Detailed Mechanism Funding and Narrative

Years of mechanism: 2010 2011 2012

Details for Mechanism ID: 9990
Country/Region: Zimbabwe
Year: 2011
Main Partner: Elizabeth Glaser Pediatric AIDS Foundation
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $5,918,000

HIV and AIDS are the single biggest determinant of child survival in Zimbabwe and have been responsible for the documented rise in child mortality since the early 1990s . HIV prevention activities are therefore critical for child survival in Zimbabwe.

The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) has supported the Ministry of Health and Child Welfare (MoHCW) to provide access to comprehensive high quality prevention of mother to child transmission (PMTCT) services that are integrated and linked to treatment, care and support of families, including children living with HIV since 2001. EGPAF provides direct support to the national PMTCT program and district and health facility support through the Family AIDS Initiative (FAI) program made up of its three implementing partners, JF Kapnek Charitable Trust (Kapnek), Organization of Public Health interventions and Development (OPHID) and the Zimbabwe AIDS Prevention Project (ZAPP).

The FAI program's strategic objectives are: 1) to advance research that increases access to and uptake of high quality integrated services of prevention, care and treatment for HIV/AIDS in Zimbabwe; 2) to support the expansion and provision of quality PMTCT and care and treatment services for children and their families affected by HIV/AIDS; 3) to advance the Family AIDS Initiative consortium's leadership role in influencing public health policy and serve as a national advocate to seek the eradication of pediatric HIV/AIDS; 4) to enhance the Family AIDS Initiative partnership's capacity to operate in an effective, efficient, accountable and responsive manner.

EGPAF is the largest partner to the national PMTCT program and currently provides direct site support to 724 MOHCW sites in 35 of the 62 districts in Zimbabwe. However, at the end of June 2010 only about 230 sites are implementing more efficacious regimens (MER) for PMTCT that were recommended by the World Health Organization (WHO) in 2006. In the 35 districts, USAID funding will support a three fold approach to strengthen the capacity of the MOHCW to 1) expand PMTCT access 2) Optimize delivery of PMTCT services to increase quality and impact, and 3) strengthen the capacity and commitment to the existing health system to ensure a sustainable and cost effective approach. Roll out and scale up of the revised 2010 WHO guidelines towards virtual elimination of pediatric HIV will be the priority for FAI program interventions.

Although interventions focus on prong 3 and 4 of WHO's four major prongs for provision of comprehensive PMTCT, EGPAF will work collaboratively with other stakeholders and donors (including ZNFPC, Population Services Zimbabwe, MCHIP, Population Services International, the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and UNICEF) to expand a family-centered approach to expanding access to services for women, children, and other affected family members. EGPAF will continue its approach to strengthen existing MOHCW structures.

As the MOHCW progresses toward full adoption of Option A of the WHO revised recommendations for PMTCT, and related recommendations for adult and pediatric treatment, and infant feeding, EGPAF will continue advocating for implementation of the new guidelines. At the national level, technical assistance will be provided for the MOHCW to revise, print, and disseminate the new guidelines for PMTCT and train site level staff to implement these new guidelines. Strengthening the capacity of the National PMTCT Programme, through secondment of eight key staff, including the National PMTCT and Pediatric ART Program Coordinator will continue as a key component of the FAI program.

At district and site level EGPAF will support the MOHCW and district level health management structures to implement the revised guidelines. Through leveraged funding from other donors DFID and CIFF, EGPAF will consolidate and strengthen direct site support through implementation of a district-focused model that provides a temporary counterpart, a District Focal Person (DFP) to strengthen capacity of the District Nursing Officers (DNO) to accelerate implementation of the new guidelines. Also through leveraged funding, EGPAF will ensure strong linkages with community structures particularly working to support revitalization of the VHW program to create demand for PMTCT services and improve follow-up of mother baby pairs.

The program will continue to strengthen the MOHCW's monitoring and evaluation system. Implementation of the new 2010 WHO guidelines will necessitate revisions to some indicators, data collection forms and registers. EGPAF will continue to provide support for these revisions, training and printing and distribution through the FAI partners.

To ensure sustainability, EGPAF works through the existing MoHCW structures to strengthen public sector capacity to implement more effective PMTCT services and EGPAF's approach is also closely aligned with MOHCW priorities. EGPAF and the FAI partners train and support government personnel to implement PMTCT services. The DFP that will be introduced through CIFF funding are "temporary" positions that will be phased out once implementation of the revised 2010 guidelines are well underway. EGPAF will develop a detailed transition plan in consultation with MoHCW before withdrawing support.

