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PMTCT and health systems in resource-limited settings: mutual strengthening and lessons learnt

PMTCT and health systems in resource-limited settings: mutual strengthening and lessons learnt . Rene Ekpini E , MD, MPH. Senior Adviser UNICEF, New York. Access to and uptake of PMTCT and Paediatric HIV care and treatment services has significantly increased .

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PMTCT and health systems in resource-limited settings: mutual strengthening and lessons learnt

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  1. PMTCT and health systems in resource-limited settings: mutual strengthening and lessons learnt Rene Ekpini E, MD, MPH Senior Adviser UNICEF, New York

  2. Access to and uptake of PMTCT and Paediatric HIV care and treatment services has significantly increased

  3. Virtual elimination of PMTCT: implications for health systems Working with communities for communities Health Systems Strengthening

  4. Percent of ANC facilities that provide HIV testing and counselling, and ARVs for PMTCT

  5. Where geographic coverage does not mean access to and utilization of services

  6. Where high coverage can be misleading: ARV regimens provided to pregnant women living with HIV in 2008

  7. Closing the funding gap to scale up programmes for virtual elimination of MTCT • Maximizing Global Health Initiatives (IHP+; H4; H8; USG GHI, etc...) -HIV/PMTCT-Health systems synergies in reaching the goal of virtual elimination of MTCT • High level advocacy • Political leadership at all level • Planning and implementation • Leveraging existing resources (GFATM , PEPFAR, ...) to strengthen the MNCH platform and laboratory infrastructure for rapid scale up of PMTCT

  8. Inducing good governance and enabling policies Strong political leadership and commitment to ensure that health system goals of access, equity, efficiency and improvement in outcomes are achieved Promotion of innovative policies on: Provider initiated HIV testing and counselling access to treatment for women and children Abolition of user fees for antenatal and delivery care Induction of changes in resource allocation including innovative approaches such as performance-based financing

  9. Bringing services closer to women, their children and families through decentralisation and devolution • Decentralisation and devolution to sub-national levels with a focus on: • strengthening sub-national management structures • Integrated management processes (integrated micro plans, integrated supervision, etc ) • Promoting innovative financing mechanisms to support implementation • Expansion of services through evidence-based planning that take into account the epidemiology and actual needs • Strengthening PSM systems

  10. Improving the quality of MNCH services including HIV interventions • Training of service providers (including CHW) on PMTCT and MNCH with mentoring and supervision. Task shifting and sharing • Building capacity to scale up 2009 WHO recommendations: • Improved antenatal and delivery care • Building the capacity within MNCH services for immunological assessment (CD4) • Improving follow up care (IF and nutritional counselling and support; CTX, EID) and linkages to ART • Strengthening the evidence base including national M&E systems, supporting operational research including impact assessment

  11. Improving postnatal care in the context of PMTCT, Swaziland % of observed providers who counselled on danger signs for mother during postnatal care % of observed providers who counselled on danger signs for infant during postnatal care

  12. Is elimination of MTCT possible without improving the performance of existing systems? • 94% of PWLWH receiving: AZT >38 wks - AZT 28-32 wks or HAART • 6% have no intervention • 94% of PWLWH receiving • universal HAART • 6% have no intervention Improving the performance of the system 100% of PWLWH receiving universal HAART

  13. Increasing access to and utilisation of services • Bridging programme areas and components (primary prevention, SRH) • Leveraging resources to improve infrastructure and equipment, optimize working conditions, and improve efficient delivery of services • Scaling up innovation to service delivery to improve the continuum of MNCH care (e.g. Mother-Baby-Packs ; Point of care machines ; Mobile phone technology) • Addressing socio-cultural and economic barriers, and ensuring equity (high cost of antenatal and delivery care, stigma, transportation, unfriendly environment)

  14. Utilisation of family planning services by HIV Infected women and their partners, Rwanda National PMTCT Program, 2005-2009

  15. Partnering with individuals, families and communities • Engaging civil society, lay counsellors, people living with HIV more systematically as a scale up strategy (planning, demand creation, provision of services) • Engaging male spouses as partners • Strengthening community structures using an integrated approach (same community workers to provide integrated package of services) • Community-based delivery of MNCH services including (antenatal, syphilis, immunization, newborn care, PMTCT)

  16. Proportion of women who reported exclusive breastfeeding last 24 hours following community based-interventions, Kenya Susan Kaai, Carolyn Baek et al. : Community-based Approaches to Prevention of Mother-to-Child Transmission of HIV: Findings from a Low-income Community in Kenya

  17. Two Worlds, Two Realities, One Hope: addressing inequity for social justice

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