S ince 2008, the USAID Bureau for Global Health’s flagship Maternal and Child Health Integrated Program (MCHIP) has worked in more than 50 developing countries in Africa, Asia, Latin

America and the Caribbean to improve the health of women and their families. MCHIP supports programming in maternal, newborn and child health, immunization, family planning, nutrition, malaria and HIV/AIDS, and encourages opportunities for integration of programs and services when feasible.

MCHIP addresses the barriers to accessing and using key evidence-based interventions

across the life stages—from pre-pregnancy to age 5—by linking communities,

primary health facilities and hospitals. By helping countries identify and focus on

those innovations that will save lives, MCHIP supports delivery of evidence-based

interventions through strengthening government health systems, nongovernmental

organizations and other local partners.

MCHIP’s overall strategic approach is guided by five interrelated principles:

• Taking high-level impact interventions to scale

• Ensuring country ownership

• Creating change through global and regional influence

• Improving measurement and use of data at the country and global levels

• Expanding coverage through integrated approaches

MCHIP brings together a partnership of organizations with demonstrated success in reducing maternal and child deaths:

Jhpiego ICF InternationalJohn Snow, Inc. (JSI) Broad BranchSave the Children PSIPATH JHU/IIP

Introduction

Greater availability of misoprostol enables trained community health workers to save the lives of women who give birth in areas that are far from health facilities.

Twenty-five-year-old Epiphanie felt her labor begin and immediately called

Immanaculee, an MCHIP-trained community health worker who supports the families

in Bugosa village in the Gakenke district of Rwanda, where she lives. Immanaculee

had educated Epiphanie on the importance of making regular prenatal care visits and

encouraged her to deliver at the health center, where she would have access to medicine

and trained providers.

Immanaculee accompanied Epiphanie on the hilly, five-kilometer trek to the health

center, but the baby would not wait. The health worker quickly found a hidden area

along the way and covered the spot with the colorful cloths that women traditionally

wrap around their waists. There, she helped Epiphanie deliver a healthy baby girl named

Patiente.

Immediately after the baby was born, Immanaculee gave Epiphanie a lifesaving drug

called misoprostol, which she had learned about in her training. When used in the first

two hours after delivery, misoprostol is highly effective at preventing excessive bleeding

after childbirth, known as postpartum hemorrhage (PPH).

PPH is the leading cause of death among pregnant women globally, and in Rwanda

an astounding 45% of women who perish during childbirth die from PPH. Making

misoprostol available to mothers is particularly important for women in remote areas,

who might have difficulty reaching a facility to give birth. Through this Rwandan pilot

program—and many other USAID/MCHIP activities being carried out globally—more

than 700,000 women have received this lifesaving medicine.

Epiphanie

Over the last two decades, the global community has witnessed remarkable reductions in the number of maternal deaths worldwide. Yet, too many women still die in pregnancy and

childbirth from treatable complications—nearly 800 women per day.

Postpartum hemorrhage (PPH) and pre-eclampsia/eclampsia (PE/E) together account

for more than 40% of maternal deaths. To combat this, MCHIP works in 30 countries

to promote access to lifesaving interventions for pregnant women, and address a

number of areas integral to improving outcomes for mothers and their babies, such as

malaria in pregnancy and care for women affected by HIV. MCHIP provides leadership

and technical assistance at the global and country levels for an integrated package

of interventions to address PPH, PE/E, preterm birth, maternal anemia and other

complications. MCHIP was a key contributor to new World Health Organization

(WHO) recommendations on PPH and PE/E. A critical change advocated by MCHIP was

the provision by lay workers of misoprostol, a lifesaving drug taken immediately after

birth to prevent excessive bleeding.

