Optimizing linkages with RMNCH in GF proposals Technical Resources and Guidance Tools

1. Optimizing linkages with RMNCHin GF proposals Technical Resources and Guidance Tools Dr. Viviana Mangiaterra Family Women and Children's Health Cluster

2. GlobalMomentum H4+

3. MNCH Guidance - Needs • Greater inclusion of evidence-based priority MNCH interventions within disease-based or HSS programming – MDGs 4, 5 and 6 • Board Decision Point: GF/B22/DP15: encourages countries, where applicable, to strengthen the MNCH content of their Global Fund-supported investments, maximizing existing flexibilities for integrated programming. • Board requested the Secretariat to develop clear guidance on strengthening RMNCH in GF portfolios. • Need for practical guidance on MNCH inclusion in proposals for GF Round 11 applicants (GF Practical guidance) • Need for wider-ranging normative MNCH technical guidance to support the above (WHO technical guidance)

4. Why it is essential to build on the linkages Maternal mortality Under-5 mortality Malaria in the World HIV Global burden

5. What is the state of integration/linkages? Abou-Zahr, C, 2010 WHO Health Matrix

6. Toolkit - 3 related documents • GF MNCH Information Note • GF practical guidance document: providing rationale for inclusion of MNCH within GF investments. • WHO technical guidance document: providing access to normative, evidence-based technical guidance on MNCH and links with HSS & HIV/TB/malaria They are all aimed at CCMs, PRs, proposal writers: providing support for preparing MNCH-inclusive applications that link and synergize with HSS & HIV/TB/malaria programming

7. GF MNCH practical guidance tool - structure Background – GF & health-related MDGs 1. Introduction - key points to consider on GF & MNCH- cross-cutting considerations: HSS/CSS; equity, gender, human rights 2. MNCH in context of HIV, TB, malaria • MNCH continuum of care • MNCH packages of care, priority interventions 3. Defining/prioritizing MNCH for GF proposals • Proposal development processes • Gap analysis & identification of barriers • Inclusion of MNCH interventions in proposals - examples

8. GF MNCH practical guidance tool - structure 4. GF proposal forms & guidelines – integrating MNCH: - GAVI-GF HSFP for HSS Support Common Proposal Form; Global Fund Round 11 Proposal Form 5. Country Case Examples – existing GF support for MDGs 4 & 5 • Examples from 13 countries 6. Complete list of key resources

9. WHO technical guidance : overview of contents Background, integration of health interventions, synergies and added value Developing RMNCH content in funding proposals for HIV, TB, malaria and HSS Defining key interventions that may be included across the continuum of care Interventions, importance for prevention of main disease, and benefit for women and children in the general population (principle of additionality) Case studies Resources and references Annexes : 1) indicators list and 2) list of RMNCH interventions linked to each disease and HSS and suggestions for gaps analysis, benefits in addition to the ones related to HIV, TB, HSS and malaria and value for money considerations.

10. Common entry points and interventions for strengthening service delivery (I) 1. Antenatal Care e.g. 2. Childbirth Care e.g. • PMTCT • MIP • TB Care, including extra-pulmonary genital TB • Prevention of congenital TB • Management of pregnancy complications • Essential care during childbirth • Essential care for the mother and newborn after birth • Care of HIV positive pregnant women • PMTCT • TB care • Care after birth for mother and baby • Appropriate management of complications • Family planning • Support for breast feeding • Screening for TB 3. Postpartum care for mother and newborn e.g.

11. Common entry points and interventions for strengthening service delivery (II) 4. Child care: e.g. • Interventions to improve nutrition • Immunization • ITNs • IMCI including HIV, TB, Malaria • Education and counseling for contraception • SRH counseling for adolescents  • Diagnosis and treatment of malaria, HIV and extra-pulmonary genital TB 5. Sexual Reproductive Health

12. Investing in improved linkages between HIV and MNCH improves MNCH outcomes WHO recommended HIV interventions Impact ARV interventions to prevent HIV transmission through breastfeeding Reduced HIV transmission among HIV-exposed children + Counselling and support to HIV-infected mothers to improve breastfeeding practices Improved HIV-free survival among HIV-exposed children + improved linkages/modest expansion Counselling and support to all mothers to improve breastfeeding practices Improved survival among all children

13. Examples of how GF grants can improve general MNCH care, HS and specific disease outcomes

14. The Gambia, Malaria grants Round 3 (2003) and 6 (2006) Outcomes Interventions • Increased access to treatment and intermittent preventive therapy (IPT). • Decline in malaria from 39 to 8% (2009). • Significantly expanded and strengthened laboratory capacities. • At rural health facilities, all pregnant women have access to a package of ANC services. • Distribution of 500,000 insecticide-treated nets to children under 5 and pregnant women • Health workers trained in adult malaria management • Integrated management of neonatal and childhood illnesses (including malaria, pneumonia, measles, diarrhoea and malnutrition).

15. Rwanda HSS Project (GFATM ROUND 5) Interventions Outcomes • Rapid increase in enrolment from 7% in 2003 to 91% in 2008 • HIV C&T in pregnant women: 95% • HIV C&T partners of pregnant women in ANC: 76% • Health facility deliveries among all women: 69% • Health facility deliveries among HIV+ women: 75% • Community–based health insurance • Micro-Insurance • Tax subsidy and cross subsidy from formal sector insurance

16. Bangladesh Grant [GFATM RD 9] Expansion of DOTS in work places that employ women IEC activities targeting women's groups at district level Expansion of case findings and care for smear negative, extra pulmonary maternal, child TB and TB-HIV co-infected cases Outcomes Interventions

17. RMNCH: working with partners to support Round 11 • To disseminate tools for capacity building and to provide hands-on practical training for countries preparing RMNCH components to be included in GF proposals • To identify technical support needs by countries for proposals preparation (national writing team, gap analysis, logframe table, costing tools) • To support relevant partners, such as The Global Fund, UNAIDS, RBM, Stop TB Partnership and others in conducting regional preparatory workshops and countries assistance.

18. RMNCH integration - Challenges Cross cutting proposals may require more preparation time. CCMs will need to identify needs for MNCH information, services, etc inclusion of MNCH specialists is needed in all key phases of gaps analysis, negotiation and implementation. Ensure that the Comprehensive National Health plan includes RMNCH as the base of the gap analysis. Consultation process broadened (and documented) to include RMNCH (affected communities, women groups, academia….). Ensure high quality technical assistance to result in the submission of a successful, well-written proposals which are scientifically, technically, financially sound.