Integrating Family Planninginto PMTCT Services: PromisingApproaches from Tanzania’sIringa and Manyara Regions
Mwanga F; Paul Perchal; Motta W; Killian R; Kikumbih N; Nielsen-Bobbit J
EngenderheathACQUIRE Tanzania Project
Outline
Background
Integration model
FP-PMTCT integration activities and results
Challenges, lessons learnt, and recommendations
Background: Demographic Profile
Size
945,087 sq. km
Population of 43,187,823 (2010 projection)
Fertility
TFR: 5.4 children per woman
Family Planning
CPR: 34% for any method; 27% modern methods
Unmet need: 25% among married women (16% spacing and9% limiting)
Maternal Health
96% received ANC from health professional
51% deliveries assisted by health professionals
HIV/AIDS
Adult prevalence rate 5.6%
Prevalence among women attending ANC is 6.9%
Source Tanzania: TDHS 2010, THIV survey 2008
The ACQUIRE Tanzania Project (ATP)
Supports the Ministry of Health and Social Welfare toincrease the quality of and access to:
–Family planning services
–Comprehensive post abortion care
–PMTCT
–Gender-based violence services
Supports integration of FP-PMTCT in Iringa andManyara
Model of FP/PMTCT Integration
Antenatal Care
Labor andDelivery/Postnatal
Postnatal Care
Care and Treatment
FP Clinic(postpartum visit)
Activities to Strengthen FP-PMTCT Integration
Supply
–Training and supportive supervision
–Renovations /infrastructure
–Procurement
–Quality improvement
Enabling environment
–Contribute to national guidelines
–Build partnerships
Demand
–Engage communities
–Increase male involvement
How Do We Put This into Practice?
1,134 PMTCT service providers trained to offer FPcounseling
HIV counseling and testing: HIV+ women who are andnot eligible for ART are given ARV for prophylaxis
All pregnant women encouraged to deliver in healthfacilities and counseled on FP
All ANC clients are counseled on safer sex and givencondoms for dual protection
How Do We Put This into Practice? cont’d.
After labor and delivery, mothers receive FP counselingand advice to attend FP clinic during their postpartumvisit
At FP clinic, women with unknown status are offeredHIV counseling and testing
If a woman chooses a LAPM and cannot get it at thatfacility, she receives a referral
Information on FP and PMTCT services also provided atmother and child health clinics (MCH)
FP data are collected using monthly PMTCT summaryforms and register books
HIV-positive Women Receiving FP Methods atATP-Supported PMTCT Sites
Assessment of FP-PMTCT Integration
In collaboration with 12 districts in Iringa and Manyara
Priority areas for action identified included:
–Additional provider training
–Addressing stock-outs
–Increased promotion of dual protection in both HIV and FPservices
–Addressing loss to follow-up through strengthening additionalentry points for FP services
Ongoing Challenges
Shortage of FP commodities
Human resource shortages
Lack of adequate space for integrated services
M&E tools are not designed to capture integratedservices
Loss to follow-up of HIV-positive women
Low male involvement
Recommendations
Let’s take it to scale!
More research to prevent loss-to-follow-up
Logistics and M&E systems need to better integrated
Coordinate and harmonize partnerships
Government commitment in integration is high but hasnot been translated to resource allocation
Client Perspectives
“A mother who has HIV should not be sent somewhere else. She shouldget everything at one table.”
– HIV+ woman at postnatal clinic
“We learnt of our HIV status when Iescorted my wife to the antenatalclinic. We followed all the advise andthanks God, our child was born HIVnegative. We were informed aboutFP during delivery we went back foran implant. We are very happy withthis method.”
– HIV+ couple
ACKNOWLEDGEMENT
PEPFAR
MOHSW
Districts – Council Health Management Teams (CHMTs)
ATP supported facility management and staff
EH HQ
Engender health Partners