HAI & PEPFAR: Strengthening Mozambique Health System by Improving HIV Care

50 %
50 %
Information about HAI & PEPFAR: Strengthening Mozambique Health System by Improving HIV Care
Health & Medicine

Published on February 24, 2009

Author: bgreenberg

Source: slideshare.net

Description

PEPFAR I Facts
Brief overview of Mozambique
PEPFAR I in Mozambique
Financial support
General approach
Primary NGOs and subpartners
Health Alliance International
General approach
Scope of work
Successes
PEPFAR Challenges
How PEPFAR II can Improve upon PEPFAR I
NGO Code of Conduct

HAI & PEPFAR: Strengthening Mozambique Health System by Improving HIV Care Jennifer Kasper, MD, MPH Former Pediatric Technical Advisor and HIV Program Manager, Health Alliance International Board Member, Doctors for Global Health Physicians for Human Rights Student Conference January 31, 2009

Outline PEPFAR I Facts Brief overview of Mozambique PEPFAR I in Mozambique Financial support General approach Primary NGOs and subpartners Health Alliance International General approach Scope of work Successes PEPFAR Challenges How PEPFAR II can Improve upon PEPFAR I NGO Code of Conduct

PEPFAR I Facts

Brief overview of Mozambique

PEPFAR I in Mozambique

Financial support

General approach

Primary NGOs and subpartners

Health Alliance International

General approach

Scope of work

Successes

PEPFAR Challenges

How PEPFAR II can Improve upon PEPFAR I

NGO Code of Conduct

PEPFAR Focus Countries Botswana Cote d'Ivoire Ethiopia Guyana Haiti Kenya Mozambique Namibia Nigeria Rwanda South Africa Tanzania Uganda Vietnam Zambia

Botswana

Cote d'Ivoire

Ethiopia

Guyana

Haiti

Kenya

Mozambique

Namibia Nigeria

Rwanda

South Africa

Tanzania

Uganda

Vietnam

Zambia

Mozambique Civil War (1980-1992)

Basics about Mozambique Population ~20 million 74% live on less than $2/day Average life expectancy 43yrs Infant Mortality Rate 96/1000 Under 5 child mortality 138/1000 24% children underweight 48% births attended by skilled personnel, maternal mortality 520/100K live births UNDP 2007/2008, UNICEF 2008

Population ~20 million

74% live on less than $2/day

Average life expectancy 43yrs

Infant Mortality Rate 96/1000

Under 5 child mortality 138/1000

24% children underweight

48% births attended by skilled personnel, maternal mortality 520/100K live births

HIV Prevalence: Top 10 Countries Zimbabwe 25.84 Botswana 25.10 Namibia 19.94 Zambia 19.10 Swaziland 18.50 South Africa 16.70 Mozambique 16.00 Malawi 14.92 Tanzania 9.42 Lesotho 8.35

~ 3 million PLWHA ~ 400,000 require ART Also high prevalence of Syphilis (~8%) Malaria (13-80%) TB (624/100,000) Malnutrition (25-40%) Central region pop 3 million 400K PLWHA (24K <15yo) 68K need ART (12K <15yo) HIV Prevalence in Mozambique

~ 3 million PLWHA

~ 400,000 require ART

Also high prevalence of

Syphilis (~8%)

Malaria (13-80%)

TB (624/100,000)

Malnutrition (25-40%)

Central region pop 3 million

400K PLWHA (24K <15yo)

68K need ART (12K <15yo)

Mozambique Health Sector Capacity for AIDS Treatment Physicians per 100,000: 3 = 650 (100 pediatricians) ~500 doctors trained in HAART (3 week course) Nurses per 100,000: 21 = 2400 Health expenditure per capita approx $10 (2.7% GDP spent on hlth) ~ 1200 health facilities Medical school in Maputo; newer one in Sofala; one being developed in Nampula Functioning drug procurement and distribution system

Physicians per 100,000: 3 = 650 (100 pediatricians)