Many women still give birth at home and MCHIP strives to deliver interventions

that can reach these women. This means that a woman has access to a skilled birth

attendant, as well as the lifesaving drugs she may need. MCHIP recognizes that a skilled

birth attendant, such as a midwife, doctor or nurse, is critical to a safe and successful

delivery. The program works to increase access to these health workers, and has

spearheaded competency-based trainings and development of resources to build provider

skills and confidence, not only in maternal health but in essential newborn care and

family planning as well. Respectful Maternity Care is woven into all aspects of MCHIP’s

work to strengthen skilled birth attendance.

Quality-of-care studies, conducted in seven countries, and a Multi-Country Analysis

Survey shed light on critical quality-of-care, health system and policy issues, allowing

governments to identify gaps and work toward solutions to prevent and manage the

leading causes of maternal death. Survey results have been used for advocacy at

national and global levels, including contributions to recommendations of the UN

Commission on Life-Saving Commodities.

Maternal Health

In spite of existing high-impact interventions for newborn health, nearly 3 million babies die each year within the first month of life, and more than three-quarters of these deaths occur in sub-Saharan

Africa and South Asia. Improvements in the prevention of newborn death have lagged behind those for maternal and child health.

MCHIP has assisted 37 countries in addressing the three main causes of newborn death:

prematurity, birth asphyxia and infections. There is substantial evidence that the vast

majority of these deaths can be prevented if mothers and newborns receive proven

low-tech solutions.

The program works to expand the use of lifesaving practices and availability of

commodities through global advocacy, collaboration with country leadership, health

worker trainings and system strengthening. In Liberia and Madagascar, for example,

MCHIP collaborated with partners to institute use of chlorhexidine on a baby’s

umbilical cord at birth for prevention of newborn infections. Bangladesh has also

recently adopted this intervention. This is a simple technology with the potential to

prevent an estimated 500,000 global newborn deaths each year.

MCHIP supports health service providers through training and the development of

resources covering lifesaving practices in newborn care. In Ethiopia, MCHIP helped

standardize newborn health education and supported the training of

24 national trainers and 256 health workers in newborn care including

resuscitation. Over the course of one year, these workers saved the lives

of more than 578 babies who had stopped breathing at birth.

MCHIP recognizes that the sharing of experiences between countries

is essential for adoption and expansion of newborn health services, so

it seeks to create platforms for countries to have the opportunity to

engage in dialogue around maternal and newborn health. In April 2013,

MCHIP and partners hosted the Global Newborn Health Conference

in Johannesburg, South Africa. As a result of this conference, many

countries, including Bangladesh, India, Liberia and Sierra Leone, have

pledged to improve the availability of and access to key neglected interventions such as

Kangaroo Mother Care and the use of antenatal corticosteroids.

Newborn Health

Sixty seconds can mean the difference between life and death for a newborn who isn’t breathing. That’s the window of time a health care provider has for resuscitation before a baby suffers injury from lack of oxygen. Jubaida Shirin knows how quickly that golden minute can tick by.

Jubaida Shirin, a community-based skilled birth attendant in Habiganj District

in Bangladesh, received a call from one of the women she routinely visited during

pregnancy. Minara Khan was in labor. When Shirin arrived at Minara’s home, she

examined Minara and found that Minara’s baby was in the breech position. She quickly

applied her training to deliver the child, but as she dried and wrapped the infant, she

heard no cries.

The baby girl wasn’t breathing.

Shirin put the newborn girl on her left side on the mother’s abdomen and tried her

hardest to stimulate the baby’s breathing by rubbing the skin over her backbone. The

tiny girl did not respond. Shirin next began resuscitating the child using a bag and

mask, just as she had been trained to do. It worked! Her training paid off.

Baby Shifa survived and is

now a healthy toddler.

Jubaida received her

resuscitation training

through a pilot study of the

Helping Babies Breathe

initiative, sponsored by

MCHIP and partners.

Due to the success of

the program and the

strong commitment of the

Bangladeshi government

to women’s and children’s

health, training in newborn

resuscitation is now

available across the country. About 1,700 health facilities have been equipped with

resuscitation equipment, and nearly 500 health facilities have received Helping Babies

Breathe training materials. Birth attendants throughout Bangladesh now have the

knowledge and confidence to save the lives of babies like Shifa.

