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Dr. Dhally M. Menda MD, MPH, MBA
Director of Health ProgrammesChurches Health Association of Zambia -
CHAZ
Engagement of CHAs in eMTCT Scale UpThe Case of CHAZ
ACHAP 7th Biennial Conference Meeting
23 February 2015 Nairobi, Kenya
CHAZ Supports 151 Member Institutions
“He sent them to preach the Kingdom of God and heal the sick” Luke 9:2
Health Services Coverage• Second largest provider of health services in Zambia. • MoU with the MoH: 75% Grant- Staff Secondment – Essential Drugs
Principal Recipient Status • PR for the Global Fund & PEPFAR: Multi-million grants
Engagement at 3 Levels
Left OutDrop OutsAdherence
SUPPLY
DEMANDQUALITY
“He sent them to preach the Kingdom of God and heal the sick” Luke 9:2
% of womenAccessing 1 ANC visit
% of Pregnant Women
Testing for HIV
% of PLHIV Receiving
ARVs
% of PLHIVInstitutional Deliveries
% of Infants born To PLHIV Receiving
ARVs for PMTCT
% of Infants born to PLHIV Receiving EID by 2 Months
It’s Leaking!
Zambian PMTCT Services Cascade
“He sent them to preach the Kingdom of God and heal the sick” Luke 9:2
“He sent them to preach the Kingdom of God and heal the sick” Luke 9:2
Availability of Services:- Few PMTCT Sites
Accessibility Coverage:- Distance & Travel
Costs
Acceptability Coverage:- Culture:
Home Delivery, Delayed 1st ANC
Contact Coverage:- Shortage of Staff- Poor Behaviour - Poorly Trained
Effective Coverage:- Stock outs: ARVs,
HIV Test Kits- Poor Linkages- Poor Referrals
Post Testing Psychological Difficulties
Poor Knowledge of ART
Limited Education
Stigma:- Anticipated - Perceived- Enacted- Internalized
No Partner Support
Culture & Tradition:- Home Delivery - Use of TBAs
Why the Leakage Across the Cascade?
Individual
Family & Community
Health System
Turan, J., Nyablade, L. (2013); Gourlay, A., et Al. (2013)
% of womenAccessing 1 ANC visit
% of Pregnant Women
Tested for HIV
Addressing Individual Factors
Strategies to increase HCT:
1. Demand Creation: Mix of Mass Media, interpersonal, and community-based communication channels
2. Training Traditional Marriage Counselor & Curriculum Review
% of womenAccessing 1 ANC visit
% of Pregnant Women
Testing for HIV
% of PLHIV Receiving
ARVs
Strategies to increase ARVs Prophylaxis:
1. Couple Counseling2. Chiefs & Chieftainesses involvement: Champions3. Community Mobilization: Support & Stigma reduction4. Health & Community System Strengthening
Addressing Family & Community Factors
% of womenAccessing 1 ANC visit
% of Pregnant Women
Testing for HIV
% of PLHIV Receiving
ARVs
% of PLWHI Institutional Deliveries
Strategies to increase HF Deliveries:
1. Maternity Waiting Homes: Building, Renovations2. Mama-Baby Packs 3. Chief involvement: Penalties for home delivery
Addressing Family & Community Factors
% of womenAccessing 1 ANC visit
% of Pregnant Women
Testing for HIV
% of PLHIV Receiving
ARVs
% of PLHIVInstitutional Deliveries
% of Infants born To PLHIV Receiving
ARVs for PMTCT
Strategies to increase Infant ARVs Prophylaxis:
1. Integration of MCH-EPI: Issuing of U5 Cards after delivery 2. Use ASWs, CHWs and SMAGs: Follow ups of women3. SMS Reminders: For mother-baby refills
Addressing Family & Community Factors
% of womenAccessing 1 ANC visit
% of Pregnant Women
Testing for HIV
% of PLHIV Receiving
ARVs
% of PLWHIInstitutional Deliveries
% of Infants born To PLWHAs Receiving
ARVs for PMTCT
% of Infants born to PLWHAs Receiving EID by 2 Months
Strategies to increase Early Infant Diagnosis:
1. Use ASWs, CHWs and SMAGs: Follow ups of Mother-Baby Pair2. SMS Reminders: For PRC Testing 3. Improve Logistics: For DBS Collection & Feedback
“He sent them to preach the Kingdom of God and heal the sick” Luke 9:2
Addressing Family & Community Factors
HSS
Transport ProvisionBuilding & Refurbishment Non Medical Equipment
Laboratory Support Trainings & TS & Mentoring
Medical Equipment Supply Chain: Quantification - Procurement - Distribution
Health Systems Strengthening
Addressing Health System Factors
CSSAwareness Creation
CBHWs Capacity Building
Transport
Chiefs Champions
Empowerment
Community Systems Strengthening
Trainings & Advocacy
ASWs SOPs
