CHRISTIAN HEALTH ASSOCIATION OF MALAWI CHAM HIVAIDS PROGRAM

CHRISTIAN HEALTH ASSOCIATION OF MALAWI (CHAM)- HIV/AIDS PROGRAM 1

CHAM BACKGROUND • An ecumenical umbrella organization that coordinates provision of health care in church-owned health facilities in Malawi • Owned by Episcopal Conference of Malawi and Malawi Council of Churches. • Membership of 172 health facilities of various sizes, located across the country, 80% of which are in hard to reach areas. It has also 10 training Colleges • Provide about 37 -40% of the health care service delivery in Malawi 2

HIV SITUATION IN MALAWI q HIV prevalence in Malawi for adult population 12% (Sentinel Survey 2007) q Prevalence of HIV in Antenatal mothers 12. 6% (Sentinel Survey 2007) q Prevalence among pregnant women had declined from 22. 8% in 1999 to 13. 5% in 2009 as measured through ANC sentinel surveillance. q 52% of pregnant women were tested for HIV in 2009. q An estimated 58% of mothers and 41% of HIVexposed infants were provided with ARVs for PMTCT in 2009. 3

CHAM PARTNERSHIPS IN HIV PROGRAMMES 4

PARTNERSHIPS FOR HIV RESPONSES. CHAM has an MOU with Govt. that supports q. Staff salaries in all CHAM facilities q. SLA (currently 38%, 66 of 172 facilities) q. Student scholarships- PEPFAR During trainings they are also equipped with HIV info. To support facilities once they graduate. q 40% & 60% of the graduates go to CHAM & GOVT. respectively. 5

OVERAL OBJECTIVES q. Strengthen the capacity to prevent HIV/AIDS; provide care, support and treatment and mitigate the impact of the epidemic q. Strengthen the delivery, coordination, scale up and monitoring of HIV/AIDS services in the faith-based health sector in Malawi. 6

1. 2. 3. 4. 5. 6. SPECIFIC OBJECTIVES OF HIV/AIDS PROGRAMS IN CHAM Strengthen quality of PMTCT services in all health facilities. currently working on EMTC Improve quality of care and treatment for HIV and AIDS, STI, TB & OIs Strengthen the capacity of CHAM in planning, M&E & use of data for management of HIV/STI/TB programmes. Ensure quality diagnostic services for surveillance, diagnosis, treatment, CD 4, HIV screening and blood safety. Improve the HR capacity to effectively provide HIV services. Strengthen HIV prevention by providing voluntary medical male circumcision (VMMC) 7

MALAWI’S ART/PMTCT ENVIRONMENT Full package q Provider Initiated Testing & Counselling (PITC) q. Confidential HIV Testing and Counselling (HTC) q ARV prophylaxis/ART therapy q Cotrimoxazole Preventive Treatment (CPT) prophylaxis q. Monitoring and Evaluation q. HRD&T (Pre-service & post basic education for HIV/AIDS) q Infant feeding counselling & support q Counselling & follow up 8

MOH PMTCT GUIDELINES q Reduce paediatric HIV infection in children and ensure an HIV-free generation, all pregnant women should have access to comprehensive quality PMTCT services q Provide a continuum of entry points to expand coverage and strengthen follow up of PMTCT and paediatric HIV/AIDS services �ANC, Labour/Delivery, Postpartum Care 9

KEY AREAS IN THE MALAWI INTEGRATED PMTCT PACKAGE There are 4 Prong Areas; 1. Prevention of HIV Infection among women of childbearing age 2. Prevention of unintended pregnancies among women living with HIV 3. Prevention of transmission of HIV from mothers living with HIV to their infants 4. Treatment, Care and Support of mothers living with HIV and their infants 10

APPROACH TO INTEGRATION q Use of new cadre of HSAs & CHCWs to provide PMTCT services at community and household levels § § Adopted PMTCT & HIV counselling & training materials for health care providers to create a learning resource package for HSAs Utilization of HSAs & VCHW to improve community awareness and demand creation for ART/PMTCT services while strengthening referral linkages for HIV women and their infants 11

