Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 7404
Country/Region: eSwatini
Year: 2010
Main Partner: John Snow, Inc
Main Partner Program: NA
Organizational Type: Private Contractor
Funding Agency: USAID
Total Funding: $500,000

Mothers2Mothers (M2M) works to enhance and support PMTCT programs by providing education and psychosocial support to HIV positive pregnant women and new mothers accessing Prevention of Mother to Child Transmission of HIV (PMTCT) services at existing PMTCT public health facilities. Activities are focused on improving the effectiveness of PMTCT in Swaziland and are aligned to the goals, priority thrust and focus on integration and collaboration in the Partnership Framework. A replicable, scalable, sustainable, integrated, cost-effective model of peer-based support is used to address the challenges facing pregnant women and mothers living with HIV. M2M trains and employs HIV positive mothers as educators and care providers; Site Coordinators (SCs) and Mentor Mothers (MMs) who then educate and support pregnant women and new mothers in effectively utilizing PMTCT services.

There are currently 550 M2M support sites operating across seven countries in Africa; South Africa, Swaziland, Lesotho, Malawi, Kenya, Rwanda and Zambia. In Swaziland, site coverage by July 2009 stood at 33 sites spread across all four regions of the country. With PEPFAR funding for FY10, M2M expects to extend to 49 sites by September 2010 and with continued financial support, expand further to 55 sites in the FY 2011.

M2M's goal is to sustain and improve the effectiveness of PMTCT through achievement of the following objectives:

- Expanding the reach of the M2M program and its capacity to increase PMTCT education and psychosocial support services for pregnant women and new mothers;

- Improving uptake of PMTCT services and actions among HIV-positive clients by providing comprehensive education and support from the antenatal to postpartum phase;

- Improving the quality and effectiveness of M2M services by strengthening current program activities and linkages with related PMTCT services.

The M2M program includes the following cross cutting issues:

Human resources for health: Effective task shifting from clinical personnel to M2M staff for the delivery of key PMTCT services is aimed at ensuring optimal utilization of facility and M2M staff in order to ensure that all pregnant women receive the full package of PMTCT care services.

Food and nutrition policy, tools and service delivery: MMs give daily demonstrations to pregnant women and new mothers on how to prepare healthy and nutritious meals for themselves and their families.

Health-Related wraparounds: M2M will enhance and improve its post delivery program to focus on safer infant feeding in order to reduce post-natal transmission. M2M will expand activities to include efforts aimed at educating pregnant women and new mothers about TB diagnosis, care and treatment. All site staff will be trained to use a simple screening tool that will help identify women in need of referrals for diagnosis/care services.

Gender: The M2M model of care will be expanded to focus on engaging male partners by encouraging couples HIV testing and providing education and support for HIV-positive and discordant couples. Education of couples will include the areas of violence against women, family planning, mutual fidelity, safer sex and partner support through treatment and care among other critical issues. MMs provide emotional support aimed at helping women confront violence and reduce their likelihood of becoming targets and victims. Women who come to the program are also given information about income generation projects in their area and are encouraged to participate in such programs. MMs and SCs are economically empowered through the salaries paid to them to assist them in caring for themselves and their families' needs.

A 2-pronged data collection strategy is used to collect facility data and program indicators at each site on a monthly basis. Site-based SCs and MMs collect the data.

Facility data - When planning the opening of new sites, facility data is collected and analyzed to inform site staffing and program needs.

M2M program data - M&E tools (notebooks & logbooks) developed by M2M are used to collect daily and monthly program indicators at each M2M site, including levels and types of daily client interactions in the education and support services provided from antenatal through to postnatal phases.

In order to efficiently and cost effectively manage the increasing number of sites and program activities, M2M has established a site cluster system and this will continue to be implemented. A group of 3-4 sites will form a cluster of sites managed by a single SC instead of a SC at each site. The program is located in public health facilities offering PMTCT which contributes to maintaining manageable infrastructural overhead costs and achieving economies of scale when adding additional sites.

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $500,000

Activity 1: Opening new sites and human capacity development

Baseline studies and detailed assessments will be conducted to decide on new site expansion, in consultation with MOH. Operational and procurement processes will be implemented to prepare for and eventually open the identified new sites.

SCs and MMs for the new sites will be recruited and trained to capacitate them in providing effective education and psychosocial support to pregnant women and new mothers with HIV. The comprehensive training curriculum includes modules on PMTCT and ART, maternal and child health, infant feeding and nutrition, disclosure, reproductive health and safe sex among others. Training ensures that site staff provides HIV positive clients with adequate support to empower them to live healthy lives, prevent transmission of HIV to their babies and nurture them.

Activity 2: Service and Mentoring

M2M SCs and MMs will provide one-on-one and group psychosocial support and education sessions for clients including group pre-test education talks in antenatal care settings; one-on-one education and support; structured group support and education sessions for HIV positive clients and provision of nutritious meals; male partner couples support sessions; referral of pregnant women, new mothers and their infants to relevant service providers for medical care and family support.

Activity 3: Ongoing program quality management

Regional Managers will provide ongoing supervision and support of SCs and MMs including periodic refresher training to ensure provision of up to date information on new protocols and/or guidelines to clients as well as further skill development on support and education techniques to continuously improve the effectiveness of quality services. M2M will implement a quality improvement plan as informed by the 2009/2010 planned M2M quality assessment exercise on program linkages and delivery. A Wellness program will be introduced to provide critical life skills to SCs and MMs to enable them to effectively manage and improve their work and personal lives, including dealing with the associated individual stresses and effects of their work as well as their own lives.

Subpartners Total: $0
Mothers2mothers: NA
Cross Cutting Budget Categories and Known Amounts Total: $126,000
Food and Nutrition: Policy, Tools, and Service Delivery $13,000
Human Resources for Health $113,000
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
Tuberculosis
Family Planning