Shifa

Tremendous achievements have been made in decreasing the number of deaths of children under the age of 5. The rate of these improvements, however, varies greatly from region to region.

In sub-Saharan Africa, for example, 1 in 9 children dies before the fifth birthday—more than 16 times the average for developed regions. For Southern Asia, about 1 in 16 children dies before age 5. The good news is that the primary killers of children—pneumonia, diarrhea and malaria—are preventable and treatable.

MCHIP has been a vital contributor to the global movement to end preventable child

deaths, working to improve access to lifesaving treatments at both a global and country

level—having worked in 17 countries. The program recognizes that efforts to end

preventable child deaths will be successful only when treatment is available to the

populations most at risk. MCHIP has been at the heart of efforts to expand integrated

Community Case Management (iCCM), a strategy to extend the management and care of

childhood illness beyond health facilities. The package addresses diarrhea, pneumonia

and malaria, and is often extended to include newborn health and malnutrition.

Diarrhea and pneumonia have long been the “forgotten” killers of children under the

age of 5. Through global advocacy, MCHIP has worked with USAID, UNICEF, WHO

and other key partners to refocus global attention on these illnesses and to increase

momentum to address these killers. The development of the Global Action Plan for the

Prevention and Control of Pneumonia and Diarrhea (GAPPD) and the Diarrhea and

Pneumonia Working Group are two examples of this essential shift.

At the country level, MCHIP works to develop child health policies, empower health

workers and ensure that clinicians are trained to accurately identify and manage

childhood illness. In Kenya, for example, MCHIP worked hand-in-hand with national

ministries to reclassify zinc to make it available to treat diarrheal disease without a

prescription and to establish a national plan to introduce iCCM.

A health worker in Mali improves the health of an entire village by enlisting the help of the community.

Samata village in Mali is a rural, agricultural

community located more than 20 miles from

the nearest health center. Lack of accessible

and high-quality health services was taking

the lives of the children. Villagers would walk

for hours to seek care when their children

were sick.

Toumani Dagno applied for a position

as a community health worker through

the Community Essential Care program,

implemented by MCHIP in collaboration with UNICEF and other partners. He received

training to provide basic health care to the community and was assigned to Samata to

provide treatment to children suffering from diarrhea, malaria and pneumonia.

Toumani quickly became popular in Samata for his kindness and dedication as well as

the quality of the services he provided. In only six months, he treated more than 600 sick

children.

Toumani recognized that he could have an even greater impact by empowering

community members to take care of their own health. He engaged the village authorities

and worked with community women and youth groups to organize educational

campaigns, including the weekly community “Day of Safety.” With Toumani’s

encouragement, the village began promoting proper handwashing and building latrines.

More than a year after Toumani began working in the village, Sidibe Bourama, advisor

to Samata’s chief, remarked on the decrease in deaths.

“Because of the presence of Toumani, we have not yet registered any child deaths,” he

said.“There is less travel to the health center to treat children, and this has reduced the

burden on families for the transport and care.”

Child HealthToumani

MaternalHealth

NewbornHealth

ChildHealth

MalariaPrevention

& Treatment

FamilyPlanning

Immunization

Preventionof HIV/AIDS

AnIntegratedApproach

MCHIP ensures an appropriate mix of interventions across the life cycle and along the household-to-hospital continuum of care. As each partner takes the lead in developing programs around a speci�c technical area, MCHIP is able to respond to the needs for a more integrated approach to services.

Globally, maternal and child deaths are signi�cantly decreasing. MCHIP activities contribute to these global reductions in maternal and child deaths, and improve the health of women (from planning a family through pregnancy and delivery) and their children (from infancy through childhood). At the household, community and hospital levels, MCHIP implements and works to scale up high-impact interventions.to Global Gains in Maternal, Newborn and Child Health

The major causes of maternal deaths are postpartum hemorrhage (PPH) and pre-eclampsia/eclampsia (PE/E) which together account for more than 40% of maternal mortality.

