1. 1 KwaZulu Natal Province URC Annual Meeting 13-17 December 2010 Provincial Coordinators: Mrs. P Harrison Mrs. M Ngema Mrs. V Mbatha

2. USAID HEALTH CARE IMPROVEMENT PROJECT HCI Facilities DistrictFacilities Uthungulu31 health care facilities UthunguluAmakhumbuza Home based care organization

3. USAID HEALTH CARE IMPROVEMENT PROJECT Level support provided DOHPerson ResponsibleReporting Timeline/ Frequency Provincial level None at present District Level Mr. M. ZunguMonthly Sub-district Level Ms S. Mavundla Mrs G. Shange Mrs C.B.Makhoba Mrs B. Mthabela Mrs R.N. Ndabandaba Mrs N. Shange Mrs E.T. Sithole Mr V. Zikhali Consulting quarterly

4. USAID HEALTH CARE IMPROVEMENT PROJECT Key Activities Health Systems Strengthening Provide on going on site mentoring and coaching. Training Provide QA/QI training to all supported facilities in all HIV and AIDS programme. Data management Capacitate staff in Data analysis and management Monitoring 70% of all DOH facilities in district supported by HCI, therefore we utilize the district targets to assess progress.

5. USAID HEALTH CARE IMPROVEMENT PROJECT Key Results: PMTCT services: FY10 PMTCTAchievedDistrict Target % Facilities providing dual therapy97%100% Exposed babies PCR at six weeks2 563 - (51%)66% Nevirapine uptake amongst exposed babies 95%99% Nevirapine uptake amongst HIV+ ante natals 91%90% % Hospitals with monthly peri-natal mortality meetings N/A100% % Ante natals receiving AZT74%92% 70% facilities have measures against district targets

6. USAID HEALTH CARE IMPROVEMENT PROJECT Key Results – TB services, FY10: TBHIVAchievedDistrict Target % PTB diagnosed with smear culture93%85% % Conversion PTB70%75% %PTB Cure rate66%81% % PTB Treatment success rate70%83% % Defaulter rate16%6.5% # PTB cases reported340414 500

7. USAID HEALTH CARE IMPROVEMENT PROJECT Key Results: Quality Assurance, FY10 Quality AssuranceAchievedDistrict Target % PHC Clinics implementing Quality Standards 59%50% % Hospitals implementing Quality Standards 88%100%

8. USAID HEALTH CARE IMPROVEMENT PROJECT HCT services in Kwa-Zulu Natal, FY09-10 Data for 31 facilities New Facilities added HCT Campaign

9. USAID HEALTH CARE IMPROVEMENT PROJECT HCT services: Performance vs. Targets, FY10

10. USAID HEALTH CARE IMPROVEMENT PROJECT PMTCT: ANC tested for HIV, FY10 Data for 31 facilities

11. USAID HEALTH CARE IMPROVEMENT PROJECT PMTCT: Performance vs. Targets, FY10 Data for 31 Facilities

12. USAID HEALTH CARE IMPROVEMENT PROJECT PMTCT: Transmission rate at six weeks, FY 08-10 Data for 31 facilities Transmission rate: 23% 4.9% 1.4% 5.5% 4.5% 5% 7.2% 2.8% Proportion of HIV-exposed babies tested: 51% 46% 42% 54% 54% 50% 44% 59%

13. USAID HEALTH CARE IMPROVEMENT PROJECT PMTCT: Compliance with guidelines, FY 09/10 220 records audited per quarter. Data for 10 facilities performing deliveries

14. USAID HEALTH CARE IMPROVEMENT PROJECT HIV/TB: TB patients offered HCT, FY 2008/10 Data for 31 facilities

15. USAID HEALTH CARE IMPROVEMENT PROJECT HIV/TB: HIV clients screened for TB, FY09/10 Data for 31 facilities %HIV+ clients screened for TB: 102% 91% 86% 96% %HIVTB clients started on TB treatment: >100% 108% 97% 100%

16. USAID HEALTH CARE IMPROVEMENT PROJECT HIV/TB: Performance vs. Targets, FY10 Data for 31 facilities

17. USAID HEALTH CARE IMPROVEMENT PROJECT ARV services: HIV + patients on ART, FY10 (9 facilities of which 4 were dropped at the end of last quarter)

18. USAID HEALTH CARE IMPROVEMENT PROJECT Key Challenges: District Management –Need to strengthen ties with the district Human Resource –Lack of skilled personnel –Staff rotation and shortage Data Management –Poor recording and reporting Infrastructure –Poor infrastructure Medicine and other stock out (Bactrim, INH, milk, food supplements)

19. USAID HEALTH CARE IMPROVEMENT PROJECT Key Successes Male circumcision campaign - 1734 male circumcised since April 2010 through this initiative. Institutionalization of QA at all facilities Significant improvements in supported programs Establishment of PHC level ART services Strengthened linkages between community, clinic and hospital levels Absorption of 4 ART( Roving teams) by the district

20. USAID HEALTH CARE IMPROVEMENT PROJECT Planned Activities for FY11 1.1 Conduct eight QA trainings for staff at Uthungulu District. 1.2. Contribution to the MDG 4, 5 & 6  MDG 4 : Reducing child mortality by: - Strengthening PMTCT services - Continuous monitoring of the programme. - Ensuring the availability of the latest guidelines. - Monitoring compliance to the guidelines - Strengthen IMCI training for both HCWs & CHWs

21. USAID HEALTH CARE IMPROVEMENT PROJECT  MDG 5 : Improve Maternal Health - Reproductive health/ Family planning - Promote HIV testing for all clients attending ANC - Encourage early antenatal booking before 12 weeks of gestation. - Strengthen initiation of HIV +ve ANC clients with CD4 count < 350 on HAART - Promote cervical cancer screening to all vulnerable clients.  MDG 6 : Combat HIV/AIDS, TB & other diseases - Strengthen collaboration of HIV/TB services - Strengthen CPT & IPT initiation to HIV+ve clients as per protocol. Planned Activities for FY11

22. USAID HEALTH CARE IMPROVEMENT PROJECT 2.18 Priority districts Uthungulu District is not among the 18 priority districts but, it does offer relevant support for clients that are referred from other districts plus those that cross boundaries. 3. Ministerial priorities.  Strengthen HCT implementation at facilities.  Strengthen CCMT approach.  Scale up MMC universal access.  Strengthen implementation of the new PMTCT guidelines.  Strengthen 6 ministerial priorities. 4. TB risk assessments and IPC Plan.  Expand implementation of IPC plans and TB risk assessment in all supported facilities. Planned Activities for FY11

23. 23 Thank you