Mobilising Communities to Eliminate Congenital Syphilis and … · Mobilising Communities to...
Transcript of Mobilising Communities to Eliminate Congenital Syphilis and … · Mobilising Communities to...
Mobilising Communities to Eliminate Congenital Syphilis and Strengthen
Antenatal CareLori Newman - RHR
Annie Portela - MPS
Nathalie Broutet - RHR
Global Health Histories Seminar
Geneva
April 27, 2011
Overview
• WHO framework to empower individuals, families, and communities (IFC) for maternal and newborn health (MNH)– Example of implementation
• How we are applying community mobilization principles to elimination of congenital syphilis– Examples of implementation
•2003 concept paper based on a review of programme experiences
• Objectives
• To contribute to the empowerment of individuals, families and communities to increase control over and improve MNH
• To increase access and utilization of quality services
WHO framework to empower individuals, families, and communities for MNH
Available at: http://whqlibdoc.who.int/hq/2010/WHO_MPS_09.04_eng.pdf
WHO framework to empower individuals, families, and communities for MNH
•Build healthy public policy•Create supportive environments•Strengthen community action•Develop personal skills•Reorient health services
Health Promotion
Main Points1. Important interventions integrated into MNH strategies can build
capacity of women, families and communities to better care for themselves and increase access and use of services
2. To achieve people-centred care and address broader determinants, need participatory approach with other health programmes, local authorities, women, and communities
3. Service delivery team and the community need certain competencies to do this
4. Need to evaluate contribution of interventions and participatory approach and document processes and lessons learned
5. WHO and others have developed tools and guides, but there are gaps
1. Priority areas for interventionsDeveloping CAPACITIES
to stay healthy, make healthy decisions,
and respond to emergencies
Increasing AWARENESS
of the rights, needs and potential
problems
Strengthening LINKAGES
for social support and within the health system
Improving QUALITY
of care, health services, and interactions
o Self-care/care in the household
o Care-seeking behaviour
o Birth and emergency preparedness
o Human and reproductive rights
o Role of men and other influentials
o Community involvement in surveillance and maternal- perinatal death audits
o Community financing and transport schemes
o Maternity waiting homes
o Roles of traditional birth attendants within the health delivery system
o Community involvement in the quality of care
o Companion of choice during childbirth
o Interpersonal and intercultural competencies of health-care providers
2. Process of implementation
Province and National Levels:
Phase 3:
Joint planning process
Phase 1:
IFC Preparation
Phase 2:
Participatory Community Assessment
(PCA)
Phase 4:
Participatory implementation
Phase 5:
Participatory evaluation
Awareness-raising Skills-building Resource Mobilization
Local Level:
Initial activities
Ongoingactivities
Scale-up activities
3. Building competencies
• Strengthen skills and attitudes– Within the health services– Within the community
• Resource person• Skilled birth attendant
– Interpersonal and intercultural skills– Community mobilization– Advocacy
• Community– Self care– Care seeking behaviour– Birth and emergency preparedness
4. Monitoring and evaluation of interventions and participatory approach
9
• Has it contributed to improvements in MNH outcomes?• Has change occurred?
• Favorable public policy for MNH• Improved coordination between levels• Community and intersectoral participation• Strengthened human resources for health
• Have priority areas of action been implemented?• Developed CAPACITIES• Increased AWARENESS• Strengthened LINKAGES• Improved QUALITY
5. WHO tools and supporting materials
• IFC Framework• IFC Implementation Tool Kit
– Start-up – Orientation Package for Health
Programme Managers– Participatory Assessment Tool
and Training Guide – Guide to Develop Final Plan,
including M&E• Handbook for Counselling and
Communication in MNH• Pregnancy, Childbirth,
Postpartum, and Newborn Care
• Standards of Care• Midwifery Education Modules• WHO Recommended Interventions
for MNH• Community-based Strategies for
Breastfeeding Promotion• Community-based Distribution of
Contraceptives
5. Existing gaps
• Tools to strengthen community capacity for participation
• Strengthen evidence base of the individual interventions (in progress)
• More & better documentation of country experiences (in progress)
The El Salvador experience
El Salvador sought to reduce maternal and neonatal mortality through
• Empowering women, their partners, families and communities to improve monitoring and self-care of their health
• Strengthening links between community actors and health service providers
• Raising awareness on the needs and rights of pregnant women
• Increasing the demand for and quality of health services
What did they achieve?• Increased number of women
attending ANC from 78% to 93%• Increased institutional births from
84% to 90%• Communities voice criticisms and
demand better health care • Health units have dedicated space
for maternal health: better quality of care for pregnant women and reduced waiting times
• Specialized personnel in rural areas: gynecologists available for 4 hours, three days a week
• Scaled up 60 municipalities and national policy on social participation
How are we applying these principles to elimination of
congenital syphilis?
Logo for Mongolia's Rapid Syphilis Testing Initiative
– Approximately 2 million pregnant women infected with syphilis per year
– Over 80% of infected women unidentified, untreated, or treated after 1st trimester
– 69% of infected pregnant women will have an adverse outcome of pregnancy (congenital syphilis)
• 25% stillbirths• 11% neonatal deaths• 13% preterm or low birth-weight infants• 20% infants with clinical infection*
Congenital syphilis is common and severe
Need to increase IFC awareness of adverse outcomes of syphilis
in pregnancy!
*Source: Kamb et al, Obstetrics and Gynecology International, 2010.
