Post on 16-Dec-2015
Improving the performance of primary providers in family planning and other reproductive health care around the world
Prevention of Mother-to-Child Transmission of HIV/AIDS in Ethiopia
The Hareg ProjectThe Hareg Project
Improving the performance of primary providers in family planning and other reproductive health care around the world
ETHIOPIAETHIOPIA
USAID
CDC
UNICEF
Ministry of Health
HIV/AIDS Prevention and Control Office (HAPCO)
Regional Health Bureaus
Regional HAPCO
Regional Teams
Hareg Project Partners Hareg Project Partners
Implementing agencies:
PRIME II (IntraHealth, Save and ACNM)
JHPIEGO
JHU/CCP
Save the Children/US
LINKAGES
UNICEF
MSH/RPM+
I-TECH
Improving the performance of primary providers in family planning and other reproductive health care around the world
ETHIOPIAETHIOPIA
Total population 70.7 million
Living with HIV/AIDS 3 million Adults 15-49 2 millionChildren 230,000
Overall prevalence6.6%Urban 13.7%Rural 3.7%
AIDS orphans 1.2 million
Life expectancy Fallen to 45 years
Hospital beds >50% to AIDS patients
HIV/AIDS Overwhelming Ethiopia HIV/AIDS Overwhelming Ethiopia
Improving the performance of primary providers in family planning and other reproductive health care around the world
ETHIOPIAETHIOPIA
91% of infections in adults 15-49 years
21.1% prevalence in women 15-24 years
As high as 25% prevalence among pregnant women in urban areas
6.425%
6.425 - 9.7%
9.7 - 12.433%
12.43 - 15.6%
15.6 - 17.275%
HIV Prevalence in Pregnant Women in Ethiopia
Data adapted June 11, 2003 from AIDS in Ethiopia 2000, an Ethiopia MOH publication
HIV/AIDS Infection in Ethiopia HIV/AIDS Infection in Ethiopia
0 5% 10% 15% 20% 25%
Gondar
Jimma
Nazereth
Jijiga
Bahir Dar
Dire Dawa
Addis
B/Gumez
Mekele
Pregnant Women HIV PositiveSentinel Site Prevalence
170,000 HIV+ women give birth each year
60,000 of their newborns infected through MTCT
Improving the performance of primary providers in family planning and other reproductive health care around the world
ETHIOPIAETHIOPIA
PMTCT BarriersPMTCT Barriers
Antenatal Care
Urban Rural
Birth Place
67%Skilled1%
TBA
32%None
22% Skilled
.5% TBA77%None
32%Health facility
68%Home
2% Health facility
98% Home
Urban Rural
Improving the performance of primary providers in family planning and other reproductive health care around the world
ETHIOPIAETHIOPIA
Preventing MTCTPreventing MTCT
Care and support for HIV+ (infected or affected)Care and support for HIV+ (infected or affected)
Prevent infection in parents-to-be
Prevent infection in parents-to-be
Prevent unwanted pregnancies in HIV+ women
Prevent unwanted pregnancies in HIV+ women
Preventtransmission from HIV+ mothers to their infants
Preventtransmission from HIV+ mothers to their infants
Improving the performance of primary providers in family planning and other reproductive health care around the world
ETHIOPIAETHIOPIA
8 regions
12 primary focus areas
First year pilot sites
Roll out plan
4 additional regions
Include more health centers
Scope based on research in Nigat
Hareg Project ScopeHareg Project Scope
Improving the performance of primary providers in family planning and other reproductive health care around the world
ETHIOPIAETHIOPIAProject SiteFemale Population Age 14–45
Adama 42,921
Addis Ababa 325,450
Assosa 29,722
Axum 4,768
Bahr Dar 28,283
Dire Dawa 28,485
Gondar 19,474
Harari 20,240
Jimma 294,198
Jijiga 35,888
Hareg Project PotentialHareg Project Potential
Improving the performance of primary providers in family planning and other reproductive health care around the world
ETHIOPIAETHIOPIA
Baseline AssessmentBaseline Assessment
Topics
Service delivery
Site audit
Staffing/personnel
Provider performance
VCT
Client perspective
Facility mapping
Family planning
TB referral
Tools
Site audit
Provider interview
Client interview
Provider observation
Client flow
Focus groups
Community mapping
PRA
Improving the performance of primary providers in family planning and other reproductive health care around the world
ETHIOPIAETHIOPIA
Key StrategiesKey Strategies
Community based
Partnerships developed with systems and service delivery
Platform created to expand care, treatment and support for HIV/AIDS patients
Improving the performance of primary providers in family planning and other reproductive health care around the world
ETHIOPIAETHIOPIACommunity / Health Post
Sites of Service Delivery to Stop MTCTSites of Service Delivery to Stop MTCT
Health Center
District
Regional Center
Central Center
Improving the performance of primary providers in family planning and other reproductive health care around the world
ETHIOPIAETHIOPIAEthiopian National Framework
Community Mobilization
RMC RMC RMC
Central Medical Centers
Teams Working TogetherTeams Working Together
Improving the performance of primary providers in family planning and other reproductive health care around the world
ETHIOPIAETHIOPIA
Teams Working TogetherTeams Working TogetherDiscussion and consensus buildingFinding solutions
Improving the performance of primary providers in family planning and other reproductive health care around the world
ETHIOPIAETHIOPIA
Hareg Major AccomplishmentsHareg Major Accomplishments
2003
September • Hareg Project launch
• Baseline assessment completed
October • Axios application accepted
November • Regional network formation
• 7 workshops, 140 participants• 7 signed MOUs among regional teams
• Solutions for clientflow for all 10 hospitals and 10 health centers
• Overall coordination of activities
Improving the performance of primary providers in family planning and other reproductive health care around the world
ETHIOPIAETHIOPIA
Key Progress from existing sitesKey Progress from existing sites
126 health workers newly trained or retrained in PMTCT
80% pregnant women with at least one ANC visit who consented to HIV test, received test, results, and post-test counseling (Nigat)
50% HIV+ pregnant women received complete course of ARV prophylaxis to reduce risk of MTCT
Improving the performance of primary providers in family planning and other reproductive health care around the world
ETHIOPIAETHIOPIA
Nevirapine administration in 6 new regions by late January 2004
Focus areas:
1. Supply system strengthening
2. Regional follow-up
3. PMTCT site readiness plan
4. Joint monitoring and evaluation
5. Community readiness
6. Policy dialogue
Short-Term TargetShort-Term Target
Improving the performance of primary providers in family planning and other reproductive health care around the world
ETHIOPIAETHIOPIA
Long-Term TargetLong-Term Target
National PMTCT coverage
Impact Indicator
Number of HIV infections averted by ARV prophylaxis
Improving the performance of primary providers in family planning and other reproductive health care around the world
ETHIOPIAETHIOPIA
ChallengesChallenges
Opt in/Opt out Infant feeding Home-based delivery NVP within 72 hours Confidentiality Stigma Competing demands with one of world’s
highest MMRs Safe motherhood/PMTCT integration Universal precautions
Improving the performance of primary providers in family planning and other reproductive health care around the world
ETHIOPIAETHIOPIA
Goals for September 2004Goals for September 2004
PMTCT initiation and expansion
PMTCT service delivery for 23 new sites and strengthening of 4 existing sites
Improved links between facilities and communities
System strengthening for service delivery
Sound HMIS system that generates data for monitoring and scale-up