Background

1. Strategies to include the private health sector in a comprehensive national PMTCT programme in Zimbabwe Mujaranji,Grapper1; Patel, Diana1; Gwanzura, Evangelista1; Mahomva, Agnes²; Engelsmann, Barbara1 1Organization for Public Health Interventions and Development Trust (OPHID), Harare, Zimbabwe²Elizabeth Glaser Pediatric Aids Foundation, Zimbabwe Zimbabwe National HIV&AIDS Conference, Harare, 5-8 Sept 2011

2. Background PMTCT Across all Health Sectors in Zimbabwe • Significant progress demonstrated in expansion of national PMTCT programme and uptake in public health institutions • BUTMissed opportunities in the private sector limit coverage of national PMTCT programme

3. Background What we know about the Private Sector in Zimbabwe? • No knowledge on who is delivering what services to whom in PMTCT within the private sector • No formal mechanism for building capacity to deliver PMTCT services in private health sector • No standardized quality control of PMTCT services delivered by private health sector

4. Issues • PMTCT service delivery in private health institutions is • Not standardized • Not nationally coordinated • Performance indicators such as uptake and service provision not routinely collected for the national system • No formal mechanisms for quality control or capacity building

5. Introduction OPHID and the National PMTCT Programme: • Family Aids Initiative (FAI) Consortium (EGPAF, Kapnek , ZAPP, OPHID) support the Zimbabwean Ministry of Health and Child Welfare and its national PMTCT programme • Within the FAI programme, the Organisation for Public Health Interventions and Development (OPHID) Trust supports the national PMTCT programme in Marondera district • District wide coverage only possible through inclusion of district’s private hospital and its referring clinics and private practices

6. Introduction Marondera District: • 16public healthcare sites • 4registeredprivate practices • 1 private hospital

7. Approaches • OPHID Partner Provincial Coordinator (PPCs) provides technical support at district level • Dedicated District Focal Person (DFP) covers 100% of sites/district present and continuously available for reference; • Formal and informal PMTCTtraining and site support provided to institutional health care staff as well as related supporting cadres (TBAs, VHWs, and sensitization of general hands);

8. Methodology Inclusion of Private Sector in Marondera: • In January 2009 initial approaches by OPHID were enthusiastically greeted by the senior medical staff at the private hospital • All staff including doctors at the private institutions sensitised on the national PMTCT programme • Nurses then orientated other staff members and stakeholders/beneficiaries in family/child care • Nurses from private health institution then formally trained in PMTCT service delivery together with nurses in the public sector • National MOHCW PMTCT data collection tools and registers introduced and used according to national guidelines • Implementation in private institution continues to be mentored and technically guided by PPC and DFP

9. Outcomes • Capacity built of private sector HCWs in PMTCT • Individual, private clinics and private referral hospital in the district now refer for or deliver HIV testing, counselling and other PMTCT services to pregnant mothers and their partners • PMTCT service delivery in the private sector is now aligned with current national MOHCW guidelines, regularly updated and monitored as part of the national programme • The National M&E system now has the capacity to capture more comprehensive data on PMTCT coverage through inclusion of women accessing PMTCT services through the private sector

10. The Data • In 2010 131 women were tested for HIV in ANC and labour and delivery in the private sector in Marondera as part of the national PMTCT programme • This is not a great number of beneficiaries but when we are reaching for virtual elimination of paediatric HIV every case counts

11. Conclusion • Inclusion of the private health sector in the national PMTCT programme delivering comprehensive PMTCT services created an opportunity to reach this “hard to reach” population • Expansion and monitoring of PMTCT service delivery to the private health sector will be an important strategy in the pursuit of scaling up PMTCT services to reach national targets

12. Additional Observations • A growing middle class, increased availability of generic drugs and low cost medical insurance is leading to an expansion in private medical care • A large proportion of women – especially urban dwellers who seek services at private health facilities - will get support for antenatal care and PMTCT services in private clinics • Possibility of Public/Private Partnership (PPP) helps to leverage co-funding to increase PMTCT coverage and programme impact e.g. Free VCT centre in private hospital • Through PPP in national PMTCT programme beneficiaries can receive integrated care into maternal-child health services and linking mother’s HIV status to child is necessary for HIV-infected mothers and HIV-exposed children to receive appropriate follow-up and treatment

13. Acknowledgements • Financial support (USAID, UKAid, EGPAF) • MOHCW Provincial and district health executives • Health care staff of health care institutions

14. Thank you, Tatenda, Siyabonga!