ACHIEVEMENTS Development of HIV/AIDS Integration Framework q Serves as a “Roadmap” throughout implementation; it enables CHAM facilities to reposition services to achieve maximum impact Development of Operational Integrated Framework q Enables our health facilities to develop joint work plan and coordinate a single agreed approach rather than haphazard, parallel systems. q Provides health facilities with single understanding of accomplishments and gaps remaining to be addressed 12

Cont’ Improved HR in HIV/AIDS management CHAM managed to train and is still training staff in areas of; Couple Counseling , PITC, ART, PMTCT, HTC for Site supervision , CD 4 testing, DBS/PCR collection and management, Motor Cycle Riding (for follow up), M&E/HMIS and Early Infant Diagnosis 13

Cont…’ Establishment of integrated HIV/AIDS static & mobile Clinics Increased number of clients accessing HIV/AIDS services: HTC (Jun 2011 -May 2012) • 124 Facilities providing HTC • 475, 494 Clients reached • 51, 828 Positive • 104, 507 on ART PMTCT 120 Facilities providing PMTCT services 5, 696 Pregnant Women reached About 30% of the facilities trained for Option B+ 14

Cont’ Establishment of HIV/AIDS interventions for vulnerable groups increased HIV/AIDS information access. (e. g. ) q Sex workers intervention/support groups reached up to 57% of the targeted numbers of sex workers in some of our facilities q Increased number of sex workers now accessing HIV/PMTCT services due to the awareness provided to them through these interventions/support groups 15

Cont…’ Promotion of male involvement through Traditional Leader has seen an improvement on PMTCT service uptake by 16%. Some communities have even developed bylaws to govern PMTCT issues within their communities; Ø Every pregnant woman to attend ANC Ø Every visit to ANC a woman to be escorted by her husbands Ø WASH intervention (where when a women comes with her husband she is given some incentives) 16

Cont…’ High quality strategic information management q A strengthened surveillance system which shows a pattern of changing behaviour and decreasing HIV prevalence, (CHAM CDC interventions highlight the needs of vulnerable hidden populations)q Significant number of HSAs & VCHWs trained in comprehensive ART/PMTCT and use of HIV rapid test kits resulting into increased HIV service delivery, improved referral system and also increased PMTCT service uptake q Renovations of key buildings q PMTCT/ART clinics and Laboratories 17

BEST PRACTICES Our facilities have formed support groups for vulnerable population help increase HIV/AIDS service uptake (e. g. ) Ø Sex workers support groups has enabled sex workers to open up and start accessing HIV/AIDS and PMTCT services. Ø Stigma and Discrimination has been reduced and this encourages other vulnerable populations to access HIV/AIDS services 18

CHALLENGES low participation of CHAM facilities in preparation of the district implementation plan despite that CHAM facilities’ budgets are included in the DHO’s budget. q EHP, Some facilities (38%) signed SLAs but for govt to pay the bills takes time which sometimes results into conflicts q Too high expectations from govt. on what CHAM can do within its limited mandate and resources q Distrust & misinformation between MOH & CHAM. This is due to poor communication system within our institutions and sometimes due to lack of transparency in the way the two bodies conduct their business q 19

LESSONS LEARNT q HIV initiatives are effective when they are situated within Govt structures and follow govt. SP & priorities q Active involvement of beneficiaries and marginalized groups ensures the effectiveness and sustainability of interventions q Working at a variety of levels-from national to localallows for more comprehensive response q Partnerships create synergies, better meet beneficiaries’ needs and maximize available resources 20

RECOMMENDATIONS CHAM & MOH are the 2 most important partners in the provision of health care in Malawi. . q Need to improve relations in areas of communication and cooperation at district level q There need for increased district based collaboration between CHAM facilities and DHOs in health planning and health policy issues q Involvement of church structures to reach out to larger population is key 21

CONCLUSION q CHAM is optimistic that through ACHAP forum FBOs shall assist in scaling-up and strengthening the HIV/AIDS/NCD service delivery in Africa (Some FBOs across Africa fail to provide HIV/AIDS/NCD services to the maximum due to lack of ideas , innovativeness and financial support) q This forum will result into meaningful contribution towards the Continent’s HIV/AIDS and NCD response q Malawi will be on track to achieve its national targets for PMTCT by 2013 since efforts to scale-up and reduce loss-tofollow up will have been redoubled 22

Thank you for your attention MAY GOD BLESS YOU ALL! 23