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Addressing nutrition of mothersand babies in partnership for HIV –Free Survival (PHFS) sites toimprove their well-being
DR. STELLA KASINDI MWITA
SENIOR QUALITY IMPROVEMENT ADVISOR
URC-ASSIST
30TH NOVEMBER 2014
TANZANIA
Ministry of Healthand Social Welfare
BackgroundBackground
Partnership For HIV Free Survival (PHFS) is a collaborativeeffort by the PMTCT Inter-Agency Technical Teams WorkingGroup on Child Survival & Infant Feeding, PEPFAR and othertechnical partners.
PHFS is implemented in response to the 'Global Plan toward theElimination of New HIV Infections among Children by 2015 andKeeping their Mothers Alive' (eMTCT).
Tanzania is among six countries that is implementing PHFS,main purpose is strengthening of the Post-partum care in 30target districts (Mbeya Urban, Nzega and Mufindi); the initiativeis led by PMTCT unit of MOHSW with support from USAID
Other countries include Mozambique, Lesotho, South Africa,Uganda and Kenya.
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Objectives and care path of PHFSObjectives and care path of PHFS
To strengthen comprehensivepostpartum care at facility withlinkage to the community
To strengthen nutrition servicesalong the continuum of care(maternal nutrition, promotionof optimal infant and youngchild feeding practices throughnutritional assessmentcounseling and support (NACS)
To establish evidence on theeffectiveness of the key selectedinterventions
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Nutrition strategies/activitiesNutrition strategies/activities
FANTA/TFNC havetrained NACS RegionalTrainers in all 3 regions
PHFS have sensitized LGAson roles and responsibilitiesin nutrition
PHFS have strengthenedoversight role of RegionalNutrition Officers, DistrictNutrition Officers/Focalpersons to managesupportive supervision
On-going supportivesupervision and mentoringto all 30 PHFS sites
FANTA/TFNC havedistributed NACS job aids,wall charts, referencemanuals, M&E tools to all30 sites
Implementing partners intarget districts – Baylor,Deloitte-Tunajali andEGPAF have coached staffon use of M&E registers andforms
TFNC has conductedtraining on IYCN to alldistricts implementing PHFSdistricts
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QI implementation in the 3 pilotdistrictsQI implementation in the 3 pilotdistricts
URC/ASSIST have trained Health workers on QIand assisted the process - QI teams at each site
Each district has held 3 QI learning sessions.
In addition three coaching visits have been conductedin all the three districts from Nov 2013 to September2014 together with RHMT and CHMT
A total of 10 indicators aligning to improvementareas of retention, nutrition, testing, ART for motherand babies are being monitored
Out of these indicators 4 are monitoring nutritionalactivities
Results
•Improved documentation of information inNACS and in mother – child follow-up registers.
• Nutritional counselling and assessments haveincreased up to more than 50% in the districts.
•NACS platform contributed to improved PMTCTB+ and retention of babies and mothers in HIVservices
•Community teams have been enacted andfollowed up to assist in ensuring retention toservices for mothers and their babies in orderto get all the appropriate care
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Introduction of NACS in RCH has increased Nutrition Counseling in 10 siteseach in Nzega, Mbeya urban and Mufindi Districts April 2013 – Aug 2014)Introduction of NACS in RCH has increased Nutrition Counseling in 10 siteseach in Nzega, Mbeya urban and Mufindi Districts April 2013 – Aug 2014)
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Changes Introduced
Trained and orientedRCH staff on NACS andassessment usingMUAC
Introduced NACS toolsat registers at RCH
Assigned 1 staff at RCHresponsible fornutrition assessmentand counseling
Attach NACS forms l tothe CTC2 card
Emphasis to healthcare workers onconducting nutritionalassessments to all HIVExposed Infants
April 2013Baselineassessment
October 2013: FirstLearning Session:Introduction ofindicators and plansfor improvement
Progress: % of HEI < 6 months who are exclusively breastfeeding in the 3 districts inthe reporting period April 2013 –August 2014Progress: % of HEI < 6 months who are exclusively breastfeeding in the 3 districts inthe reporting period April 2013 –August 2014
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Percentage of Mother baby pair attending HIV services each monthPercentage of Mother baby pair attending HIV services each month
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Percentage of HIV positive pregnant and Lactating mother taking ARVS eachmonthPercentage of HIV positive pregnant and Lactating mother taking ARVS eachmonth
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Observed Challenges and Way forwardObserved Challenges and Way forward
Challenges
Consistent unavailabilityof NACS tools andregisters
Availability ofsupplementary feeding
Capacity and consistencyof HCW in providingnutrition services
Way Forward
Scale up of thenutritional activities toother districts
District coaches tomentor HCW onnutrition as part ofroutine activities
Nutritional informationsystem to be part ofHMIS
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AcknowledgementAcknowledgement
MOHSW – PMTCT Unit
All Tanzanian PHFS partners –EGPAF, Baylor - Tanzania, Deloitte -Tunajali, TFNC, FANTA, URC-ASSIST, JHEPEIGO, FHI360
USAID Tanzania
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