Transcript C Zvandaziva1, B Engelsmann1, D Patel1, T Mukotekwa1, M

Strategies to include the private health
sector in a comprehensive national
PMTCT programme in Zimbabwe
Mujaranji,Grapper1; Patel, Diana1; Gwanzura, Evangelista1; Mahomva, Agnes²;
Engelsmann, Barbara1
1Organization
for Public Health Interventions and Development Trust (OPHID), Harare, Zimbabwe
²Elizabeth Glaser Pediatric Aids Foundation, Zimbabwe
Zimbabwe National HIV&AIDS Conference, Harare, 5-8 Sept 2011
Background
PMTCT Across all Health Sectors in
Zimbabwe
• Significant progress demonstrated in
expansion of national PMTCT programme
and uptake in public health institutions
• BUT Missed opportunities in the private
sector limit coverage of national PMTCT
programme
Background
What we know about the Private Sector
in Zimbabwe?
• No knowledge on who is delivering what
services to whom in PMTCT within the private
sector
• No formal mechanism for building capacity to
deliver PMTCT services in private health
sector
• No standardized quality control of PMTCT
services delivered by private health sector
Issues
• PMTCT service delivery in private health
institutions is
– Not standardized
– Not nationally coordinated
– Performance indicators such as uptake
and service provision not routinely
collected for the national system
– No formal mechanisms for quality control
or capacity building
Introduction
OPHID and the National PMTCT Programme:
• Family Aids Initiative (FAI) Consortium (EGPAF,
Kapnek , ZAPP, OPHID) support the Zimbabwean
Ministry of Health and Child Welfare and its
national PMTCT programme
• Within the FAI programme, the Organisation for
Public Health Interventions and Development
(OPHID) Trust supports the national PMTCT
programme in Marondera district
• District wide coverage only possible through
inclusion of district’s private hospital and its
referring clinics and private practices
Introduction
Marondera District:
• 16 public healthcare sites
• 4 registered private practices
• 1 private hospital
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Approaches
• OPHID Partner Provincial Coordinator
(PPCs) provides technical support at district
level
• Dedicated District Focal Person (DFP) covers
100% of sites/district present and
continuously available for reference;
• Formal and informal PMTCT training and
site support provided to institutional health
care staff as well as related supporting
cadres (TBAs, VHWs, and sensitization of
general hands);
Methodology
Inclusion of Private Sector in Marondera:
• In January 2009 initial approaches by OPHID were enthusiastically greeted
by the senior medical staff at the private hospital
• All staff including doctors at the private institutions sensitised on the
national PMTCT programme
• Nurses then orientated other staff members and
stakeholders/beneficiaries in family/child care
• Nurses from private health institution then formally trained in
PMTCT service delivery together with nurses in the public sector
• National MOHCW PMTCT data collection tools and registers
introduced and used according to national guidelines
• Implementation in private institution continues to be mentored
and technically guided by PPC and DFP
Outcomes
• Capacity built of private sector HCWs in PMTCT
• Individual, private clinics and private referral
hospital in the district now refer for or deliver HIV
testing, counselling and other PMTCT services to
pregnant mothers and their partners
• PMTCT service delivery in the private sector is now
aligned with current national MOHCW guidelines,
regularly updated and monitored as part of the
national programme
• The National M&E system now has the capacity to
capture more comprehensive data on PMTCT
coverage through inclusion of women accessing
PMTCT services through the private sector
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The Data
• In 2010 131 women were tested for HIV in
ANC and labour and delivery in the private
sector in Marondera as part of the national
PMTCT programme
• This is not a great number of beneficiaries but
when we are reaching for virtual elimination
of paediatric HIV every case counts
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Conclusion
 Inclusion of the private health
sector in the national PMTCT
programme delivering
comprehensive PMTCT services
created an opportunity to reach this
“hard to reach” population
 Expansion and monitoring of PMTCT service delivery
to the private health sector will be an important
strategy in the pursuit of scaling up PMTCT services to
reach national targets
Additional Observations
• A growing middle class, increased availability of generic drugs
and low cost medical insurance is leading to an expansion in
private medical care
• A large proportion of women – especially urban dwellers who
seek services at private health facilities - will get support for
antenatal care and PMTCT services in private clinics
• Possibility of Public/Private Partnership (PPP) helps to
leverage co-funding to increase PMTCT coverage and
programme impact e.g. Free VCT centre in private hospital
• Through PPP in national PMTCT programme beneficiaries can
receive integrated care into maternal-child health services
and linking mother’s HIV status to child is necessary for HIVinfected mothers and HIV-exposed children to receive
appropriate follow-up and treatment
Acknowledgements
• Financial support (USAID, UKAid, EGPAF)
• MOHCW Provincial and district health
executives
• Health care staff of health care institutions
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Thank you, Tatenda, Siyabonga!
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