Immunization is estimated to prevent the deaths of 2 to 3 million children each year. But another 1.5 million children still die from diseases that could be prevented by vaccination.

Child pneumonia remains the leading cause of death among children under 5, accounting for 1 in 5 child deaths globally.

Over 3.6 MILLION women were counseled on family planning as part of integrated essential care services at MCHIP-supported facilities over the last 5 years.

were attended by a skilled attendant in MCHIP programs.

Over

Over

women were provided AMTSL.

Sustaining these achievements requires improved national policies, training and contributions to global learning

Across MCHIP countries, USG-supported training programs graduated nearly 282,000* participants.Over the life of the project, 155 national policies were drafted with USG support.

*Actual total for life of project is 281,834 total participants (Program Year 1 through Program Year 2 did not count unique individuals).

expanded postnatal care and essential newborn care.

introduced PPIUCDs with MCHIP assistance.

immunization programs in

MCHIP has provided technical support to strengthen routine

Through MCHIP-supported programs, over

cases of child pneumonia were treated with antibiotics.

expanded implementation of ORT and zinc for treatment of diarrhea.

MCHIP supported the treatment of over

cases of child diarrhea.

underutilized vaccines (Penta, PCV and Rota) in

MCHIP has provided technical support to introduce new and

Over the life of MCHIP, more than...

children received DTP3 (from MCHIP supported immunization programs).

expanded Kangaroo Mother Care.

Helping Babies Breathe resuscitation programs in

Antibiotic treatment for over

FAMILY PLANNING MATERNAL HEALTH NEWBORN HEALTH CHILD HEALTH

30% of maternal deaths could be prevented simply by ful�lling the unmet need for family planning.

MCHIP is working in more than 40 countries worldwide.

MCHIP CONTRIBUTIONS YEARS 1–5

1.8 MILLION couple years of protection to avert pregnancy were supported by MCHIP family planning services. 953,000

1.5

309,000

190,000

88

6

740,000

13introduced PE/E prevention and treatment.

15 expanded PPH prevention programs.30

improved skilled attendance at birth.19

25 11

14

An estimated 85% of all deaths from malaria occur in children under 5. In malaria-endemic areas, 50 million women will become pregnant each year. These women are highly susceptible to the

consequences of malaria, which lead to increased maternal death and severe maternal anemia, low birth weight and infant death.

MCHIP works to control malaria, focusing on the prevention and treatment of the

disease among the most vulnerable groups—women and children in low- and middle-

income countries. The program contributes to global programs and partnerships, most

notably by working with the Roll Back Malaria partnership and the President’s Malaria

Initiative (PMI).

Through these high-level, global partnerships, MCHIP has helped focus attention on

the importance of addressing MIP, including assisting with the rollout of WHO global

policies regarding MIP prevention and treatment to countries across sub-Saharan

Africa.

At the country level, MCHIP has supported Ministries of Health in 20 African countries

to increase malaria prevention and treatment, integrated with maternal and child

health and HIV programming. Through PMI’s Malaria Communities Program, MCHIP

supports efforts of communities and nongovernmental organizations to combat malaria

at the local level.

Because malaria is one of the leading killers of children under the age of 5, MCHIP

strengthens malaria prevention and treatment services for children by working

with countries to introduce and scale up integrated Community Case Management

(iCCM). The iCCM strategy extends lifesaving treatment to children without access to

health facilities by training community health workers in remote villages in the case

management of childhood illness.

By training providers of routine care for pregnant women in Burkina Faso, the National Malaria Control Program keeps more women malaria-free during their pregnancy.

