Detailed Mechanism Funding and Narrative

Years of mechanism: 2010 2011 2012 2013 2014

Details for Mechanism ID: 10592
Country/Region: Ethiopia
Year: 2011
Main Partner: Pathfinder International
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $1,200,000

Ensuring programmatic integration within Integrated Family Health Program (IFHP)

The activities in support of PMTCT are conceived as activities that fully integrate within the overall FP and MNCH mandate of the project and that rely on strategies and approaches formulated in the work plan and approved by USAID and MOH. This integration is achieved by considering antenatal care as the overarching service delivery framework and by considering attention to maternal and newborn health, to specific HIV/AIDS prevention in mother and child and to birth spacing or prevention of unwanted pregnancies as essential and non exclusive components of quality and focused antenatal care.

Structuring IFHP teams in support of functional integration

The IFHP organogram reflects the emphasis of the original RFA to merge two existing programs: FP/RH and MNCH. The introduction of HIV/AIDS interventions that go beyond integration of FP in HIV/AIDS prevention and treatment interventions require different IFHP staff to work in novel coordination structures.

Two Deputy Technical Directors will jointly coordinate the planning and implementation of the combined ANC, PMTCT and FP interventions. Their teams consist of the HIV/AIDS Advisor, the RH/FP Advisor, the Maternal Health Advisor, the CH and Nutrition Advisor, the Adolescent Sexual and Reproductive Health Advisor, the Gender and Harmful Traditional Practices Advisor, the Community Mobilization Advisor, the BCC Advisor and the Systems Strengthening Advisor.

At regional level, the relevant officers (HIV/AIDS/ASRH, MNCH and FP/RH Officers) work together under leadership of the Regional Manager. Cluster coordinators and field officers, in collaboration with IPO program officers, will provide day to day technical support to facilities and community level implementation of ANC, PMTCT and FP (training, supervision and follow up of service providers and volunteers; supply of FP commodities and job aids).

Collaboration with PEPFAR partners

The suggested activities of Prong 3 (Prevention of Mother to Child Transmission) will be implemented in collaboration with other PEPFAR partners in the regions.

In regions where HIV Care and Support Porgram (HCSP) is the main partner, IFHP focus will be on support to focused antenatal care and integration of FP with HIV services. In Amhara and Oromia where IFHP continues the Intra Health support, the full range of ANC, PMTCT and FP support is provided. With regard to PMTCT, it includes health center based HIV/AIDS counseling and testing and provision of ARV prophylaxis, follow-up of exposed infants and early infant diagnosis.

During the transition of PMTCT sites from IntraHealth to IFHP, support has been given to filling the gaps in staff training, supportive supervision, review of job aids and other materials. Subsequently, technical assistance will continue through training, system strengthening, and mentorship of the comprehensive PMTCT services by IFHP and the Capacity Project.

Consultant mentors on PMTCT will be deployed every quarter from respective nearby hospitals to the operational health centers in coordination with regional HIV/AIDS program officer, cluster coordinators, and zonal health offices

IFHP will collaborate with partners who ensure availability of commodities and supplies required for the implementation of the program: HCT test kits, ARVs for PMTCT. For contraceptives, IFHP already has a system in place.

The overall IFHP result framework is integrative of PMTCT activities. Below are the key result areas: Result 1: Improve health practices at the household and community level. Activities will refer to PMTCT and other HIV prevention methods. Result 2: Improved availability and quality of services, information and products. Activities will refer to PMTCT and other HIV prevention methods. Result 3: Key elements of health system. Activities will refer to PMTCT and other HIV prevention methods. Result 4: Systematic program learning to inform policy and program investment.

Health related wraparounds: Family planning and reproductive health: Expand access to high-quality voluntary family planning services and information, and reproductive health care. This element contributes to reducing unintended pregnancy and promoting healthy reproductive behaviors of men and women, reducing abortion, and reducing maternal and child mortality and morbidity.

Gender: Addressing gender and issues of harmful traditional practices at policy, community and facility level. Integrating gender concerns into various thematic areas.

Malaria: Support the implementation of the President's Malaria Initiative (PMI) to reduce malaria-related mortality.

Maternal, newborn and child health: Increase the availability and use of proven life-saving interventions that address the major killers of mothers and children and improve their health and nutrition status, including effective maternity care and management of obstetric complications; prevention services including newborn care, routine immunization, polio eradication, safe water and hygiene, and micronutrients; improved maternal, infant and young child feeding; and treatment of life-threatening childhood illnesses.

PMTCT activities which will be implemented in Amhara and Oromia regions. The target population is pregnant women in catchment areas. IFHP will utilize the comprehensive M&E tools developed for other activities and National HMIS system. The M&E tools also address data quality and there is a quality assurance program in place.

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $1,200,000

IFHP will increase its support of facility-based PMTCT interventions from the COP 10, 33 health centers (HCs) in Amhara Region and Oromia Regions to 50 facilities. The program addresses all four PMTCT prongs and emphasizes capacity building of healthcare providers to provide PMTCT services in an integrated manner at predominantly low prevalence sites. FP/SRH, MNCH and PMTCT will be integrated and provided as one service. IFHP, through its strong community networks, will also strengthen focused ANC/infant feeding and establish/strengthen linkages with community services, such as nutrition programs. Community facility linkages as well as support groups like Mother Support Groups (MSG) will promote follow up of mother-infant pairs, access to EID, linkages to postnatal care and male involvement. Linkages through referral to HIV care/support for HIV-positive women and exposed children to pediatric and OVC programs will be taken to scale. At Healtb centers (HCs), ANC group counseling with opt out, rapid testing and same day results will be provided. CT as well in labor and delivery (L&D) and postnatally. The ARV regimen will include single-dose nevirapine (sdNVP) where no other alternatives are possible, AZT from 28wks and 3TC and sdNVP in L&D at these low prevalence sites. IFHP will support GOE to adopt the new WHO guidleines. FP integration into PMTCT will be promoted by IFHP across other implementing partner sites as its area of comparative strength (FP commodities will be supplied by IFHP). FP will be linked to facility-based youth activities. IFHP will promote use of review meetings for HEWs, and other volunteers to provide health workers and other agents with updates on Sexual and reproductive health (SRH), MNCH and PMTCT. This will equip them to influence healthcare seeking behaviors at the household level, resulting in increased referrals to health centers. Training of health care providers on PMTCT, FP/HIV service integration and syndromic management of STIs will be done using the national curriculum as well as ongoing retraining of PMTCT providers to ensure provision of more efficacious ARV regimens. Through integration of FP in HIV care services in 200 health facilities in Amhara, Oromia, SNNP, and Tigray, it is hoped that FP needs of HIV infected women will be addressed reducing the number of unwanted pregnancies. These are sites where ART, HCT, CHBC are part of the service package.

Subpartners Total: $0
Academy for Educational Development: NA
Consortium of Reproductive Health Agencies : NA
John Snow, Inc: NA
Cross Cutting Budget Categories and Known Amounts Total: $750,000
Human Resources for Health $750,000
Key Issues Identified in Mechanism
Addressing male norms and behaviors
Increasing gender equity in HIV/AIDS activities and services
Increasing women's access to income and productive resources
Child Survival Activities
Safe Motherhood
Family Planning