~500 doctors trained in HAART (3 week course)

Nurses per 100,000: 21 = 2400

Health expenditure per capita approx $10 (2.7% GDP spent on hlth)

~ 1200 health facilities

Medical school in Maputo; newer one in Sofala; one being developed in Nampula

Functioning drug procurement and distribution system

Donor-Induced Management Burden Mozambique (2008) $228 million (1/3 CDC, 2/3 USAID) > 200 health NGOs (50 prime partners and > 100 sub-partners) > 150 independent sites of operation 10-20 program categories Independent planning cycles, implementation Reliability dependent on donor policies “ Neocolonization” – NGO spheres of control

$228 million (1/3 CDC, 2/3 USAID)

> 200 health NGOs (50 prime partners and > 100 sub-partners)

> 150 independent sites of operation

10-20 program categories

Independent planning cycles, implementation

Reliability dependent on donor policies

“ Neocolonization” – NGO spheres of control

Foreign Policy May/June 2004 Additional management burden by donors & NGOs Tanzania 1,371 different projects to manage

Health Alliance International supports the development of equity-oriented policies and public-sector health systems . Our vision is a just world with universal access to quality health care .

Health Alliance International supports the development of equity-oriented policies and public-sector health systems . Our vision is a just world with universal access to quality health care .

HAI’s Approach Work from within health system at all levels (national, provincial, district and health facilities) Offices in MOH Advisors working with MOH program managers Multidisciplinary teams: Clinical advisors, MCH, M&E, laboratory, HBC and community mobilization/VCT program assistants Integrated supervision, technical support, clinical mentoring Financial and logistics support

Work from within health system at all levels (national, provincial, district and health facilities)

Offices in MOH

Advisors working with MOH program managers

Multidisciplinary teams:

Clinical advisors, MCH, M&E, laboratory, HBC and community mobilization/VCT program assistants

Integrated supervision, technical support, clinical mentoring

Financial and logistics support

HAI’s Approach Plan jointly - respond to local priorities at provincial and district level Strengthen human resources Pre-service training, task shifting, lay workers Funds to hire recent graduates Strategies to improve staff allocation Improve infrastructure: Outpatient services, laboratories, maternity wards Staff housing Training center Promote operations research Beira Operations Research Center Strengthen supply chain management

Plan jointly - respond to local priorities at provincial and district level

Strengthen human resources

Pre-service training, task shifting, lay workers

Funds to hire recent graduates

Strategies to improve staff allocation

Improve infrastructure:

Outpatient services, laboratories, maternity wards

Staff housing

Training center

Promote operations research

Beira Operations Research Center

Strengthen supply chain management

HAI’s Approach Integrate vertical programs into comprehensive PHC, expanding and decentralizing services: Integration of OIs and ART PMTCT as part of basic package ANC services C&T into routine clinical services HIV/TB programs HBC strengthening links between health care facility and community Food support and insecticide treated bednets with HIV care and ANC

Integrate vertical programs into comprehensive PHC, expanding and decentralizing services:

Integration of OIs and ART

PMTCT as part of basic package ANC services

C&T into routine clinical services

HIV/TB programs

HBC strengthening links between health care facility and community

Food support and insecticide treated bednets with HIV care and ANC

HIV Treatment Expansion Plan 2003 HF Providing HAART 1 PLWHA Registered 2,000 Eligible in HAART 94 Guro Tambara Chemba Maringue Macossa Sussundenga Machaze Machanga Muanza Cheringoma Chibabava 2003

2004 Guro Tambara Chemba Maringue Macossa Sussundenga Machaze Machanga Muanza Cheringoma Chibabava HF Providing HAART 2 PLWHA Registered 7,300 Eligible in HAART 600 2003 2004 Free ART in Public Health Sector

2005 Guro Tambara Chemba Maringue Macossa Sussundenga Machaze Machanga Muanza Cheringoma Chibabava HF Providing HAART 7 PLWHA Registered 18,600 Eligible in HAART 2,520 CS HCB HR HPC HG HeathC CentH RurH ProvH GenH

