INTEGRATING PMTCT WITH MNCH
SERVICES AT HEALTH FACILITIES
By: Dr. Maureen Kwikiriza
End of Fellowship report: 22nd March 2013
Host mentors: Dr. Francis Engwau and Dr.
David Serukka
Academic mentor: Dr. Elizabeth Nabiwemba
Roving mentors: Dr. Noerine Kaleeba, Dr. Olico Okui
Background about PREFA
• Local NGO formed in 2004 to contribute to Uganda’s effort in enhancing access to quality PMTCT services
• Funded by PEPFAR through CDC
• PREFA support includes:-
capacity building – hire, train, Mentor and coach Health workers
infrastructure improvement
facility based PMTCT service delivery monitoring
NATIONAL LEVEL: Policy/Guidelines
BEST PRACTICES: Document and share
-Document review
-Rapid assessment
-Consultations
-Train H/W
-Technical support
FACILITY LEVEL: Develop and implement integration plan for PMTCT /MNCH services
COMMUNITY LEVEL: Improve linkages
-MNCH/HIV
Quality of care
improvement tool
-Draft roles of VHTS -Train VHTS -Form FSGs
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Terms of Reference and Achievements
Best practices
Participatory assessment and monitoring of integrated PMTCT and Postnatal care services
Exchange learning visits for health workers
Provide the data tools and orient health workers on recording
Timely dissemination of the new guidelines
Other activities
Program Officer for 3
months
Participated in developing
PREFA strategic plan
Participated in developing
protocols: PREFA M&E
protocol and the
BABIES surveillance
protocol
Coordinated events to
mark 2011 World AIDS
day
Provided technical
Support to Gender
department
Member of the Comm.
and Advocacy sub-
committee for the
Paediatric HIV/AIDS
conference
Publications
News paper articles: 5/6 articles published in New Vision paper
Oral presentations: Early infant diagnosis an opportunity for timely provision of effective care and treatment: PREFA experience from PMTCT-EID program, Wakiso district
Manuscript: Readiness of Public Health Facilities to Implement Integrated PMTCT and postnatal care in Uganda: Results from a Facility Assessment Study (submitted to BMC-Health Services Research)
Programmatic activity
Title: Integrating PMTCT with post natal care services in Uganda: Process Documentation and monitoring outputs
Background
• Uptake of PMTCT services during PNC services
remains low despite high immunization coverage
• Integrating PMTCT with PNC service will improve
service delivery
• PREFA thus piloted integration of PMTCT and PNC in
Wakiso and Nakasongola districts.
Objectives
1. To document the processes leading to implementation
of integrated PMTCT and PNC services
2. To monitor progress of outputs following the
implementation of integrated PMTCT and PNC
services
3. To identify best practices for PMTCT and PNC
integration
Participatory assessment phase 1. Orientation workshop on assessment framework and tools
2. Complete assessment of facilities including interviews with
health workers and observation of facility functioning
3. Collection of routine PMTCT data from registers.
Feedback and planning phase 1. Review of assessment results
2. Identification of areas of weakness
3. Target setting and action plans
Implementation and monitoring phase 1. Planned interventions implemented
2. Monthly support visits by the task force to
determine progress towards targets
Implemented at four health facilities from May to August 2012
Steps involved in implementation of integrated
PMCT/PNC services
PMTCT indicator performance following
integration (Nakasongola HC IV 2012)
0%
20%
40%
60%
80%
100%
120%
April May June July August September
<18 months done 1st PCR
Infants received results PCR
resultsHIV+ women received any
FP methodHIV+ mothers followed up in
community
Lessons learnt
Rapid assessment gives insight of the challenges
particular to a health facility
Data driven implementation of integrated PMCT /
PNC services increases uptake of PMTCT
interventions.
Challenges
• Program different from
research
• Working with district
Solutions
• Be open and willing to
learn
• Learn to be patient
Acknowledgements
• My Mentors
• PREFA staff
• Health workers
• DHO
• Fellow Fellows
• Fellowship program
staff
• Family