1. 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

2. 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

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

4. Do we have to do things differently?

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

6. 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 2011 9 provincial workshops held Data analysis for every district + province completed Action plans + priorities identified based on the data review

7. e-MTCT update for South Africa Sept 2011 Inputs provided to the new National Strategic Plan for HIV/STI/TB 2012-2016 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

8. STEP 1: DATA ANALYSIS

9. Action based on evidence Thorough review of data for national, 9 provinces & 52 districts (trend analysis 2008-2010 ) 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

11. STEP 2: BOTTLENECK ANALYSIS

12. 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.

13. :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

14. STEP 3: PRIORITY SETTING

15. 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

16. Critical policy/programme issues to be addressed in 2011-2012 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

17. STEP 4: STRUCTURE OF THE ACTION FRAMEWORK

18. ACTION FRAMEWORK (NSP 2012-2016) No child born with HIV by 2015 and improving health and wellbeing of mothers, partners and babies in South Africa

19. 2012-2016 NSP – Strategic document PMTCT and Pediatric ART action framework (MNCHW) at national, provincial and district levels Annual work plans Strategic objective, targets, costing

20. 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

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

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

23. STEP 5: SETTING UP MONITORING MECHANISMS AND TOOLS

24. e MTCT TRACKER ROBOT DASHBOARD CASCADE INDICATORS

25. 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%

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

27. 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

28. National action framework Provincial action framework District action framework

29. STEP 6: TRACKING IMPLEMENTATION OF THE FRAMEWORK

30. 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

31. Dec 2011 – launch of new NSP, announce ment of PMTCT campaign, PMTCT steering committee 2012 - Priority actions 2013 – Mid point stock taking 2014 – Targeted support and focus 2015 – REACH THE GOAL

32. 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

33. 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