2006 Guro Tambara Chemba Maringue Macossa Sussundenga Machaze Machanga Muanza Cheringoma Chibabava HF Providing HAART 17 PLWHA Registered 36,270 Eligible in HAART 5,250 2003 2004 2005 2006 Decentralization to Rural Sites

2007 Guro Tambara Chemba Maringue Macossa Sussundenga Machaze Machanga Muanza Cheringoma Chibabava HF Providing HAART 47 PLWHA Registered 63,390 Eligible in HAART 13,225 2003 2004 2005 2006 2007

HIV Treatment Plan 08-09 Guro Tambara Chemba Maringue Macossa Sussundenga Machaze Machanga Muanza Cheringoma Chibabava HF Providing HAART: 87 March 2008: 55 Registered: 180,000 March 2008: 92,600 HAART: 45,000 March 2008: 22,000 <15 y in HAART: 5,000 March 2008: 900 HeathC CentH RurH ProvH GenH Pending

Hematology and chemistry in 22 of 36 laboratories CD4 decentralization and referral: High volume, complex machines in provincial capitals Lower volume, less complex in 3 rural districts 55 PMTCT sites referring CD4 20 hemoglobinometers in isolated sites w/o other lab equipment Support referral system for early infant diagnosis (DNA-PCR) Strengthening Laboratory Network Chemba Maringue Machaze Machanga Muanza Cheringoma Hem. + Chemistry Mangunde Sena Guro Tambara Macossa Sussundenga CD4+ Chemba Maringue Machaze Machanga Muanza Cheringoma Hem. + Chemistry Mangunde Sena CD4+ CD4+ Guro Tambara Macossa Sussundenga CD4+ CD4+ CD4+ Labs referring samples

Hematology and chemistry in 22 of 36 laboratories

CD4 decentralization and referral:

High volume, complex machines in provincial capitals

Lower volume, less complex in 3 rural districts

55 PMTCT sites referring CD4

20 hemoglobinometers in isolated sites w/o other lab equipment

Support referral system for early infant diagnosis (DNA-PCR)

Successes from HAI/MOH Collaboration (as of June 2008) Work in all 23 districts in 2 provinces Voluntary Counseling and Testing 103 sites Cumulative total number tested since 2002: 280,000 HIV prevalence 31% PMTCT 156 sites; 250,000 served HIV/AIDS care and treatment 55 sites; >100,000 served; 25,000 on ART Home-Based Care 12 community-based organizations Serve 7000 clients/month (60% HIV positive, 50% of these on ART) Radio, popular theater, world food program

Work in all 23 districts in 2 provinces

Voluntary Counseling and Testing

103 sites

Cumulative total number tested since 2002: 280,000

HIV prevalence 31%

PMTCT

156 sites; 250,000 served

HIV/AIDS care and treatment

55 sites; >100,000 served; 25,000 on ART

Home-Based Care

12 community-based organizations

Serve 7000 clients/month (60% HIV positive, 50% of these on ART)

Radio, popular theater, world food program

 

Pediatric Challenges PCR DNA Breastfeeding Care and follow-up in Child at Risk Clinic Counseling children and adolescents about their illness Adherence and its effects on overall child health and life expectancy OVC

PCR DNA

Breastfeeding

Care and follow-up in Child at Risk Clinic

Counseling children and adolescents about their illness

Adherence and its effects on overall child health and life expectancy

OVC

More Challenges Human resources “ Brain drain” Multi sector approach Prevention – discordant couples Poverty, food security Socioeconomic improvement Structural problems Debt reduction Reversal of structural adjustment policies and expansion of public spending Improve intra-governmental allocations

Human resources

“ Brain drain”