Adissa Silga had traveled to the local health clinic for prenatal care and to protect

herself and her unborn child against malaria, a disease endemic to this rural area about

a two-hour drive from Burkina Faso’s capital. But the side effects of the chloroquine

pills made her ill and she stopped taking them, which left her at risk of contracting

malaria. Indeed, she later became sick from the disease.

“This type of treatment was very hard for me because I often forgot to take my tablets,”

Adissa said. “Sometimes I avoided taking them because of side effects such as dizziness

and itchiness and, therefore, I contracted malaria and had to stay in the health center

for care. Pregnancies were very hard for me.”

Through the MCHIP-supported National Malaria Control Program, Adissa benefited

from an improved prevention regime to help keep her malaria-free during her next

pregnancy. The program works at the national, regional and district levels to build

capacity and strengthen health systems for malaria control and prevention services. The

program pays particular attention to pregnant women and children under the age of 5,

who bear the heaviest burden of malaria.

Each year, approximately 750,000 women in Burkina Faso become pregnant and are at

risk of malaria, which leads to higher rates of maternal anemia and low birth weight

babies. In order to reach more women with interventions to reduce the dangers of

malaria in pregnancy, MCHIP focuses on training the health care providers who see

women during regular antenatal care visits. Since the program began in 2009, MCHIP

has trained health care providers from 17 districts.

Adissa has become a new champion for the program: “I can tell you that I feel better. I

would like to encourage each pregnant woman to attend health facilities and that their

pregnancy will be safe and they will have healthy babies.”

Malaria Prevention and Treatment Adissa

Worldwide, 222 million women currently wish to delay or prevent pregnancy, yet do not use contraceptives to plan their family. The reasons for non-use are complex, involving social, cultural

and economic barriers, fears about side effects and lack of access to a trusted provider. There is significant evidence, however, that greater access to family planning can be vital to achieving global goals in maternal health and child survival.

MCHIP has helped 21 countries integrate postpartum family planning (PPFP) into

maternal, newborn and child health programming, averting unintended pregnancies

and promoting healthy spacing between pregnancies. MCHIP takes advantage of the

frequent contact women have with health care providers during a pregnancy, birth,

and child health and immunization services to integrate PPFP counseling and services

whenever possible. The program has also developed materials to educate and advocate

for expanded access to the postpartum intrauterine contraceptive device as a reliable

and convenient method of family planning, as well as screening and referral processes to

offer PPFP linked with child health visits.

MCHIP generates and disseminates information on the benefits of integrating PPFP

with maternal, newborn and child health services. In Bangladesh, for example, MCHIP

worked with Johns Hopkins University to conduct the Healthy Fertility Study to

examine the effect of an integrated package of services delivered by a female community

health worker on key newborn and infant health practices and use of PPFP to achieve

healthy pregnancy spacing. The study’s positive results influenced other programs in

Bangladesh to adopt the practices, leading to successful scale-up of these practices.

At the global level, MCHIP is a leader in the effort to gather evidence, build consensus,

advocate and innovate around PPFP. An MCHIP-facilitated PPFP Community of

Practice draws attention to the barriers that restrict postpartum women’s access to

family planning and tests solutions to address them. MCHIP was an integral partner

with USAID and WHO on the development of the Statement for Collective Action for

Postpartum Family Planning and the forthcoming WHO document on Programming

Strategies for Postpartum Family Planning, garnering global support for PPFP.

An auxiliary nurse-midwife in India educates her community about options for family planning after birth.

Seema Verma is on a mission. An auxiliary nurse-midwife in Uttarakhand, India,

the mother of two wants to help other women make an informed choice about family

planning services, just as she was able to do.

“I want to pass on the same hope and

possibilities to other women in my

community,” she said.

When Seema was pregnant for the second

time and looking for a viable, long-term

family planning method, she received

counseling from a visiting team from MCHIP.

They explained the importance of using

contraceptives after delivery to delay or

prevent the next pregnancy. They also gave

her information about the intrauterine contraceptive device (IUCD), which can be

inserted within 48 hours of delivery.

