CHRISTIAN HEALTH ASSOCIATION OF MALAWI (CHAM)-

1. CHRISTIAN HEALTH ASSOCIATION OF MALAWI (CHAM)- • HIV/AIDS PROGRAM

2. CHAM BACKGROUND • An ecumenical umbrella organization that coordinates provision of health care in church-owned health facilities in Malawi • Owned by Episcopal Conference of Malawi and Malawi Council of Churches. • Membership of 172 health facilities of various sizes, located across the country, 80% of which are in hard to reach areas. It has also 10 training Colleges • Provide about 37-40% of the health care service delivery in Malawi

3. HIV SITUATION IN MALAWI • HIV prevalence in Malawi for adult population 12% (Sentinel Survey 2007) • Prevalence of HIV in Antenatal mothers 12.6% (Sentinel Survey 2007) • Prevalence among pregnant women had declined from 22.8% in 1999 to 13.5% in 2009 as measured through ANC sentinel surveillance. • 52% of pregnant women were tested for HIV in 2009. • An estimated 58% of mothers and 41% of HIV-exposed infants were provided with ARVs for PMTCT in 2009.

4. CHAM PARTNERSHIPS IN HIV PROGRAMMES

5. PARTNERSHIPS FOR HIV RESPONSES. CHAM has an MOU with Govt. that supports • Staff salaries in all CHAM facilities • SLA (currently 38%, 66 of 172 facilities) • Student scholarships- PEPFAR During trainings they are also equipped with HIV info. To support facilities once theygraduate . • 40% & 60% of the graduates go to CHAM & GOVT. respectively.

6. OVERAL OBJECTIVES • Strengthen the capacity to prevent HIV/AIDS; provide care, support and treatment and mitigate the impact of the epidemic • Strengthen the delivery, coordination, scale up and monitoring of HIV/AIDS services in the faith-based health sector in Malawi.

7. SPECIFIC OBJECTIVES OF HIV/AIDS PROGRAMS IN CHAM • Strengthen quality of PMTCT services in all health facilities. currently working on EMTC • Improve quality of care and treatment for HIV and AIDS, STI, TB & OIs • Strengthen the capacity of CHAM in planning, M&E & use of data for management of HIV/STI/TB programmes. • Ensure quality diagnostic services for surveillance, diagnosis, treatment, CD4, HIV screening and blood safety. • Improve the HR capacity to effectively provide HIV services. • Strengthen HIV prevention by providing voluntary medical male circumcision (VMMC)

8. MALAWI’S ART/PMTCT ENVIRONMENT Full package • Provider Initiated Testing & Counselling (PITC) • Confidential HIV Testing and Counselling (HTC) • ARV prophylaxis/ART therapy • Cotrimoxazole Preventive Treatment (CPT) prophylaxis • Monitoring and Evaluation • HRD&T (Pre-service & post basic education for HIV/AIDS) • Infant feeding counselling & support • Counselling & follow up

9. MOH PMTCT GUIDELINES • Reduce paediatric HIV infection in children and ensure an HIV-free generation, all pregnant women should have access to comprehensive quality PMTCT services • Provide a continuum of entry points to expand coverage and strengthen follow up of PMTCT and paediatric HIV/AIDS services ANC, Labour/Delivery, Postpartum Care

10. KEY AREAS IN THE MALAWI INTEGRATED PMTCT PACKAGE There are 4 Prong Areas; • Prevention of HIV Infection among women of childbearing age • Prevention of unintended pregnancies among women living with HIV • Prevention of transmission of HIV from mothers living with HIV to their infants • Treatment, Care and Support of mothers living with HIV and their infants

11. APPROACH TO INTEGRATION • Use of new cadre of HSAs & CHCWs to provide PMTCT services at community and household levels • Adopted PMTCT & HIV counselling & training materials for health care providers to create a learning resource package for HSAs • Utilization of HSAs & VCHW to improve community awareness and demand creation for ART/PMTCT services while strengthening referral linkages for HIV women and their infants

12. ACHIEVEMENTS Development of HIV/AIDS Integration Framework • Serves as a “Roadmap” throughout implementation; it enables CHAM facilities to reposition services to achieve maximum impact Development of Operational Integrated Framework • Enables our health facilities to develop joint work plan and coordinate a single agreed approach rather than haphazard, parallel systems. • Provides health facilities with single understanding of accomplishments and gaps remaining to be addressed

