pmtct and health systems in resource-limited settings: mutual strengthening and lessons learnt
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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 . - PowerPoint PPT PresentationTRANSCRIPT
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PMTCT and health systems in resource-limited settings: mutual strengthening and lessons learnt
Rene Ekpini E, MD, MPHSenior Adviser
UNICEF, New York
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Access to and uptake of PMTCT and Paediatric HIV care and treatment
services has significantly increased
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Virtual elimination of PMTCT: implications for health systems
C •Geographic coverage: bringing services to all women and children in need
Q•Quality/efficacy of interventions:
providing the most efficacious/quality interventions
U •Access to and utilization of services Wor
king
wit
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mm
unit
ies
for
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mun
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Health Systems Strengthening
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Percent of ANC facilities that provide HIV testing and counselling, and ARVs
for PMTCT
0
20
40
60
80
100 >95>95 9587 86
7664
58 58 55 53 5144
19 16 148 8 3
Source: WHO, UNICEF and UNAIDS, Towards Uni-versal Access: Scaling up priority HIV/AIDS interven-tions in the health sector, Geneva, 2009.
Percent
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Where geographic coverage does not mean access to and utilization of
services
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Where high coverage can be misleading:
ARV regimens provided to pregnant women living with HIV in 2008
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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
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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
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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
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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
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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
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Current Scenario Scenario under policy shift If all women are reached with HAART
0
100
200
300
400
500
600
Transmission rate Number of children infected
3.7% 2.8%.9%
490
366
119
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
100% of PWLWH receiving universal
HAART
Improving the performance of the
system
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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)
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Utilisation of family planning services by HIV Infected women and their partners, Rwanda National PMTCT Program, 2005-
2009
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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)
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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
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Two Worlds, Two Realities, One Hope: addressing inequity for social justice