facility and community services; 2) Improve bi-directional linkages/referrals between PMTCT/MCH services at the community, health post, and health center and hospital level; 3) Increase demand for MCH/PMTCT services through community outreach; and 4) Improve the quality of community and facility -based MCH/PMTCT services

Geographic coverage and target population(s)

The Community PMTCT program will work in Tigray, Amhara, Oromia, SNNPR and Addis Ababa. These five regions have a total of 654 health centers and 4,735 health posts all together. These regions are considered high yield as they accounted for about 91% of nationally expected pregnancies in 2010. These regions also have a low percentage of deliveries attended by a Skilled Birth Attendants. The program will work primarily at the health post and surrounding community levels in higher HIV prevalence areas. The program will also work at selected health centers.

A description of the partner/implementing mechanism's cross-cutting programs and key issues:

The partner will work on the four PMTCT prongsand will also focus on: 1) male involvement and gender, 2) HIV-related palliative care for women and children, counseling on infant feeding, 3) Basic and emmergency obstetrics care and neonatal and child health care servies; 4) training or capacity building, 5) PMTCT program monitoring, evaluation and quality assurance, system strengthening, integration & referrals. The Program will support the full integration of PMTCT and MCH service provision and ensure linkages to HIV care and treatment services, especially between pediatrics and PMTCT services. Priority will be given to follow-up the mother and infant in the community and linking to health and social services.

Other key issues to be addressed by the partner are: testing and Counseling for women in the reproductive age in general and pregnant women and HIV exposed infants in particular, ARV Prophylaxis & referral for highly Active Antiretroviral Therapy for eligible HIV positive pregnant women and their babies. This program will introduce a mechanism for effectively linking health facilities and community services, including confidential community registers for HIV+ mothers and exposed babies with regular updating of both registers to capture every mother baby pair. Innovative outreach sessions can also positively impact community PMTCT coverage and should be considered a strategy for addressing the current demand challenge.

Cost efficient strategy will include achieving improved economies in procurement, coordinating service delivery with other partners in the public and private sector, and expanding coverage of programs with low marginal costs.

Monitoring & Evaluation plans for included activities:The partner will have plans to document, monitor and evaluate program performance. The USG in Ethiopia will evaluate progress by monitoring selected indicators and assessing these in relation to the targets and overall objectives set by program staff. Data quality is a critical component of this program and the program will develop systems to ensure data quality and be prepared for data quality audits.

a. Work plan, Exit Strategy and Performance Monitoring Plan (PMP): The partner will have exit strategy documenting steps that it will take to strengthen host country ability to sustain the deliverables of the services that it agreed to render. The initial work plan will include a proposed PMP for the entire period of performance including the process for collecting baseline data.

Funding for Care: Pediatric Care and Support (PDCS): $256,666

The community based prevention of mother to child transmission (CPMTCT) program will promote comprehensive pediatric HIV/AIDS care and support (CPCS) activities. A key activity will be training for health workers on integrated management of neonatal and childhood illnesses (IMNCI) and chronic HIV/AIDS follow-up care using standard manuals. Other training will include decentralized one day training for maternal and child health (MCH) entry-unit health providers on case detection and referral, and a two-day training for the respective HEW/volunteers on active case detection and referral, adherence to treatment, and defaulter tracing. Reinforcement of skills and knowledge learned will be provided to each trained health worker post-training, to ensure that the quality of service delivery conforms to established standards.

The practice of monthly meetings of referring units, particularly the health centers, the woredas, and the community (HEW/volunteers), which are well established in some areas, will be strengthened in many places to improve coordination between all levels of care. CPMTCT program will continue to collaborate with the US universities to link HIV exposed children 0-18 months for dried blood spot analyses, and HIV positive children above 18 months to 14 years for CD4 counts and ART initiation. The program will work with orphans and other vulnerable children projects to link clinically malnourished infants to nutritional support and other community services. CPMTCT will also work with Integerated Family Health Program (IFHP)d to identify chronically ill, malnourished, and/or HIV-exposed infants and children in order to refer them for testing and appropriate treatment.

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $5,400,000

The Community PMTCT (CPMTCT) program will work in Amhara, Tigray, Oromia, SNNPR and Addis Ababa to provide integrated PMTCT/MCH services. It will support health posts, over 200 health centers and implement community PMTCT services, including outreaches, in partnership with RHBs, with a focus on increasing uptake of services. The program will engage UHEWs, HEWs and other volunteers to sensitize and mobilize communities to create demand and provide access to quality ANC/PMTCT services at health facilities.

The CPMTCT program will ensure that point of service 'opt out' CT is offered to all women in ANC, labor and delivery (L&D), and postnatally in FP units, encourage male involvement through community gatekeepers and use, where available, lay counselors to avoid counselors burnout. The program will ensure that ARV drugs are offered to HIV-positive women, prioritizing identification of women needing highly active antiretroviral treatment (HAART) for their own health. HIV-positive women will be linked to HAART if indicated as well as FP, food and nutrition services. Women who test negative will be counseled to stay negative. MSG and volunteers will track and support mother-infant pairs and link family members to care/support, pediatric treatment, and access to EID and OVC programs. The program will ensure continuum of care through functional referral linkages between hospitals, health centers, and health posts/community services. It will utilize lessons learned and provide single-dose nevirapine (sdNVP) if a woman is identified in L&D and at first contact to ensure that women who deliver outside health facilities have sdNVP. Otherwise more viable regimen will be used. CPMTCT will support the GOE to adopt the new WHO guidelines. Care and treatment will be provided to qualifying mothers and exposed infants including Cotrimoxazole provision from six weeks until definitive diagnosis.

At the national level, the program will participate in the PMTCT TWG and strengthen GOE capacity in quality assurance, supportive supervision and monitoring. The CPMTCT program will advocate and facilitate revisions of key policy issues, such as integrating mother and child health cards, and support regional, zonal and woreda health bureaus in the areas of capacity building, system strengthening, and improved use of strategic information for decision making, among others.The partner embarked in to full implementation only in the third quartar of FY2010. However, because of shortage of RTKs, delay in the UHEWs training and deployment, added with remoteness of some of the health centers, the partner performed low for PEPFAR indicators than was expected. Because of this the team decided to cut the COP budget by about two million from what it was last year.

Subpartners Total: $0
International Orthodox Christian Charities: NA
Program for Appropriate Technology in Health: NA
Pathfinder International: NA
Cross Cutting Budget Categories and Known Amounts Total: $500,000
Human Resources for Health $500,000
Key Issues Identified in Mechanism
Increasing gender equity in HIV/AIDS activities and services
Increasing women's legal rights and protection
Child Survival Activities
Safe Motherhood
Family Planning