INTEGRATING PMTCT WITH MNCH

SERVICES AT HEALTH FACILITIES

By: Dr. Maureen Kwikiriza

End of Fellowship report: 22nd March 2013

Host mentors: Dr. Francis Engwau and Dr.

David Serukka

Academic mentor: Dr. Elizabeth Nabiwemba

Roving mentors: Dr. Noerine Kaleeba, Dr. Olico Okui

Background about PREFA

• Local NGO formed in 2004 to contribute to Uganda’s effort in enhancing access to quality PMTCT services

• Funded by PEPFAR through CDC

• PREFA support includes:-

capacity building – hire, train, Mentor and coach Health workers

infrastructure improvement

facility based PMTCT service delivery monitoring

NATIONAL LEVEL: Policy/Guidelines

BEST PRACTICES: Document and share

-Document review

-Rapid assessment

-Consultations

-Train H/W

-Technical support

FACILITY LEVEL: Develop and implement integration plan for PMTCT /MNCH services

COMMUNITY LEVEL: Improve linkages

-MNCH/HIV

Quality of care

improvement tool

-Draft roles of VHTS -Train VHTS -Form FSGs

Act

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IPS

Up

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Terms of Reference and Achievements

Best practices

Participatory assessment and monitoring of integrated PMTCT and Postnatal care services

Exchange learning visits for health workers

Provide the data tools and orient health workers on recording

Timely dissemination of the new guidelines

Documents developed

Other activities

Program Officer for 3

months

Participated in developing

PREFA strategic plan

Participated in developing

protocols: PREFA M&E

protocol and the

BABIES surveillance

protocol

Coordinated events to

mark 2011 World AIDS

day

Provided technical

Support to Gender

department

Member of the Comm.

and Advocacy sub-

committee for the

Paediatric HIV/AIDS

conference

Publications

News paper articles: 5/6 articles published in New Vision paper

Oral presentations: Early infant diagnosis an opportunity for timely provision of effective care and treatment: PREFA experience from PMTCT-EID program, Wakiso district

Manuscript: Readiness of Public Health Facilities to Implement Integrated PMTCT and postnatal care in Uganda: Results from a Facility Assessment Study (submitted to BMC-Health Services Research)

Programmatic activity

Title: Integrating PMTCT with post natal care services in Uganda: Process Documentation and monitoring outputs

Background

• Uptake of PMTCT services during PNC services

remains low despite high immunization coverage

• Integrating PMTCT with PNC service will improve

service delivery

• PREFA thus piloted integration of PMTCT and PNC in

Wakiso and Nakasongola districts.

Objectives

1. To document the processes leading to implementation

of integrated PMTCT and PNC services

2. To monitor progress of outputs following the

implementation of integrated PMTCT and PNC

services

3. To identify best practices for PMTCT and PNC

integration

Participatory assessment phase 1. Orientation workshop on assessment framework and tools

2. Complete assessment of facilities including interviews with

health workers and observation of facility functioning

3. Collection of routine PMTCT data from registers.

Feedback and planning phase 1. Review of assessment results

2. Identification of areas of weakness

3. Target setting and action plans

Implementation and monitoring phase 1. Planned interventions implemented

2. Monthly support visits by the task force to

determine progress towards targets

Implemented at four health facilities from May to August 2012

Steps involved in implementation of integrated

PMCT/PNC services

PMTCT indicator performance following

integration (Nakasongola HC IV 2012)

0%

20%

40%

60%

80%

100%

120%

April May June July August September

<18 months done 1st PCR

Infants received results PCR

resultsHIV+ women received any

FP methodHIV+ mothers followed up in

community

Lessons learnt

Rapid assessment gives insight of the challenges

particular to a health facility

Data driven implementation of integrated PMCT /

PNC services increases uptake of PMTCT

interventions.

Way forward

• Manager HIV or MNCH program

• Write abstracts

• More publications

Challenges

• Program different from

research

• Working with district

Solutions

• Be open and willing to

learn

• Learn to be patient

Acknowledgements

• My Mentors

• PREFA staff

• Health workers

• DHO

• Fellow Fellows

• Fellowship program

staff

• Family