Detailed Mechanism Funding and Narrative

Years of mechanism: 2010 2011

Details for Mechanism ID: 12213
Country/Region: Tanzania
Year: 2010
Main Partner: Not Available
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $0

Documenting and Addressing Obstacles in PMTCT: Poor ARV Prophylaxis Uptake, Limited Facility Deliveries, and Lack of Integration of PMTCT with MCH Platform - Analysis, Recommendations, Technical Assistance

The Prevention of Mother-to-Child Transmission (PMTCT) program in Tanzania aims to reach pregnant women with quality PMTCT services during antenatal clinic visits and labor and delivery. These services are best provided in the Maternal-Child Health (MCH) platform and in an integrated manner. The specific services include HIV counseling and testing services and, for those found to be HIV positive, ARV and other interventions to prevent mother-to-child HIV-transmission.

The PMTCT program in Tanzania has scaled up, and PEPFAR Tanzania has recorded impressive results in terms of site coverage and women counseled, tested, and received results. However, the coverage of ARV prophylaxis has not been satisfactory. At the same time, the proportion of facility deliveries are below 50%; considerably lower in some remote locations. The program is still struggling to understand and address factors influencing facility delivery and its impact on ARV prophylaxis uptake. Also, while several initiatives to integrate PMTCT with MCH, there is little documentation of successes related to the provision of PMTCT on to the Maternal Child Health platform and its impact on patient outcomes and the district. In the light of the Global Health Initiative, it is important to document and understand the interventions that work best for effective service delivery so that best practices can be understood and shared.

Objectives: The PMTCT program in Tanzania plans to:

1. conduct a study to understand why women fail to access ARV prophylaxis, and why they deliver outside the health facility (precluding prophylaxis for the infant), including identification of barriers to these interventions;

2. document approaches for the provision of PMTCT on the MCH platform and

3. use the information collected in objective 1 and 2 above to target technical assistance needs and interventions that will help increase facility-based deliveries and the uptake of prophylaxis, reduce mother-to-child transmission, increase the sustainability of the PMTCT program, and further the goals of the Global Health Initiative for more comprehensive and integrated programs.

4. Scale up the most effective interventions to achieve increased facility-based deliveries and uptake of prophylaxis for broader scale.

Technical advisors from USAID/Washington, working through an implementing partner (TBD), will provide technical assistance to the Tanzania interagency PMTCT team up to three times a year with the following objectives:

1. Identifying and sharing best practices in PMTCT interventions;

2. Relating the goals of the Global Health Initiative with the ongoing PMTCT programs, documenting opportunities and recommendations;

3. Assisting the country team to address some of the bottlenecks facing ARV uptake in PMTCT, identifying areas for operational research to further improve program quality.

Contributions to system strengthening

The study will build on the previous efforts to identify challenges related to the limited use of facilities for deliveries. Results of the study and documentation will be shared with the Ministry of Health and Social Welfare (MOHSW), as well as implementing partners to inform policy and strategies for effective scale-up of PMTCT services and increased uptake of ARV prophylaxis. The technical assistance will help to identify the most effective service delivery model, which will also have spill over effect of increasing facility-based deliveries and reduce maternal and infant mortality.

Geographic Coverage

The program will be conducted in TBD sites in selected regions on Tanzania mainland. The target population will be HIV+ women receiving PMTCT services at RCH and maternity wards.

Links to Partnership Framework

The study is linked to Goal 1 of the PF: maintenance and scale-up of quality services. Results of this program will help identify obstacles to service and inform strategic scale up of services.

Goal 2 of the PF focuses on prevention, including PMTCT efforts. This program is directly in line with this goal, as it will strengthen PEPFAR Tanzania's current understanding of the barriers and help to target more effective PMTCT interventions.

Goal 6 of the PF aims to ensure evidence-based decision making and strategic planning. The program will inform decision making around the obstacles to deliver PMTCT services especially ARV prophylaxis and delivery services so that more infants can be reach with prophylaxis.

Monitoring and evaluation

PEPFAR Tanzania is working to improve the quality of services and the uptake of prophylaxis by pregnant women. The program will contribute to a better understanding of the most effective deployment of ARV interventions in PMTCT programs, while the technical assistance will inform how to improve measurement of quality of service delivery in PMTCT in Tanzania.

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $0

The Prevention of Mother-to-Child Transmission (PMTCT) program in Tanzania aims to reach pregnant women with quality PMTCT services during antenatal clinic visits and labor and delivery. These services are best provided in the Maternal-Child Health (MCH) platform and in an integrated manner. The specific services include HIV counseling and testing services and, for those found to be HIV positive, ARV and other interventions to prevent mother-to-child HIV-transmission.

The PMTCT program in Tanzania has scaled up, and PEPFAR Tanzania has recorded impressive results in terms of site coverage and women counseled, tested, and received results. However, the coverage of ARV prophylaxis has not been satisfactory. At the same time, the proportion of facility deliveries are below 50%; considerably lower in some remote locations. The program is still struggling to understand and address factors influencing facility delivery and its impact on ARV prophylaxis uptake. Also, while several initiatives to integrate PMTCT with MCH, there is little documentation of successes related to the provision of PMTCT on to the Maternal Child Health platform and its impact on patient outcomes and the district. In the light of the Global Health Initiative, it is important to document and understand the interventions that work best for effective service delivery so that best practices can be understood and shared.

Objectives: The PMTCT program in Tanzania plans to:

1. conduct a study to understand why women fail to access ARV prophylaxis, and why they deliver outside the health facility (precluding prophylaxis for the infant), including identification of barriers to these interventions;

2. document approaches for the provision of PMTCT on the MCH platform and

3. use the information collected in objective 1 and 2 above to target technical assistance needs and interventions that will help increase facility-based deliveries and the uptake of prophylaxis, reduce mother-to-child transmission, increase the sustainability of the PMTCT program, and further the goals of the Global Health Initiative for more comprehensive and integrated programs.

4. Scale up the most effective interventions to achieve increased facility-based deliveries and uptake of prophylaxis for broader scale.

Technical advisors from USAID/Washington, working through an implementing partner (TBD), will provide technical assistance to the Tanzania interagency PMTCT team up to three times a year with the following objectives:

1. Identifying and sharing best practices in PMTCT interventions;

2. Relating the goals of the Global Health Initiative with the ongoing PMTCT programs, documenting opportunities and recommendations;

3. Assisting the country team to address some of the bottlenecks facing ARV uptake in PMTCT, identifying areas for operational research to further improve program quality.