Multi sector approach

Prevention – discordant couples

Poverty, food security

Socioeconomic improvement

Structural problems

Debt reduction

Reversal of structural adjustment policies and expansion of public spending

Improve intra-governmental allocations

How PEPFAR II can Improve upon PEPFAR I Pre-service training, task shifting Integrate into existing health infrastructure Increase $ for treatment Increase $ for PMTCT Increase funding for OVC Partnership for HIV-Free Generation – youth-initiated and implemented activities Opt-out testing for all clinical encounters Discordant partners, married couples Know your epidemic – concentrated (ex commercial sex workers, IVDU, MSM) vs generalized pandemic

Pre-service training, task shifting

Integrate into existing health infrastructure

Increase $ for treatment

Increase $ for PMTCT

Increase funding for OVC

Partnership for HIV-Free Generation – youth-initiated and implemented activities

Opt-out testing for all clinical encounters

Discordant partners, married couples

Know your epidemic – concentrated (ex commercial sex workers, IVDU, MSM) vs generalized pandemic

Distribution of Disease vs Distribution of Funding

A Balanced Approach to Health Care Delivery: Vertical, Horizontal, Diagonal?

US FINANCIAL SUPPORT: GLOBAL HEALTH AND DEVELOPMENT

NGO Code of Conduct 6 areas: Hiring practices Compensation Training and support Minimize mgmt burden on govt due to multiple NGO projects Help govt connect communities to govt hlth systems Provide better support to govt thru policy advocacy www.ngocodeofconduct.org

6 areas:

Hiring practices

Compensation

Training and support

Minimize mgmt burden on govt due to multiple NGO projects

Help govt connect communities to govt hlth systems

Provide better support to govt thru policy advocacy

 

References PEPFAR 5th Report to Congress WHO, PEPFAR, UNAIDS. Task-Shifting: Rational Redistribution of Tasks among Health Care Workforce Teams, Global Recommendations and Guidelines. 2008. www.who.int Granich R, Gilks CF, Dye C, DeCock KM, Williams BG. Universal voluntary HIV testing with immediate antiviral treatment as a strategy for elimination of HIV transmission: a mathematical model. Published online November 26, 2008. www.thelancet.com IOM. The US Commitment to Global Health: Recommendations for the New Administration. Washington, DC: National Academies Press; 2008. www.nap.edu www.ngocodeofconduct.org

PEPFAR 5th Report to Congress

WHO, PEPFAR, UNAIDS. Task-Shifting: Rational Redistribution of Tasks among Health Care Workforce Teams, Global Recommendations and Guidelines. 2008. www.who.int

Granich R, Gilks CF, Dye C, DeCock KM, Williams BG. Universal voluntary HIV testing with immediate antiviral treatment as a strategy for elimination of HIV transmission: a mathematical model. Published online November 26, 2008. www.thelancet.com

IOM. The US Commitment to Global Health: Recommendations for the New Administration. Washington, DC: National Academies Press; 2008. www.nap.edu

www.ngocodeofconduct.org

Add a comment

Related presentations

Related pages

HAI & PEPFAR: Strengthening Mozambique Health System by ...

HAI & PEPFAR: Strengthening Mozambique Health System by Improving HIV Care Jun 10, 2015 Health & Medicine physicians-for-human-rights
Read more

Clinical Director, Quelimane, Mozambique | UNjobs

Clinical Director, Quelimane, Mozambique: ... will continue supporting HIV/AIDS care and ... Strengthening Mozambique Health System by Improving HIV ...
Read more

Health care exposure to hepatitis & hiv - Health & Medicine

August 2013 PLUS Health care reform and people with HIV. HAI & PEPFAR: Strengthening Mozambique Health System ... Improving Accessing to HIV Care through ...
Read more

An anthropology of aid in Africa - The Lancet

An anthropology of aid in Africa. ... the health system by luring ... health system strengthening. For example, PEPFAR funding was ...
Read more

The art of medicine - TheLancet.com Homepage

The art of medicine ... the health system by luring workers away with high salaries, ... strengthening. For example, PEPFAR funding was channelled
Read more