ACTION FRAMEWORK No child born with HIV by 2015 and improving the health and well being of Mothers, partners and Babies in South Africa ICASA December 7 th 2011

Precious Robinson, Deputy Director, PMTCT, NDoH, South Africa Lerato Lesole, CDC, South Africa Maryet Mogashoa, CDC, South Africa Sanjana Bhardwaj, Senior PMTCT and Paediatric AIDS Specialist, UNICEF, South Africa AUTHORS

OVERVIEW Background Current status- PMTCT programme Bottleneck analysis (P & D) Action Framework for eMTCT Monitoring Tools Cyclical process of feedback

Do we have to do things differently?

How do we become more efficient and more effective in what we do?

e-MTCT update for South Africa May 2011 PMTCT Working group meeting to take stock Data analysis of progress on PMTCT June 2011 Draft action framework for consultation developed PMTCT Steering committee meeting July to Sept provincial workshops held Data analysis for every district + province completed Action plans + priorities identified based on the data review

e-MTCT update for South Africa Sept 2011 Inputs provided to the new National Strategic Plan for HIV/STI/TB Final draft action framework for e-MTCT ready October 2011 PMTCT steering committee meeting Consultation with implementing Partners Consultation with civil society Dev of QI framework for eMTCT Nov to Dec 2011 Review of district action plans Data for Action reports – 1 st set by 15 th December’11 Final Action Framework at national level Final draft of action frameworks at provincial and district levels

STEP 1: DATA ANALYSIS

Action based on evidence Thorough review of data for national, 9 provinces & 52 districts (trend analysis ) Data understanding of bottlenecks to key priority actions Data from different sources (programme, laboratory, research studies) Setting targets at district level 52 Action frameworks + 9 provincial action frameworks + National Addressing issues related to MCH and PMTCT service delivery

STEP 2: BOTTLENECK ANALYSIS

Bottleneck analysis Provincial and district workshops Data used as the starting point Review of issues related to availability of services, access, coverage, human resource, systems (supply) completed Participation of all key Stakeholders.

:RESULT: Priority actions/cost/responsible person/timeline agreed and included in the draft action frameworks at district and provincial levels. The results were linked to the dashboard and targets set at district and provincial level The bottleneck analysis will be ongoing in 2012: done each quarter based on the Data for Action reports

STEP 3: PRIORITY SETTING

PMTCT Cascade priorities Late booking Family planning ART/ARV for eligible women Retesting for negatives Post natal follow up Safer infant feeding Early infant ART Enabling + engaging community priorities Male partners Couple counseling Social mobilization Community engagement Clear Standards for operation Getting to scale Quality enhanced Data quality + capacity enhanced Foster innovation e-MTCT Targets achieved

Critical policy/programme issues to be addressed in ARV regimens + eligibility Post natal testing schedules for mother and child Data - quality + use regularly Need for SOPs for the PMTCT and Pediatric ART cascade Integration of all service(mncwh,tb, Nutrition) Community involvement and engagement

STEP 4: STRUCTURE OF THE ACTION FRAMEWORK

ACTION FRAMEWORK (NSP ) No child born with HIV by 2015 and improving health and wellbeing of mothers, partners and babies in South Africa

NSP – Strategic document PMTCT and Pediatric ART action framework (MNCHW) at national, provincial and district levels Annual work plans Strategic objective, targets, costing

Programme Information Note Situation report Operational framework 5 key areas Support AWP activities e MTCT TRACKER Dashboard Baselines Targets Annexes Costing Partnership Management ACTION FRAMEWORK FOR eMTCT Key components

Five key areas Implementation Drill areas for focus each year Key activities to address issues + Tasks identified under each activity Operational framework

Leadership, management and coordination Coverage and quality of services Integration with Primary Health Care Monitoring and evaluation Community involvement and social mobilization

STEP 5: SETTING UP MONITORING MECHANISMS AND TOOLS

e MTCT TRACKER ROBOT DASHBOARD CASCADE INDICATORS

DASHBOARD: National (DHIS data) Baselin e 2010 Target 2011 Jan to June 2011 ANC visit < 20 weeks36%50%41% ANC client CD 4 first test rate 64%80%72% ANC initiated on AZT during antenatal care rate 79%85%84% ANC initiated on HAART rate 92%90%73% Post natal follow up of mother within 6 days 29%50%65% ANC client retest at 32 weeks rate 25%40%38% Baby PCR test positive around 6 weeks rate 10% (DHIS) <57%

DATA FOR ACTION REPORTS: QUARTERLY (PROVINCIAL AND DISTRICT – SUB DISTRICT – FACILITY)

Partnership Framework Tool Eg – district from Eastern Cape province PRONG 1 ( primary prevention) PRONG 2 (preventing unwanted pregnancies) PRONG 3 (PMTCT) PRONG 4 (Protection, care and support) Leadership, Management and coordination Broad reachX ESI project RTC X Coverage and quality (<2% at 6 weeks and <5% at 18 months) RTCXBroad reach ESI project RTC Broad reach PHCBroad reachX Monitoring and Evaluation Broad reach RTC XBroad reach ESI project RTC Broad reach RTC Social mobilizationXXXX

National action framework Provincial action framework District action framework

STEP 6: TRACKING IMPLEMENTATION OF THE FRAMEWORK

Robot Dashboard Cascade Indicators Discussion/review at district/provincial/national level meetings (quarterly) Review partnership framework Discussions/review with all partners /shared accountability Review progress against work plan Review expenditure rates ACTION Response to robot dashboard (within a month) Data for Action – reports from national Quarterly

Dec 2011 – launch of new NSP, announce ment of PMTCT campaign, PMTCT steering committee Priority actions 2013 – Mid point stock taking 2014 – Targeted support and focus 2015 – REACH THE GOAL

Spin-offs & in-roads? PMTCT integrated with MNCH PMTCT integrated with Primary Health Care Bringing together different elements – common vision – setting up mentoring and monitoring systems Achieving less than 2% MTCT at 6 weeks after birth in every district and province Reducing perinatal mortality & maternal mortality irrespective of the cause

ACKNOWLEDGEMENTS DDG-Dr Y Pillay for support PMTCT Technical working group and the steering committee All provincial and district stakeholders CDC – South Africa UNICEF UNFPA Clinton Health Access Initiative PEPFAR Members of the civil society All partners working in PMTCT/MCH