1. Improving the performance of primary providers in family planning and other reproductive health care around the world Prevention of Mother-to-Child Transmission of HIV/AIDS in Ethiopia The Hareg Project

2. Improving the performance of primary providers in family planning and other reproductive health care around the world ETHIOPIA  USAID  CDC  UNICEF  Ministry of Health  HIV/AIDS Prevention and Control Office (HAPCO)  Regional Health Bureaus  Regional HAPCO  Regional Teams Hareg Project Partners Implementing agencies:  PRIME II (IntraHealth, Save and ACNM)  JHPIEGO  JHU/CCP  Save the Children/US  LINKAGES  UNICEF  MSH/RPM+  I-TECH

3. Improving the performance of primary providers in family planning and other reproductive health care around the world ETHIOPIA Total population70.7 million Living with HIV/AIDS 3 million Adults 15-492 million Children 230,000 Overall prevalence6.6% Urban 13.7% Rural 3.7% AIDS orphans1.2 million Life expectancy Fallen to 45 years Hospital beds >50% to AIDS patients HIV/AIDS Overwhelming Ethiopia

4. Improving the performance of primary providers in family planning and other reproductive health care around the world ETHIOPIA  91% of infections in adults 15-49 years  21.1% prevalence in women 15-24 years  As high as 25% prevalence among pregnant women in urban areas 6.425% 6.425 - 9.7% 9.7 - 12.433% 12.43 - 15.6% 15.6 - 17.275% HIV Prevalence in Pregnant Women in Ethiopia Data adapted June 11, 2003 from AIDS in Ethiopia 2000, an Ethiopia MOH publication HIV/AIDS Infection in Ethiopia 0 5% 10% 15% 20% 25% Gondar Jimma Nazereth Jijiga Bahir Dar Dire Dawa Addis B/Gumez Mekele Pregnant Women HIV Positive Sentinel Site Prevalence  170,000 HIV+ women give birth each year  60,000 of their newborns infected through MTCT

5. Improving the performance of primary providers in family planning and other reproductive health care around the world ETHIOPIA PMTCT Barriers Antenatal Care Urban Rural Birth Place 67% Skilled 1% TBA 32% None 22% Skilled.5% TBA 77% None 32% Health facility 68% Home 2% Health facility 98% Home Urban Rural

6. Improving the performance of primary providers in family planning and other reproductive health care around the world ETHIOPIA Preventing MTCT Care and support for HIV+ (infected or affected) Prevent infection in parents-to-be Prevent unwanted pregnancies in HIV+ women Prevent unwanted pregnancies in HIV+ women Prevent transmission from HIV+ mothers to their infants Prevent transmission from HIV+ mothers to their infants

7. Improving the performance of primary providers in family planning and other reproductive health care around the world ETHIOPIA  8 regions  12 primary focus areas  First year pilot sites  Roll out plan  4 additional regions  Include more health centers  Scope based on research in Nigat Hareg Project Scope

8. Improving the performance of primary providers in family planning and other reproductive health care around the world ETHIOPIA Project Site Female Population Age 14–45 Adama42,921 Addis Ababa325,450 Assosa29,722 Axum4,768 Bahr Dar28,283 Dire Dawa28,485 Gondar19,474 Harari20,240 Jimma294,198 Jijiga35,888 Hareg Project Potential

9. Improving the performance of primary providers in family planning and other reproductive health care around the world ETHIOPIA Baseline Assessment Topics  Service delivery  Site audit  Staffing/personnel  Provider performance  VCT  Client perspective  Facility mapping  Family planning  TB referral Tools  Site audit  Provider interview  Client interview  Provider observation  Client flow  Focus groups  Community mapping  PRA

10. Improving the performance of primary providers in family planning and other reproductive health care around the world ETHIOPIA Key Strategies  Community based  Partnerships developed with systems and service delivery  Platform created to expand care, treatment and support for HIV/AIDS patients

11. Improving the performance of primary providers in family planning and other reproductive health care around the world ETHIOPIA Community / Health Post Sites of Service Delivery to Stop MTCT Health Center District Regional Center Central Center

12. Improving the performance of primary providers in family planning and other reproductive health care around the world ETHIOPIA Ethiopian National Framework Community Mobilization RMC Central Medical Centers Teams Working Together

13. Improving the performance of primary providers in family planning and other reproductive health care around the world ETHIOPIA Teams Working Together Discussion and consensus building Finding solutions

14. Improving the performance of primary providers in family planning and other reproductive health care around the world ETHIOPIA Hareg Major Accomplishments 2003 September Hareg Project launch Baseline assessment completed October Axios application accepted November Regional network formation 7 workshops, 140 participants 7 signed MOUs among regional teams Solutions for clientflow for all 10 hospitals and 10 health centers Overall coordination of activities

15. Improving the performance of primary providers in family planning and other reproductive health care around the world ETHIOPIA Key Progress from existing sites  126 health workers newly trained or retrained in PMTCT  80% pregnant women with at least one ANC visit who consented to HIV test, received test, results, and post-test counseling (Nigat)  50% HIV+ pregnant women received complete course of ARV prophylaxis to reduce risk of MTCT

16. Improving the performance of primary providers in family planning and other reproductive health care around the world ETHIOPIA Nevirapine administration in 6 new regions by late January 2004 Focus areas: 1. Supply system strengthening 2. Regional follow-up 3. PMTCT site readiness plan 4. Joint monitoring and evaluation 5. Community readiness 6. Policy dialogue Short-Term Target

17. Improving the performance of primary providers in family planning and other reproductive health care around the world ETHIOPIA Long-Term Target National PMTCT coverage  Impact Indicator Number of HIV infections averted by ARV prophylaxis

18. Improving the performance of primary providers in family planning and other reproductive health care around the world ETHIOPIA Challenges  Opt in/Opt out  Infant feeding  Home-based delivery  NVP within 72 hours  Confidentiality  Stigma  Competing demands with one of world’s highest MMRs  Safe motherhood/PMTCT integration  Universal precautions

19. Improving the performance of primary providers in family planning and other reproductive health care around the world ETHIOPIA Goals for September 2004  PMTCT initiation and expansion  PMTCT service delivery for 23 new sites and strengthening of 4 existing sites  Improved links between facilities and communities  System strengthening for service delivery  Sound HMIS system that generates data for monitoring and scale-up

20. Improving the performance of primary providers in family planning and other reproductive health care around the world ETHIOPIA Eyes on the Prize Averted infections are the ultimate goal