Seema chose to deliver her baby at Women’s Hospital in Dehradun—an MCHIP

intervention site—so that she could get an IUCD immediately after the birth of her

daughter, Ritika.

For Seema, an IUCD was the best family planning choice for many reasons: It lasts

for 10 years, could be inserted while she was still in the hospital and was free under

government policy. Moreover, she appreciates that she does not need to remember to

take a pill every day.

Seema was so enthusiastic

about her family planning

decision that, while resting

in the postpartum ward, she

counseled two other women

who were sharing the room

with her. They too chose to

have an IUCD inserted. Seema

is optimistic that her decision

offers a promising future for her own two daughters. As one of four children in a poor

family, Seema struggled to finish her schooling and became the most educated member

of her family.

“I want my daughters to study more than me,” she said. “My husband and I want to work

hard to make this possible.”

Family PlanningSeema

The collaboration of civil society is pivotal to achieving global aims to end preventable maternal, newborn and child deaths worldwide. Many international nongovernmental organizations

(iNGOs) and their in-country partners reach underserved and vulnerable populations with low-cost, high-impact interventions. They are also often at the forefront of developing practical solutions to the barriers they encounter on the ground related to implementation and scale-up of integrated intervention packages to inform national policies and strategies.

MCHIP supports iNGOs through USAID’s Child Survival and Health Grants Program

(CSHGP)—currently 32 projects in 24 countries—the majority of which involve

partnerships with academia, Ministries of Health and other local entities to implement

and test approaches that bridge gaps in the household-to-health-facility continuum of

the health system.

The MCHIP team provides technical assistance to the grantees in program design,

monitoring, implementation and evaluation, including operations research. This

capacity building promotes a standard level of quality and rigor across projects.

MCHIP also works closely with the CORE Group to foster communities of practice and

contribute to global learning for community health.

Operations research supported through the CSHGP contributes to national and global

evidence. Topics included smart integration of services, civic participation, private-

public partnerships, promoting and advancing equity, community health system

capacity building, and the introduction of low-cost technologies to improve access and

efficiency of health interventions.

Grantee work has also been included in recent peer-reviewed publications including:

Health Policy and Planning (February 2013), demonstrating plausible evidence for child

mortality impact, and Global Health: Science and Practice (March 2013), documenting

improvements in under-nutrition at scale in Mozambique, using the Care Group Model.

Catholic Medical Missions Board (CMMB) implemented a President’s Malaria

Initiative-funded Malaria Communities Program project in three districts of Luapula

Province, Zambia, from 2009 to 2012. Kawambwa, Mwense and Samfya districts are

among those with the highest burden of malaria in the country. Through community

mobilization by community volunteers and traditional leaders, CMMB increased

uptake of malaria prevention and care-seeking and addressed gaps in knowledge and

misconceptions about the use of long-lasting insecticide-treated bed nets (ITNs) and

prevention of malaria in pregnancy.

Just after receiving their award from the President’s Malaria Initiative (PMI), CMMB

staff joined staff from the 19 other PMI grantees in Nairobi, Kenya, for an MCHIP-

designed and -led training on Program Design, Monitoring, and Evaluation. During the

training, CMMB defined specific project objectives, developed indicators to measure

progress and outcomes, and drafted a monitoring and evaluation plan.

To measure coverage of key interventions and

behaviors and assess project success, CMMB

conducted baseline and endline population-

based coverage surveys. This was the first time

CMMB had implemented such an exercise in

Zambia. MCHIP worked closely with CMMB

to prepare survey methodology and tools, and

provided on-the-ground training for CMMB

survey enumerators and supervisors. With

the experience gained through the baseline

exercise and ongoing technical assistance

from MCHIP, CMMB was able to conduct

the endline survey independently. CMMB

measured increases in household ITN

ownership, ITN use by children under the age

of 5 and treatment-seeking for children with

fever.

