1. 1 Experiences with integrated Community Health Workers in the Partnership for HIV Free Survival project Roland van de Ven – Technical Director Tatu Mtambalike – Program Coordinator Community Linkages 14 January 2015

2. Content outline EGPAF Background Integration of Community MNCH activities with Home Based Care Achievements Lessons learnt Challenges

3. Background EGPAF supports the national RCH/PMTCT program through the USAID funded LIFE Program (Linking Initiatives For Elimination of pediatric AIDS) –EGPAF applies a health system strengthening approach at district level, to build local capacity for program planning, implementation and monitoring Partnership for HIV Free Survival is implemented in Nzega district in Tabora region leveraging the LIFE program

4. Integration of Community MNCH EGPAF supported the integration of Community MNCH with the existing Home Based Care program in Nzega district: –Using national integrated Community MNCH guideline the program trained 50 HBC providers as MNCH CHWs –Trained 10 HF staff as supervisors –Mentoring the CHWs in collaboration with MOHSW and JHPIEGO

5. Community MNCH main activities CHWs (with support from the site supervisors and village leaders) conduct: –Mapping of households to identify and follow up clients, i.e. pregnant and lactating women, children, HIV+ women on ART and HIV exposed children. –Household visits and community meetings to promote clinic attendance, facility delivery, birth planning counselling, the use of ITN etc –Referrals to health facilities –Monthly reporting at health facility where supervisor meets with all CHWs and discusses: The contents of the monthly reports comparing clients in the registers with report forms Successes, challenges and solutions Learn from others

6. Progress on RCH clients followed up by CHWs RCH clients followed by CHWs Q4 2013Q1 2014Q2 2014Q3 2014 Pregnant and postpartum women Pregnant women (new and second visits) 17012847981014 Women followed after delivery 0521303414 Total 170180511011428 Infants and Children Children 0-28 days 91562429483 Children between 1 month to 1 year 283157012161463 Children above 1 yr to 5 years 374271920852768 Total 748335637304714 Total number of House hold visits -214032303989

7. Trends in couple testing

8. Increased attendance of HIV+ mother-baby pairs

9. Increased uptake of PNC services

10. Tracing efforts by integrated CHWs

11. Main lessons learnt Working with already known and accepted volunteers in the community has enabled the program to introduce the MNCH aspect smoothly Enabling HBC providers to offer additional health education on MNCH services has provided an opportunity to remove stigma around HIV and HBC. CHWs improve relationship between HF and community CHWs substantially contribute to increased uptake of RCH services.

12. Sustainability and scale up Concerns: CHWs are mainly supported through NGOs budgets Number of volunteer CHWs limited, which does not allow a large coverage of households in the area. Integration of HBC and MNCH services adds a huge burden on volunteer CHWs Way forward: Integration of CHWs support into district health plans and budgets Establishment of a fulltime cadre of Community Health Workers / Extension Workers

13. 13 Asanteni