Detailed Mechanism Funding and Narrative

Years of mechanism: 2011 2012 2013 2014 2015

Details for Mechanism ID: 12638
Country/Region: Malawi
Year: 2012
Main Partner: Johns Hopkins University
Main Partner Program: JHPIEGO
Organizational Type: University
Funding Agency: USAID
Total Funding: $2,650,000

The Support for Service Delivery Excellence (SSD-E) project will reach 6.5 million Malawians with Essential Health Package (EHP) services, including PMTCT and other HIV services. SSD-E will implement an integrated service delivery program that will ensure expansion and improved quality of priority EHP services at the community and referral (health centers and district hospitals) levels. All actors in the household-to-facility continuum of care (i.e., women, men, youth, community leaders, HSAs, clinical providers, and district managers)will be empowered to play their part in increasing access, utilization, quality, and demand for health services. SSD-Es strategy will reach the un-reached by tracking individuals along the life cycle to ensure continuity of care, and other strategies such as engaging in catchment area mapping to enlist target households. Specific HIV interventions will include PMTCT, HCT, infection prevention, parent-infant pair follow-up for HIV-positive mothers and/or fathers and exposed infants, nutrition and HIV care support groups.The project activities will be implemented in 11 out of 28 districts and will contribute to the PFIP goals of reducing new HIV infections, improving quality of care and strengthening health systems. The projects M&E will enable effective tracking of project implementation and results. SSD-E will strengthen the capacity of its local partners with the aims of fostering a sustainable HIV response. Some examples of capacity building efforts include clinical skill transfer through mentoring, infrastructure improvement, monthly supportive supervision to health facilities and districts for M&E, and sub-granting to community-based organizations along with technical support on financial management.

Funding for Biomedical Prevention: Injection Safety (HMIN): $100,000

Support for Service Delivery-Excellence (SSD-E) project will support the Ministry of Health to roll out Malawis Essential Health Package (EHP) in 11 of Malawis 28 districts. This includes addressing injection safety and Post-exposure Prophylaxis (PEP) and supportive supervision efforts on injection safety practices to 220 service providers. SSD-E is targeting approximately 20 providers per district to receive injection safety and PEP mentorship. The Government of Malawi will provide essential injection safety commodities and supplies.As an integrated program, these trainings offer an opportunity to build the knowledge and skills of health providers across multiple service points (e.g., PMTCT, HTC, etc.) Injection safety practices in the supported health facilities will benefit from the Performance and Quality Improvement (PQI) program the project will implement. These interventions are expected to result in improved injection safety practices including safe disposal of injection wastes and sharps as well as avoiding needle stick injury.

To build sustainability and country ownership, SSD-E will coordinate its activities with Nurses and Midwives Council of Malawi (NMCM) which is the main provider of injection safety and PEP trainings in Malawi.

Funding for Testing: HIV Testing and Counseling (HVCT): $492,968

HIV testing and counseling is a key HIV prevention tool and an entry point to HIV/AIDS care and treatment services. In order to expand access to HTC, SSD will train and mentor HCWs on HIV counseling and testing. In addition to health facility HTC, the project will implement door-to-door HTC that is integrated with counseling on and provision of family planning commodities. In total, its expected that SSD will facilitate the counseling and testing of 149,400 individuals including pregnant women.SSD will also strengthen provider-initiated testing and counseling in multiple points within the health facility, including immunization clinics, cervical cancer screening programs, STI and post-abortion care clinics.SSD will maximize the benefit of increasing access to HTC by establishing effective referral systems for HIV positive individuals both in health facilities and communities. The program will also promote couples counseling and testing and improve healthcare worker skills in couples counseling.SSD, in collaboration with USG lab partners, will assist District Health Offices (DHOs) and health facilities to establish an External Quality Assurance (EQA) for HIV tests.The project has established a robust monitoring and evaluation system that will enable effective tracking of HTC activities and results including number tested, test result, couples testing, client-initiated/provider-initiated HTC, etc.

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $2,057,032

SSD will support implementation of the national PMTCT program through both facility- and community-based approaches to establish ART/PMTCT mentoring programs in 50% of health facilities in 11 districts and will ascertain the HIV status of 124,500 pregnant women. At the facility level, SSD will assist the Ministry of Health (MOH) and districts to improve access to and quality of PMTCT services by training health workers, supporting integrated clinical mentoring, and improvement of infrastructure. These interventions will aid successful application of Malawis new integrated ART/PMTCT guidelines adopted in July 2011. Through its life-cycle approach, SSD will foster provision of integrated services for HIV positive pregnant and breastfeeding women including FP, MCH, and ART. In order to promote continuous quality improvement in service delivery, SSD will implement Performance and Quality Improvement (PQI) initiatives using its Standards Based Management and Reward (SBM-R) approach. SSD will work with District Health Management Teams (DHMTs) and communities during action planning to identify areas where dilapidated or insufficient infrastructure creates barriers to effective integration and might be remedied through a simple intervention (e.g., modifying a health facility structure through the construction of a wall enclosure that create conditions for counseling to take place with privacy and confidentiality). SSD will establish mother-infant pair (MIP) follow-up programs in the facilities and communities it targets. The MIP follow up will improve adherence to ART, early access to EID and linkage to pediatric care and treatment services. As part of its community MNCH package, SSD will deploy community health workers who will engage the community with the aim of increasing utilization of key health services including HTC, ANC early in pregnancy, and institutional delivery. Its community volunteers will provide door-to-door HIV testing and counseling and link HIV positive individuals with facilities for pre-ART or ART services. The program will champion male involvement in PMTCT and other health needs of the community. Finally, SSD will work with HPSS to strengthen district and health center leadership capacity.

Subpartners Total: $0
CARE International: NA
Plan International: NA
Save the Children: NA
Cross Cutting Budget Categories and Known Amounts Total: $1,350,000
enumerations.Construction/Renovation $150,000
Food and Nutrition: Policy, Tools, and Service Delivery $200,000
Human Resources for Health $1,000,000
Key Issues Identified in Mechanism
Addressing male norms and behaviors
enumerations.Impact/End-of-Program Evaluation
Increasing gender equity in HIV/AIDS activities and services
enumerations.Malaria (PMI)
Child Survival Activities
Safe Motherhood
Family Planning