Throughout CMMB’s three-year project,

MCHIP reviewed drafts of CMMB’s project

work plans, M&E plan and reports to PMI,

providing support and recommendations to strengthen project implementation and

monitoring progress. MCHIP provided technical assistance to 20 NGOs in PMI’s

Malaria Communities Program.

Support for Nongovernmental Organizations, Innovation and Collaboration

Catholic Medical Missions Board (PVO/NGO)

G lobally, immunization prevents 3 million child deaths each year, and WHO estimates that 17% of the remaining under-5 deaths—approximately 1.5 million deaths annually—could be prevented

with existing vaccines. Success in reducing vaccine-preventable mortality has been dramatic, but it cannot be taken for granted.

Achievements in immunization must be maintained and built upon every year. While

infant vaccination coverage in some countries now exceeds 80%, coverage is not the

only measure of success. Before they are exposed to disease, women and newborns must

be reached by both potent vaccines and high-quality services in a timely, safe, effective

and affordable manner so that they return to complete all of their doses. Coverage

disparities also continue within countries, with few countries reaching 80% or higher

coverage in all districts.

MCHIP is dedicated to ensuring that every infant and woman of childbearing age in the

developing world is fully immunized. A great deal of work and planning must take place

behind the scenes before a country can introduce a new lifesaving vaccine. The MCHIP

team applies its technical expertise to support 15 countries through every step of the

introduction process and strengthen routine immunization. When possible, MCHIP

explores opportunities to integrate immunization services with the delivery of other

interventions.

MCHIP programs aim to reach the hard-to-reach and marginalized groups to improve

access, use and equity. The program works with Ministries of Health, civil society

and other partners to identify and prioritize under-immunized populations and

operationalize the Reaching Every District approach.

MCHIP also recognizes that it is important not only to achieve high, countrywide

coverage of each vaccine, but also to ensure that success is sustained even after

coverage goals have been achieved. To prevent outbreaks, uniform and consistently high

coverage is needed everywhere, year after year.

MCHIP works closely with international organizations, such as the GAVI Alliance,

WHO and UNICEF, on important global and regional initiatives. For example, the

program provided technical support to WHO to assist with the response to the pandemic

H1N1 influenza. MCHIP also serves on many global advisory bodies to use its in-country

experience to influence immunization policy and strategies.

With meticulous planning and a dedicated staff, the Senegal Ministry of Health protects the population from meningitis through a successful vaccine rollout.

In November of 2012, Senegal became the ninth country in the “meningitis belt”—a band

of 26 countries stretching from Senegal to Ethiopia—to introduce the effective, low-cost

MenAfriVac vaccine through the Meningitis Vaccine Project (MVP), a partnership

between WHO and MCHIP partner PATH. In countries where the vaccine has been

introduced, there has been a dramatic reduction in reported meningitis cases.

The Senegalese Ministry of Health

launched a two-week immunization

campaign in one of the areas of the country

most severely affected by meningitis

outbreaks. Vaccination campaigns

typically target infants under the age of

one, so this project produced a particular

challenge in that it targeted the region’s

1- to 29-year-olds—nearly 4 million people.

Organizers needed to take a creative

approach to reach this population by

sending campaign volunteers to the many

places where they would find young

people—at work, markets, universities, military camps, prisons, taxi stands, workshops

and in the fields. They traveled by automobiles, bikes, motorcycles and even carts pulled

by donkeys and horses.

MCHIP was a key technical partner in supporting the preparation and implementation

of the campaign. There are many elements that must be planned and considered before

an immunization campaign can even begin, such as public information, staff training,

transportation and distribution logistics, community partnerships, crowd control,

surveillance and planned active monitoring following the campaign to measure the

coverage, quality and impact of the effort.

The launch and distribution of the MenAfriVac vaccine were successful due to the

meticulous organization and careful management of the processes.