Funding for Treatment: Adult Treatment (HTXS): $530,000

Treating HIV positive pregnant women who require ARVs for their own health has been identified as a cost effective strategy to prevent vertical transmission of HIV. Traditionally MoHCW has been providing adult OI/ART services in stand alone OI/ART clinics; HIV positive pregnant women seen in ANC are referred to these clinics with many women failing to complete this referral chain. In FY10, EGPAF initiated support for strengthening ART and MCH integration through support to 20 learning sites and printing of referral registers. USAID support to these 20 sites will continue in FY11 and with lessons learned and leveraged funds from CIFF to expand to an additional 50 high volume PMTCT sites.

Major areas of support will include

Training of midwives in OI/ART initiation in the high volume sites

Strengthening referrals between MCH and ART

Supporting one week clinical mentorship attachments for the trained midwives

Training on use of POC machines

The POC machines for the 50 sites will be supported through leverage funding.

Funding for Care: Pediatric Care and Support (PDCS): $669,000

The new WHO guidelines emphasize strengthened and extended follow up of HIV exposed infants during the postnatal period and throughout the breastfeeding period and early identification and treatment of HIV infected infants. During FY10, EGPAF collaborated with CHAI and MoH to finalize the national EID training materials and to include a practical component in the training. EGPAF will continue to support these activities using PEPFAR and leveraged funding (CIFF, DFID, UNICEF).

Major activities will include

Provide training EID training

Strengthen provision of cotrimoxazole prophylaxis at 6 weeks

Training of health care workers on pediatric OI/ART management

Disseminate the results of the Child Health Card (CHC) evaluation initiated in FY10 to strengthen follow-up of HIV exposed infants

Revise the CHC to accommodate the revised 2010 WHO guidelines

Although FY11 funding will not directly support activities described below,

to ensure follow up of HIV exposed infants lost to follow up EGPAF will strengthen community linkages using the VHW program. Through leveraged funding from CIFF, EGPAF will support "PMTCT champions" (VHWs with intensified training in PMTCT). PMTCT programming in 5 districts and two cities will strengthen linkages with the UNICEF supported National Action Plan for Orphans and Vulnerable Children program that is providing psychosocial support for children in 25 play centers

Funding for Treatment: Pediatric Treatment (PDTX): $920,000

Funding will continue to support the position of a National PMTCT and Pediatric HIV Care coordinator at national level.

Due to the fact that Pediatric HIV care services have significantly lagged behind PMTCT services, using leveraged funds EGPAF will recruit a consultant to develop a comprehensive National pediatric HIV care and treatment strategy.

Health workers trained in adult OI/ART management will also be trained in pediatric OI/ART management so that initiation and follow up of HIV infected infants can take place in MCH.

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $3,799,000

In FY11, EGPAF will expand support to implementation of quality PMTCT services into an additional 175 sites in 8 districts to bring the total number of sites supported to 900 in 43 districts. While EGPAF is currently providing comprehensive PMTCT services at 724 sites, only 230 are currently offering the more efficacious regimens (MER) as per the 2006 WHO guidelines for PMTCT prophylaxis. WHO has since released the revised 2010 recommendations and Zimbabwe has since incorporated these recommendations into its own standard treatment guidelines. Adaption and implementation of these new guidelines will be priority for EGPAF support in this financial year. FY11 funding will support the revision of existing training and IEC materials, printing of these materials and national and provincial training of trainers on the use of these new materials. EGPAF will leverage funding from other donors to build site level capacity required to effectively implement these new guidelines.

Major areas of support include

Support to MoHCW

o Human resources through secondments to the national PMTCT program

o Participation in various technical working groups

o Support coordination bimonthly PMTCT partnership forum (PPF) meetings

o Strengthen the integration of PMTCT with ART and other family health delivery systems including safe motherhood and family planning services

Adaptation of new guidelines

? Review and printing of training and IEC materials

? Revision and printing of M&E tools

Training of trainers for new guidelines

o One national training and 10 provincial level trainings

Site support and supervision

o Data quality assessments

o Quarterly programmatic support visits

o Procure vehicle and hire driver for one of 3 DFP coordinators other partner funding will support the other two coordinators

PMTCT demand creation activities

o Advocacy training

o One day sensitization meetings with key stakeholders TMT, parliamentarians, journalists and community players (CWHG)

Quarterly FAI technical review meetings

Technical exchange visits national, regional

Attendance at regional/international conferences

Subpartners Total: $0
J.F. Kapnek Charitable Trust: NA
Organisation for Public Health Interventions and Development: NA
Zimbabwe AIDS Prevention Project: NA
Cross Cutting Budget Categories and Known Amounts Total: $2,100,000
Food and Nutrition: Policy, Tools, and Service Delivery $300,000
Human Resources for Health $1,800,000
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