Syphilis seropositivity among women attending ANC reported for 2008 & 2009
Madagascar 7.70%
Chad 7.30%
Mozambique 6.93%
Ghana 6.15%
CAR 5.88%
PNG 5.78%
Kiribati 5.61%
Grenada 5.25%
Fiji 5.15%
Zambia 5.10%
*Source: HIV Universal Access reporting data, WHO.
Congenital syphilis is preventable and treatable
Congenital syphilis is preventable and treatable
– Inexpensive test less than US $1.00• Traditional tests require laboratory• Rapid tests do not require laboratory
– Treatment• Widely available• Penicillin (one dose) = US $0.50
– Screening all pregnant women is cost- effective even in low-prevalence settings
– Treatment given early in pregnancy is more likely to avoid bad outcomes – should test at first ANC visit!
*Source: The global elimination of congenital syphilis: rationale and strategy. WHO, 2007.
Reported proportion of ANC attendees tested for syphilis in African countries in 2008*
0%10%20%30%40%50%60%70%80%90%
100%
Guinea
-Biss
auBuru
ndi
Ethiopia
MaliMad
agasc
arZim
babwe
Guinea
United
Rep
ublic
of Tan
zania
Centra
l Afric
an R
epub
licMoz
ambiq
ueRwan
daCôte
d'Ivo
ireCom
oros
Sao To
me and
Prin
cipe
Namibi
aCap
e Verd
eGab
onSey
chell
es
*Source: WHO, HIV Universal Access reporting system, unpublished data, 2009.
Why does CS persist despite an effective intervention?
Stillbirths: what difference can we make and at what cost?*
"Screening pregnant women for syphilis and treating them — recommended almost everywhere, but overlooked in many places —
would prevent 136,000 stillbirths. "The Washington Post, Wed, April 13, 2011
*Bhutta, Yakoob, Lawn Rizvi, Friberg, Weissman, Buchmann, Goldenberg, for The Lancet Stillbirths Series steering committee. The Lancet, April 13, 2011.
WHO Global Elimination of Congenital Syphilis Initiative
• Objective– To eliminate congenital syphilis (ECS) as a public health problem
• Targets by 2015– Screen >90% of first ANC attendees for syphilis– Treat >90% of syphilis-seropositive ANC attendees
• The four pillars of ECS
Available at: http://whqlibdoc.who.int/publications/2007/9789241595858_eng.pdf
I. Ensure sustained political commitment and advocacy
Example: raise awareness of adverse outcomes of syphilis
in pregnancy
II. Increase access to, and quality of, maternal and newborn health services
Example: strengthen linkages with PMTCT of HIV
to improve MCH services
III. Screen all pregnant women and treat all positives
Example: improve quality of antenatal care
IV. Surveillance, monitoring and evaluation systems
Example: develop capacity of traditional and skilled birth attendants to report stillbirths and CS
Congenital Syphilis Elimination helps to reach goals
Millennium Development Goals– 3: Building capacity for self-care empowers women– 4: Prevention of congenital syphilis reduces neonatal
mortality– 5: Early antenatal care and fewer spontaneous
abortions and stillbirths improve maternal health– 6: Women with syphilis are at greater risk of acquiring
and transmitting HIV
Secretary General's Global Strategy for Women's and Children's Health
– Ensure universal access for women and children to a comprehensive, integrated package of essential interventions and services
Congenital Syphilis Elimination
ECS
HIV (PMTCT)Reproductive
Health
MNCH
Demonstrates the importance of linkages
STI
A generation free of HIV and syphilis?
Conceptual Framework for the Elimination of
Pediatric HIV and Congenital Syphilis in the Asia Pacific, 2011-
2015
USG Global Health
Initiative
Building capacity and awareness
Men in Brazil
Partners in Argentina
October 16, 2011Communities in Mongolia
Source: Mongolia, Brazil, and Argentina ministries of health.
Improving the quality of antenatal care in Peru
*RST = Rapid Syphilis TestSource: Patty Garcia, Universidade Caeyetana Heredia, Lima, Peru.
*
Strengthening linkages: the Cambodia Linked Response
Source: National Centre for HIV/AIDS Dermatology and STD (NCHADS), Ministry of Health Cambodia
Evaluating the Cambodia Linked Response
Kirivong and Prey Veng Districts
-Syphilis screening integrated in early 2009-Increased HIV and syphilis testing coverage-Increased ANC 1st visit, delivery, and family planning coverage
Source: National Centre for HIV/AIDS Dermatology and STD (NCHADS), Ministry of Health Cambodia andDelvaux T et al. Linked Response for prevention, care, and treatment of HIV/AIDS, STIs, and reproductive health issues: Results after 18 months of implementation in 5 operational districts in Cambodia. JAIDS, published ahead of print.
3% 6% 8% 7%11%
55%
79%74%
85%85%80%88%90%
85%
70%68%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
2007 2008 2009
Per quarter and year
Per
cent
ages
HIV testing coverage Syphilis testing
HIV/syphilis testing coverage
Summary thoughts on community mobilization to strengthen ANC and ECS• Working with individuals, families, and
communities can contribute to congenital syphilis elimination
• WHO has developed a range of tools to support countries
• Role for more systematic efforts to mobilize community as part of comprehensive MNH package
Contact informationDr. Lori Newman – [email protected]
More information available at: www.who.int/reproductivehealth/topics/rtis/syphilis/en/index.html
Working together to eliminate congenital syphilis!