Transcript Mushavi_Community-Engagement-Zimbabwe

Zimbabwe: Engaging Community
in HIV and AIDS programming
Dr Angela Mushavi
National PMTCT and Paediatric HIV Care and
Treatment Coordinator
9/11/2012
IATT Webinar
IATT Webinar
• Zim’s community engagement program to
discuss the benefits, challenges, and barriers
to engaging communities in HIV prevention,
care, and treatment efforts
Zimbabwe
Population 12 million
PLHIV
1.1 million
CLHIV
150 000
HIV prevalence in ANC
16,1%
3
ZDHS 2010/11
• 15% of adults are HIV-positive. This is a significant
decrease from 18% in 2005-06.
– Currently, 18% of women and 12% of men are
infected
• HIV prevalence is highest in Matabeleland South
Province (21%)
• 12% of couples are discordant—meaning one partner is
infected and the other is not.
• 6% of young people age 15-24 are HIV-positive
Background of Zimbabwe
• 90 % ANC attendance-and only 19% in the first
trimester (ZDHS 2010/11)
• 86% of HIV positive pregnant women receive ARVs
for PMTCT (2011 data)
• 65% of live births delivered in a health facility*
• Maternal Mortality Ratio (MMR) has increased from
555/100 000 (ZDHS 2005/6) to 960/100 000*
• 26% of MMR is attributable to HIV/AIDS
• 21% of the Under 5 Mortality (<5MR) is attributed to
HIV/AIDS (MIMS 2009)
• Contraceptive prevalence rate is 66%* with unmet
need for FP of 13%
*ZDHS
2010/11
The 7 Strategic Objectives of the eMTCT Plan
1. Strengthen program leadership, management,
coordination and supervision of sites
2. Strengthen provision of quality PMTCT and
Paediatric HIV treatment services integrated within
the MNCH platform
3. Strengthen human resource capacity
4. Strengthen the supply chain management system
for commodities
6
The 7 Strategic Objectives of the
eMTCT Plan
5. Strengthen laboratory capacity to support
eMTCT
6. Strengthen community involvement and
participation
6. Improve generation, dissemination and use
of strategic information
Bottlenecks to eMTCT that Community
Based Workers Can Best Tackle
• Late booking for ANC
• Low percentage of pregnant women
presenting for at least 4 ANC visits
• Low proportion of institutional deliveries
• Low male participation
• Low postnatal mother-baby pair follow-up
rates
N.B. Indeed community based workers can deal
with all of the bottlenecks along the
PMTCT/EID cascade
Zimbabwe’s Village Health Workers
The History of Village Health Worker Programme
• The VHW dates back to 1981, when Ministry of Health
and Child Welfare introduced this cadre for the first
time at community level (PHC approach)
• Cadre is selected by her own community, and trained
for 8 weeks
• Works on assigned duties part time-and stays in own
community
• The VHW program is national; with a strategy-and is
managed by the Director of Nursing Services in the
MOHCW
• Anticipated to have 15 000 VHWs in post
Village Health Worker (VHW) program: an
Opportunity in PMTCT implementation
• VHWs have become
important in tackling
HIV
• For PMTCT, VHWs
encourage
• Early ANC booking
and repeated ANC
attendance
• HIV testing
• Facility deliveries
• Postnatal motherbaby pair follow-up
•Picture: Courtsey of Zvitambo
Village Health Care Workers in PMTCT
• Global Fund supports the VHW program currently;
though this should be by MOHCW (budgetary
constraints)
• Zvitambo supports VHWs in 2 of the country’s
districts
• Elizabeth Glaser Pediatric AIDS Foundation (EGPAF)
is supporting VHWs to scale-up eMTCT in 8 districts
• Early reports: average age at booking has improved
to 21 weeks gestation-from average 25 weeks at
booking
ZAPP’s Community Involvement in the
PMTCT Program
• ZAPP-UZ: first in Zimbabwe to meaningfully involve
community in PMTCT as peer counsellors-known as
community mobilisers (CMs)
• CMs are men and women who have benefited from
the PMTCT program
• Recruited in collaboration with the Community
Advisory Board in Chitungwiza - link between
community and health services
• Trained to serve as community advocates; mobilizing
and educating communities on PMTCT, EID and
pediatric treatment
ZAPP-UZ Community Mobilizers Performing
Drama at a Church Meeting
MSF support for mentor mothers in
Bulawayo
• Modelled along the lines of the M2M program in
South Africa
• Women living with HIV provide support to other such
women during pregnancy and beyond (mother-infant
pairs)
• 24 mentor mothers each looking after 15 clients at
any given time
• Promising results coming out of clinic sites where
mentor mothers are operating
RESULTS - PROGRAMMATIC DATA
P value
<0.0005
After testing - did mother obtain result?
P value
<0.0005
Male participation in PMTCT
• Countries within sub-Saharan Africa are mostly male
dominated communities: Men give permission to
the woman to seek care, give money for transport
and even decide whether the woman should fall
pregnant or not
• Low male participation places eMTCT efforts at risk;
and women face the threat of GBV and dissertion
especially if they disclose an HIV positive status
• Initiatives such as the male champions initiative
supported by UNICEF; as well as Padare Men’s
Forum (UNAIDS) are implemented to tackle this
Male Partner HIV Testing in ANC in
Zimbabwe
Community initiatives key to tackling
low male participation in eMTCT
• An organization called Padare/Enkundleni/Men’s
forum on gender, is leading an initiative to strengthen
the capacity of traditional leaders (chiefs) to increase
male participation HIV and AIDS programming
• Given an opportunity, men can be positively engaged
to address issues of low male participation in health
and improve male health seeking behaviour as it
relates to HIV testing treatment and supporting
women for PMTCT
• Results: in 1 district, male participation in PMTCT has
increased to 70% (with a national average of 10%)
Padare Works Through the Chiefs
Challenges to engaging communities in HIV
prevention, care and treatment
• There are many different organizations with different
community cadres and it is difficult to harmonize all of
them in terms of
– Scope-what they do
– How they work
– Allowances and support for travel and
communication e.g. airtime for cell phones
• There are issues of confidentiality where clients visited
by community based cadres may feel that there will be
inadvertent disclosure of their HIV status (dealing with
stigma and discrimination)
• Dealing with community cadre burnout-care of carers
Recommendations
• There is no underestimating the role that
communities can play in supporting HIV
prevention, care and treatment programs
• Various initiatives are in place-and all of these
will need to be scaled-up and probably
harmonized to allow attainment of goals for
HIV prevention care and treatment
• And in-country, the discussion is how to scaleup these initiatives for nationawide coverage
Acknowledgements
•
•
•
•
•
•
•
•
•
•
MOHCW Director Nursing Services
MOHCW PMTCT Program
National AIDS Council
EGPAF
ZAPP-UZ
Zvitambo
MSF Zimbabwe
UNICEF
UNAIDS
Padare
Thank you
Tatenda
Siyabonga
24