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Experiences with integrated Community Health Workers in the Partnership for HIV Free

Survival project

Roland van de Ven – Technical DirectorTatu Mtambalike – Program Coordinator Community Linkages

14 January 2015

Content outline

• EGPAF Background• Integration of Community MNCH activities

with Home Based Care• Achievements• Lessons learnt• Challenges

Background

• EGPAF supports the national RCH/PMTCT program through the USAID funded LIFE Program (Linking Initiatives For Elimination of pediatric AIDS)– EGPAF applies a health system strengthening approach at

district level, to build local capacity for program planning, implementation and monitoring

• Partnership for HIV Free Survival is implemented in Nzega district in Tabora region leveraging the LIFE program

Integration of Community MNCH

• EGPAF supported the integration of Community MNCH with the existing Home Based Care program in Nzega district:–Using national integrated Community

MNCH guideline the program trained 50 HBC providers as MNCH CHWs–Trained 10 HF staff as supervisors–Mentoring the CHWs in collaboration

with MOHSW and JHPIEGO

Community MNCH main activities

• CHWs (with support from the site supervisors and village leaders) conduct: – Mapping of households to identify and follow up clients,

• i.e. pregnant and lactating women, children, HIV+ women on ART and HIV exposed children.

– Household visits and community meetings to promote clinic attendance, facility delivery, birth planning counselling, the use of ITN etc

– Referrals to health facilities– Monthly reporting at health facility where supervisor meets

with all CHWs and discusses: • The contents of the monthly reports comparing clients in the

registers with report forms • Successes, challenges and solutions• Learn from others

Progress on RCH clients followed up by CHWs

RCH clients followed by CHWs Q4 2013 Q1 2014 Q2 2014 Q3 2014

Pregnant and postpartum women Pregnant women (new and second visits)

170 1284 798 1014

Women followed after delivery 0 521 303 414Total 170 1805 1101 1428Infants and ChildrenChildren 0-28 days 91 562 429 483Children between 1 month to 1 year 283 1570 1216 1463Children above 1 yr to 5 years 374 2719 2085 2768Total 748 3356 3730 4714Total number of House hold visits - 2140 3230 3989

Trends in couple testing

Increased attendance of HIV+ mother-baby pairs

Increased uptake of PNC services

Tracing efforts by integrated CHWs

Main lessons learnt

• Working with already known and accepted volunteers in the community has enabled the program to introduce the MNCH aspect smoothly

• Enabling HBC providers to offer additional health education on MNCH services has provided an opportunity to remove stigma around HIV and HBC.

• CHWs improve relationship between HF and community

• CHWs substantially contribute to increased uptake of RCH services.

Sustainability and scale up

Concerns:•CHWs are mainly supported through NGOs budgets •Number of volunteer CHWs limited, which does not allow a large coverage of households in the area. •Integration of HBC and MNCH services adds a huge burden on volunteer CHWs

Way forward:•Integration of CHWs support into district health plans and budgets•Establishment of a fulltime cadre of Community Health Workers / Extension Workers

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