Harnessing community capacities: integration & scale-up of the Mentor Mother Model Shungu Gwarinda mothers2mothers Country Director South Africa

Transcription

1 Closing the Gap in PMTCT Harnessing community capacities: integration & scale-up of the Mentor Mother Model Shungu Gwarinda mothers2mothers Country Director South Africa CCABA, 20 July 2012

2 Presentation outline Setting the context Mentor Mother Model overview Impetus for scale up National Scale-up Business Model MM Model Scale-up framework MM Model integration Framework SAG, 2008; WHO 2009

3 Health Systems Sub-Saharan Africa 24% of world disease burden 3% of healthcare workforce

4 Staffing Ratios Health care workers per 100,000 population (2007) Region/Country Physicians Nurses United States South Africa Botswana Zambia Zimbabwe Lesotho 5 62 Mozambique

5 SA Population (2009): 49 million population dependent on public health sector health professionals in public sector vacant posts in public health sector Nurses 85% 44% 36% Doctors 30% 10% 34%

6 Primary Health Center Doctor: 30 patients per day Nurse: 40 patients per day 16 minutes per patient 12 minutes per patient

7 PMTCT Program Interventions in ) Counsel for HIV test 2) Perform HIV test, explain results 3) Dispense single dose nevirapine, explain how to take 4) Discuss infant feeding options 5) Reinforce exclusive infant feeding 6) Perform infant HIV test at 12-months, explain results Nurse: has only 12 minutes per patient

8 PMTCT Program Interventions in 2010 Nurse: 1) Counsel for HIV test 2) Perform HIV test, explain results 3) Perform CD4 test, get and explain results 4) Dispense cotrimoxazole 5) Discuss infant feeding options 6) Dispense AZT (from 28 weeks), explain how to take 7) Dispense HAART (if eligible), explain how to take 8) Counsel on adherence to HAART 9) Screen for HAART related toxicity 10) Reinforce exclusive infant feeding 11) Where ARVS for breast feeding are available, explain how to use 12) Perform infant HIV test at 6 still has only weeks, explain results 13) Refer mother to follow-up care, encourage her to attend 12 minutes per patient

9 PMTCT services what s working? 95% coverage of ANC facilities 95% of pregnant women tested for HIV (2009) 3.5% MTCT rate at 6 weeks postpartum Decentralising services to improve access Goga et al, 2010; W HO, 2009

10 PMTCT services what s not working? High maternal mortality (43.7% HIV related) Increasing infant mortality from 59 per 1000 births in 1998 to 104 in 2010 Poor retention in care Low uptake of early infant diagnosis - 15% of infants born to mothers with HIV were tested in the first twomonths of life SAG, 2008; WHO 2009

11 Underlying causes Health Systems o too few doctors, nurses and midwives o fragmented health services o poor links between health care facility and community o limited supportive services Societal factors o disempowered women o stigma o same across all countries where m2m provides services

12 ...

13 m2m Mentor Mother

14 Three m2m goals: Goal 2. Healthy mothers and infants Goal 1. PMTCT Goal 3. Empowerment

15 Simple, scale-able model of care Mothers are a community s single greatest resource Mothers living with HIV (Mentor Mothers) educate and support HIV-positive pregnant women and new mothers in health facilities Individual and group meetings Daily presence for education and support MBPT & ACFU Mentor Mothers: professional members of health care team - paid for service 600 sites & MMs in 7 countries

16 Site Coordinators and Mentor Mothers Recruited locally Selection Criteria: Mothers HIV-positive Attended PMTCT Disclosed Basic numeracy and literacy skills Site Coordinators manage services Mentor Mothers engaged for up to two years

17 training

18 what we do

19 Helping mothers Saving Babies

20 Scaling impact: Demand side interventions seen as missing link in global elimination of PMTCT DOHs are including m2m Mentor Mother program model into national guidelines Governments requesting plans for national scale-ups m2m: Scaling impact through portfolio of new business models.

21 emtct Framework: Impetus for national scale-up Scaling up coverage Service integration Improving quality of care Strengthening community ownership Putting women at the centre of the response Utilising innovations to achieve results

22 Institutionalizing the MM model Health care systems Levels of IMPACT: Communities Mothers & babies EMPOWERMENT

23 Institutionalising the MM model in Government health system Government ownership and integration National standards and guidelines Package of services Terms of service for MMs Support system(s) (training, wellness, management) M&E system (DHIS integration) Costing Framework

24 National Scale-up Business Model Health Systems Strengthening Supporting and preparing Government(s) to effectively implement and roll-out a national Mentor Mother model. Capacity Building Local implementing partners Direct Service Delivery m2m delivering a Mentor Mother model; model sites for continued innovation and model development

25 Mentor Mother Program Scale-up Framework Capacity Development & Training Policy & Frameworks Research to Action Program Model Innovations

26 Level MM Model Integration Framework HSS function HSS intervention point Expected results National policy & guidelines Policy guidance & IGR Policy implementation guidance & costing framework DHMT District Health Services Primary Health Care Facilities Management of service delivery ; specialized care and treatment PHC outreach; Comprehensive minimum package of services Specialized district support teams with MMs PHC Mgmt & outreach teams with MMs Comprehensive District Based Support for Better HIV/TB Patient Outcomes Community Platform (& household) Linkages & referrals; community mobilization; patient tracking & follow-up CHW & CBO structures with MMs

27 MMP Training Program Material Development, SAG/MOH MMP Curricula MMP Participant Material MMP Trainer Manual Supports Training Cascade MMP TOT Manual MMP Toolkit Orientation Package Supports DHMT Capacity Building

28 HOPE win this fight

29 Expanding the MM model Client PMTCT RMNCH HIV+ pregnant women HIV+ new mothers Exposed infants HIV infected children (up to 2 years) HIV- pregnant women attending AN services Pre- and post-test HIV education and PSS PMTCT education/pss through: Client follow-up/retention mechanism/service Referrals Pre-test HIV education and PSS Selected core RMNCH education/pss Education/PSS for Neonatal Circumcision Screening services: - TB; Nutritional assessment (MUAC); Growth & development monitoring Linking well children into under-5 clinic for routine care Group post-test HIV education and PSS One-on-one post-test education/pss for re-testing, risk reduction, importance of safe delivery at health facility, exclusive breastfeeding

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31 MMP Service Delivery Points Province Option 1: Dedicated Mentor Mothers at high-volume PHCs District & Sub-District Ward-Based Option 2: Dedicated MMs as part of PHC outreach teams Option 3: Dedicated MMs as facilitycommunity linkage with CHWs Option 4: Model Adaptation - Capacitated CHWs or MM Linkages Mentor Mother Program

32 THANK YOU!