integration of hiv and nutrition services – action and measurement
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Integration of HIV and Nutrition Services – Action and Measurement. Barbara Engelsmann , Sweden Chiruka, Charity Zvandaziva, Fitsum Assefa, Diana Patel Abstract No MOAE0102 Session Title: Integrated HIV, Health and Human Development Programs - PowerPoint PPT PresentationTRANSCRIPT
Integration of HIV and Nutrition Services –
Action and MeasurementBarbara Engelsmann, Sweden Chiruka, Charity Zvandaziva, Fitsum Assefa,
Diana Patel
Abstract No MOAE0102Session Title: Integrated HIV, Health and Human Development Programs
20th International AIDS Conference Melbourne, Australia20-25 July 2014
What is Integration? Integration means different things to different
people: Integration of type of services Integration referring to service delivery
points Integration of services over time Integration of vertical levels of service Integration at policy/management level
WHO definition: “The management and delivery of health services so that clients receive a continuum of preventive and curative services, according to their needs over time and across different levels of the health system.”
Why Integration?
Resource constraints – available resources have to be used as efficiently as possible Rise of single disease funding or population group specific programs Different disease goals based on common service delivery resources Client oriented, closer to the goal of universal access For smaller programs integration might be survival
Why NOT Integration?
Risk of reduced quality of service provision Challenges to showcase achievements AIDS exceptionalism –
“it is important to regard HIV/AIDS services as a special case which needs to be well-resourced, expanded quickly and protected from the inefficiencies of the broader health system”
Integration of HIV (PMTCT/ped. HIV) and Nutrition (IYCF/CMAM) services
IYCFCMAM
PMTCTPediatric
HIV
• Mutual dependence of HIV and nutrition services Yet Largely vertical implementation of their programs to date
• Potential to maximise on different entry points for service provision
• PILOT PROGRAM to integrate service delivery for HIV and nutrition
• WHERE: Three country program (in Zimbabwe, Malawi and Mozambique)
• SUPPORT: Funded by DFATD through UNICEF
• WHEN: Over three years (July 2011 to June 2014)
In Zimbabwe:
• 32 sites in two rural districts(Marondera and Hwedza)
Implementation: by the Organization for Public Health Interventions and Development (OPHID) trust in Zimbabwe linked to/leveraged by existing PMTCT program
Integration - Activities
At national/provincial levelStimulation of policy dialogue at national level
Sensitization at provincial level
At service delivery levelSkills building
Encouragement of bi-directional linkages and referral systems
Supervision and mentoringDevelopment of job-aides
At community levelMobilization of
Voluntary community cadresTraditional leaders
Mother-baby support groups
At outreach levelCapacity building of outreach teams
Training and sensitization of village health workers
Integration - Monitoring & Evaluation
To monitor the delivery of service integration specific integration indicators were defined measuring the concurrent provision of HIV and nutrition services at different service delivery points
Examples: % of children with SAM receiving HIV
testing % of children in pediatric ART program
screened for SAM
Indicator 1: % PMTCT clients with children under 2 years of age receiving at least 2 IYCF counselling sessions
Indicator 2: % HIV exposed infants attending DPT3 immunization who are exclusively breastfed
Indicator 3: % children in pediatric ART program screened for SAM
Jan-Jun 2012
Jul-Dec 2012
Jan-Jun 2013
Jul-Dec 2013
0
10
20
30
40
50
60
70
80
90
100
Indicator 1Indicator 2Indicator 3
Indicator 4: % children with SAM receiving HIV-testingIndicator 5: % of HIV positive children at CMAM enrolling on ART
Jan-Jun 2012 Jul-Dec 2012 Jan-Jun 2013 Jul-Dec 20130
10
20
30
40
50
60
70
80
Indicator 4Indicator 5
Integration – Success
Baseline integrated service delivery
Program interventions to promote service integrations
Recording of indicators to define and prompt integrated service delivery
Integration now measurable
Outcome: Integrated service provision increased
Integration – Challenges
Action Challenges: In particular at higher level
Monitoring and Evaluation Challenges: Information required for integration indicators originating
from different source registers (CMAM register, ART register, EPI register) at different service delivery points over a period of time
Enumerators and denominators were not always routinely available as part of the national M&E system eg IYCF counseling provided, currently breastfeeding
Integration – Recommendations Support of integration efforts at national level
(even if different departments are involved)
More attention to national routine M&E tools to include measures for integration and set targets for integration indicators
Next Steps: Impact analysis Cost-effectiveness analysis
Acknowledgements
President’s Emergency Plan for AIDS Relief through USAID under the terms of Families and Communities for Elimination of Pediatric HIV in Zimbabwe (AID-613-A-12-00003)
Disclaimer“This study was made possible by the generous support of UNICEF and the American people through the U.S President’s Emergency Plan on AIDS relief (PEPFAR) and United States Agency for International Development (USAID). The contents are the responsibility of OPHID and do not necessarily reflect the views of UNICEF, DFATD, PEPFAR, USAID or the United States Government”
UNICEF HQ, regional and country office
And many more….
Zimbabwe Ministry of Health and Child Care
Department of Foreign Affairs, Trade and Development Canada