Immunization

Senegal Ministry of Health

HIV is a leading cause of death among women of reproductive age and a major contributor to maternal mortality in high-prevalence settings. According to recent estimates, HIV-infected pregnant

or postpartum women have about eight times higher mortality than their counterparts who are not infected with HIV. Moreover, despite a 24% drop in new pediatric infections, 900 children are still newly infected every day.

For the first time, the global community has the tools needed to virtually eliminate

pediatric HIV and keep HIV-infected women alive and healthy. MCHIP continues to

focus on a strategic approach that

has helped 16 countries scale up

high-impact interventions to prevent

new infections and ensure that HIV-

infected persons are linked to the

care and treatment they need.

To eliminate mother-to-child

transmission of HIV, MCHIP engages

communities to increase access to

services and ensure that women

are utilizing the services. When

and where appropriate, MCHIP

integrates HIV services with other

maternal and newborn health

programs to ensure that women and their families receive the appropriate care they need

for all aspects of their health.

MCHIP is committed to reaching the unreached and underserved populations with

comprehensive HIV services. By adapting the Reaching Every District approach for

prevention of mother-to-child transmission in Kenya, MCHIP and the district health

office increased coverage of community health workers in Kenya’s Bondo district from

38% to 100% in two years. This led to an improvement in earlier first antenatal care

visits (from 45% to 76%) as well as labor and delivery coverage in the new facilities (5%

to 15%).

MCHIP has made great strides in the implementation of voluntary medical male

circumcision (VMMC) services, ensuring that the programs are truly country-owned and

integrated within existing health systems. In addition to serving as global advocates for

the intervention, MCHIP has implemented VMMC programs in three countries: Malawi,

Lesotho and Tanzania. As of June 2013, nearly 200,000 MCHIP-supported VMMCs had

been performed.

HIV testing and counseling (HTC) remains a critical gateway to treatment, care and

prevention interventions. MCHIP works with countries to improve HTC systems and

conduct HTC research. In South Sudan, MCHIP’s work with 56 health facility staff from

15 facilities meant that staff were trained in testing and counseling; this enabled the

staff to test 4,500 people by January 2013.

Community health workers in Kenya are creating an AIDS-free generation one pregnancy at a time.

Beatrice and Grace are proof that an AIDS-free generation is within our power. The two

mothers live in the Bondo district in Kenya, where 20% of the community is infected

with HIV, including Beatrice and Grace. Both women, however, gave birth to healthy,

HIV-negative babies thanks to help from community health worker Jane Akoth of the

Barkowino Community Unit.

During their pregnancies, Jane saw Beatrice and Grace regularly, either through home

visits or appointments at the clinic, to ensure that the women were well and their

pregnancies remained healthy.

“I like working with these two. They are very good at following advice,” said Jane.

“Both attended all four of their antenatal clinics and also adhere to their medication.”

And both women are grateful for Jane’s support.

“After I delivered my baby, Jane advised me on how to take care of my child by exclusive

breastfeeding for six months and to continue taking my medication,” Grace said. “I

request Jane to continue doing what she is doing so that she can help other mothers.”

Jane is among more than 300 community health workers whose outreach has resulted in

impressive gains. Since 2010, the number of community units under the program more

than doubled, expanding coverage to women living in the most hard-to-reach areas of

Bondo district. As a result, more women are taking advantage of these services—the

percentage of expectant mothers going to all four antenatal care visits increased from

25% to 41% in two years, and the percentage of HIV-exposed infants who were tested for

HIV increased from 27% to 78%.

Prevention of HIV/AIDS

Beatrice and Grace

• Recognizes that more women and children will have improved health outcomes if they have high-quality health services

• Values equitable care in all phases of the work it does to reach the unreached

• Increases the impact of tested health care innovations by taking them to scale

• Integrates services, where feasible, to ensure there are no missed opportunities to provide care

• Provides services within the community while also maintaining and improving services at facilities

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