Bristol-Myers Squibb Foundation Secure the Future
Technical Assistance Programme
(BMSF STF TAP)
Adventist Development and Relief Agency
(ADDRA) /
REGIONAL FOCUS / Kazangulu and Kapiri Mposhi districts, Zambia
SCOPE OF PARTNERSHIP: / To provide technical assistance in Community Mobilisation, Prevention of Mother to Child Transmission (PMTCT); Monitoring and Evaluation; andOperational Research in Kazungula District as a follow up to PMTCT interventions
OBJECTIVES: / To determine trends in PMTCT uptake since the introduction of the programme; determine community and society factors responsible for uptake in the Mother to Child Transmission (MTCT) programme and to develop an appropriate model for community care, support, and treatment of children on the Zambian IMCI and PMTCT programmes.
VALUE OF ASSISTANCE: / $ 366,904.49
PERIOD OF ASSISTANCE: / 15 months
BACKGROUND
In 2008, BMSF STF TAP partnered with the Zambian Ministry of Health (HHHHMOH) to provide equitable access to cost-effective and quality health care in Zambia by increasing access to PMTCT of HIV services and Paediatric HIV and AIDS Care, Support and Treatment (PPCST) for all pregnant women and their children. The second phase of the project supported scientific analysis to determine the success of the project. It was at this stage that the Adventist Development and Relief Agency (ADDRA), an independent development and humanitarian agency founded by the Seventh-day Adventist Church in 1984 and established in Zambia in 1986, engaged as partner to conduct the research process.
INITIAL PARTNERSHIP
The aim of the collaboration was to expand and integrate PMTCT/PPCST services into Maternal, Newborn and Child Health (MNCH) services. This entailed linkages with other support programmes within the framework of a continuum of care for people living with HIV/AIDS (PLWHA) starting at community level through to the various levels of facility based health care.
BMSF STF TAP support was provided to assist the MOH to increase child survival, more specifically to strengthen existing linkages between facility and community-based health care delivery systems with clear management and referral structures; build on existing community-based responses, strengthen the implementation of the integrated management of childhood illnesses strategy at community level and optimise patient outcomes.
Technical assistance was provided in community mobilisation, IMCI, PMTCT and Monitoring and Evaluation
EXTENDED PARTNERSHIP
Following the initial partnership, preliminary estimates showed a marked improvement of access to the PMTCT services in both the districts of Kazangulu and Kapiri Mposhi,. These factors, however, could not be directly transferred from one cultural setting to theother. Applied research was undertaken to determine the success of PMTCT.
The research aimed to determine trends in PMTCT uptake since the introduction of the programme; determine community and society factors responsible for uptake in the MTCT programme, and develop an appropriate model for community care, support, and treatment of children within the Zambian IMCI and PMTCT programmes
THE METHODOLOGY
This research was undertaken in the district of Kazangulu only for a period of one week (10-16 May 2010). A qualitative research approach was employed to gather information from various stakeholders in the Kazangulu District. Focus Group Discussions (FGD) and Local Level Key Informant Interviews (LLKII) were conducted with service providers and clients. To demonstrate with confidence how the programme was doing, this research addressed outcome measures that reflect the objectives of the programme.
Interviews were conducted in health facility in the catchment areas of Makunka, Katapazi, Sons of Thunder, Mambova as well as other stakeholders in the town of Livingstone.
As part of its mandate to transfer skills and build the capacity of stakeholder organisations including the MOH, the TAP research team worked closely with District Health Planner and MOH staff members throughout the research period. The ADDRA PMTCT District Coordinator was also part of the team. Their responsibilities were to conduct interviews with the above-mentioned groups and individuals, and participate in all research activities.
The research team collected quantitative M&E data from the MOH and BostonUniversity.
THE RESULTS
  • Institutional linkages of PMTCT partners: The District Health team coordinates efforts by local and international stakeholders who support PMTCT interventions through various means such as training, treatment support, counselling, community mobilisation and data capturing and analysis. The health team’s coordination efforts were guided by the Government’s policies, guidelines and procedures.
  • The Policy Framework: PMTCT interventions are guided by the national policy frameworks as well as guidelines. An interesting guideline that was introduced was the promotion of male involvement in PMTCT through couple testing during the first antenatal visit. In all the sites that were visited, it was reported that this approach had been well received and had led to a significant increase in the number of males who accompany their partners to the first antenatal visit and subsequently embrace PMTCT intervention. Data received also supported these reports.
  • Access to PMTCT Services: Access to PMTCT services in the district increased over time. PMTCT services are provided at 20 MOH district health facilities in the Kazangulu District. Another donor also provides PMTCT/HAART services in the Kazangulu District.
  • Antenatal Care (ANC) Deliveries and Postnatal Care (PNC): Overall, health workers, volunteers and clients alike reported a satisfaction with the turn-out of pregnant women for ANC and PMTCT services. Mothers who delivered at home were encouraged to access health facilities for PNC as early as possible.
  • Male Involvement: Male involvement was found to be satisfactorily high in the district. Interviewees indicated that it was national government’s initiative to encourage men to get actively involved in HIV/AIDS activities including PMTCT. An increasing number of men are now accompanying their female partners to the health facilities for ANC services
  • Volunteers: They were selected by the traditional authorities inconsultation with general community members. This process is important to ensure that selected persons areaccepted by communities. There was accord among stakeholders and various volunteers belonging to the groups and training was provided by more than one stakeholder in various health matters.
SIGNIFICANCE
  • A total of 107 Community PMTCT agents were trained in the two districts. Kapiri-Mposhi trained 75 and Kazangulu trained 32.
  • Forty-one (41) active community PMTCT agents were able to reach 5,377 people with PMTCT messages using different methods such as one to one, focus group and group discussions; door to door visits and group counseling. The target group was mothers mainly during their antenatal and post-natal visits. A few men who accompanied their wives to the clinics also participated.
  • In Kazangulu a total of 1,282 mothers attended first counseling on PMTCT and 606 were enrolled in PMTCT. Out of this number 91 attended the ante-natal clinic for the first time.
  • Training of PMTCT and other community agents has contributed significantly to an increase in PMTCT uptake;
  • Promotion of couple testing has led to an increase in the level of male involvement;
  • The involvement of traditional leaders is regarded as a best practice worthy of replication.
  • Government’s approach to discourage partner organisations from paying or providing incentives that would create huge disparities between community cadres;
  • Smooth ordering procedures for drugs – facilities reported that they never experienced drug shortages.