13. Cont’ Improved HR in HIV/AIDS management CHAM managed to train and is still training staff in areas of; Couple Counseling , PITC, ART, PMTCT, HTC for Site supervision , CD4 testing, DBS/PCR collection and management, Motor Cycle Riding (for follow up), M&E/HMIS and Early Infant Diagnosis

14. Cont…’ Establishment of integrated HIV/AIDS static & mobile Clinics Increased number of clients accessing HIV/AIDS services: HTC (Jun 2011-May 2012) • 124 Facilities providing HTC • 475,494 Clients reached • 51,828 Positive • 104,507 on ART PMTCT • 120 Facilities providing PMTCT services • 5,696 Pregnant Women reached • About 30% of the facilities trained for Option B+

15. Cont’ Establishment of HIV/AIDS interventions for vulnerable groups increased HIV/AIDS information access. (e.g.) • Sex workers intervention/support groups reached up to 57% of the targeted numbers of sex workers in some of our facilities • Increased number of sex workers now accessing HIV/PMTCT services due to the awareness provided to them through these interventions/support groups

16. Cont…’ Promotion of male involvement through Traditional Leader has seen an improvement on PMTCT service uptake by 16%. Some communities have even developed bylaws to govern PMTCT issues within their communities; • Every pregnant woman to attend ANC • Every visit to ANC a woman to be escorted by her husbands • WASH intervention (where when a women comes with her husband she is given some incentives)

17. Cont…’ • High quality strategic information management • A strengthened surveillance system which shows a pattern of changing behaviour and decreasing HIV prevalence, (CHAM CDC interventions highlight the needs of vulnerable hidden populations)- • Significant number of HSAs & VCHWs trained in comprehensive ART/PMTCT and use of HIV rapid test kits resulting into increased HIV service delivery, improved referral system and also increased PMTCT service uptake • Renovations of key buildings • PMTCT/ART clinics and Laboratories

18. BEST PRACTICES Our facilities have formed support groups for vulnerable population help increase HIV/AIDS service uptake (e.g.) • Sex workers support groups has enabled sex workers to open up and start accessing HIV/AIDS and PMTCT services. • Stigma and Discrimination has been reduced and this encourages other vulnerable populations to access HIV/AIDS services

19. CHALLENGES • low participation of CHAM facilities in preparation of the district implementation plan despite that CHAM facilities’ budgets are included in the DHO’s budget. • EHP, Some facilities (38%) signed SLAs but for govt to pay the bills takes time which sometimes results into conflicts • Too high expectations from govt. on what CHAM can do within its limited mandate and resources • Distrust & misinformation between MOH & CHAM. This is due to poor communication system within our institutions and sometimes due to lack of transparency in the way the two bodies conduct their business

20. LESSONS LEARNT • HIV initiatives are effective when they are situated within Govt structures and follow govt. SP & priorities • Active involvement of beneficiaries and marginalized groups ensures the effectiveness and sustainability of interventions • Working at a variety of levels-from national to local-allows for more comprehensive response • Partnerships create synergies, better meet beneficiaries’ needs and maximize available resources

21. RECOMMENDATIONS CHAM & MOH are the 2 most important partners in the provision of health care in Malawi.... • Need to improve relations in areas of communication and cooperation at district level • There need for increased district based collaboration between CHAM facilities and DHOs in health planning and health policy issues • Involvement of church structures to reach out to larger population is key

22. CONCLUSION • CHAM is optimistic that through ACHAP forum FBOs shall assist in scaling-up and strengthening the HIV/AIDS/NCD service delivery in Africa (Some FBOs across Africa fail to provide HIV/AIDS/NCD services to the maximum due to lack of ideas , innovativeness and financial support) • This forum will result into meaningful contribution towards the Continent’s HIV/AIDS and NCD response • Malawi will be on track to achieve its national targets for PMTCT by 2013 since efforts to scale-up and reduce loss-to-follow up will have been redoubled

23. Thank you for your attentionMAY GOD BLESS YOU ALL!