Detailed Mechanism Funding and Narrative

Years of mechanism: 2011 2012 2013 2014

Details for Mechanism ID: 12955
Country/Region: Ethiopia
Year: 2011
Main Partner: Johns Hopkins University
Main Partner Program: JHPIEGO
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $1,200,000

MCHIP's work aims to improve the accessibility and quality of Maternal and Newborn Health services in selected woredas in Ethiopia. MCHIP will provide technical assistance at the National, regional and district levels in MNCH and PMTCT.

On the national level, the project will conduct a Desk Review and qualitative study of cultural practices, traditional harmful practices, affecting utilization of health services and optimal health practices with the objective of increasing utilization of skilled birth attendants and facility delivery. MHCIP will provide PMTCT services in keeping with the four PMTCT prongs and will focus on counseling and testing of women and ARV prophylaxis with referral for those needing HAART at 50 Health Centers in COP 11. These centers will be selected based on HIV prevalence and existing need in the region/woreda. The project will also focus on providing TA to RHB and facility staff to institute PQI around obstetric and immediate newborn care in facilities. It will promote a postpartum care culture to include postpartum FP like LAM, IUD insertion and TL. The project will support facilities to ensure that all signal functions of BEmONC are available in health centers, i.e., ensure availability of essential drugs, supplies, and skills required for BEmONC. MCHIP will provide support to Amhara and SNNP regions for pre-service midwifery training.

In the area of newborn care, MCHIP will expand newborn resuscitation within the context of immediate essential newborn care, including linking with resuscitation global development alliance (GDA) to bring in master trainers, institute a quality assurance system through RHB supportive supervision system, and link with UNICEF's procurement of Laerdal devices. It will provide TA and materials to regions to expand and evaluate community Kangaroo Mother Care (KMC) linking with global KMC technical working group. It will also strengthen community based newborn care using the new UNICEF-WHO materials to promote early PNC in selected areas.

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.

Geographic coverage and target population(s)

The MCHIP program will work in Tigray and Amhara. These regions have a low percentage of deliveries attended by a Skilled Birth Attendants. The program will work primarily at the health centers and health posts and surrounding community levels in higher HIV prevalence areas.

A description of the partner/implementing mechanism's cross-cutting programs and key issues. The partner will focus on HRH issues as well as address some nutritional issues as it affects pregnant, lactating women and their infants. Key issues will include Child Survival Activities , Family Planning , Safe Motherhood , Increasing gender equity in HIV/AIDS activities and services and addressing male norms and behaviors

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

This is a new activity in COP11 and will provide an integrated and comprehensive, MNCH/PMTCT service package focused on HIV+ve pregnant and lactating women as well as HIV-exposed infants and young children. Utilizing a network model with basic health posts providing PMTCT services and linked to Health centers "hub sites", 26,658 women will receive PMTCT counseling and testing and receive their results and 532 will receive ARV prophylasix at 50 PMTCT sites.

"Opt out" counseling and testing (C&T), with same day test results, will be provided to all pregnant women presenting for ANC and untested women presenting for labor and delivery. All women will be provided pre-test counseling services on prevention of HIV infection including the risks of MTCT. Partner testing will be offered as part of counseling through referral to on-site HCT centers and at the ANC clinic. Counseling services will include a focus on strategies for negative women to remain negative. A step down training of partner focused counseling techniques will be utilized at all new sites and a prevention for positives package will be implemented in all sites. This will provide an opportunity to interrupt heterosexual transmission, especially in discordant couples. Trainers will train Labor and Delivery staff in the use of HIV rapid tests for women who present for delivery without previously being seen at the hospital for antenatal care.

As a result of these PMTCT HIV counseling and testing activities, an anticipated 532 HIV+ pregnant women will be identified and provided with a complete course of antiretroviral prophylaxis based upon our current program prevalence of slightly over 2%. HIV+ women will have access to facility laboratory services but will have CD4 measurement within the USG network through specimen transport. Staff at these 50 PMTCT sites will be trained in WHO staging. Women requiring HAART for their own health care will be linked to a USG network ARV center. For the anticipated 2/3 of women not requiring HAART, the current national optimized recommended short course ARV option will be provided.

To address barriers to facility-based treatment access, mobile clinic outreaches will be integrated at the community level to bring services to women who otherwise will opt out of care and treatment. HIV+ women will be counseled pre- and post-natally regarding exclusive breast feeding with early weaning or exclusive BMS using the WHO UNICEF curriculum adapted for Ethiopia. JHPIEGO will support the GOE to adopt the new WHO guideline and will change its implementation to reflect whatever options are adopted from the new recommendations.

Subpartners Total: $0
Broad Branch Associates: NA
John Snow, Inc: NA
Johns Hopkins University: NA
ICF International: NA
Program for Appropriate Technology in Health: NA
Population Services International: NA
Save the Children: NA
Cross Cutting Budget Categories and Known Amounts Total: $350,000
Construction/Renovation $100,000
Food and Nutrition: Policy, Tools, and Service Delivery $50,000
Human Resources for Health $200,000
Key Issues Identified in Mechanism
Addressing male norms and behaviors
Increasing gender equity in HIV/AIDS activities and services
Child Survival Activities
Safe Motherhood
Family Planning