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GOAL: To contribute to the reduction of MTCT through support to PMTCT program in xx district of yz Region of Uganda between 2010 - 2015.
Activity Target population Target OutputObjectively verifiable indicator
Sources and Means of verification
Timeline
Responsible / lead
Critical Assumptions
Q1
Q2
Q3
Q4
Objective 1: Increase service coverage of comprehensive, high quality, integrated, PMTCT services up to all HC III and functional HC II in the district.
1.1.1 Documentation of number of active PMTCT sites supported by project
PREFA Existing sites will provide services continuously inspite of resource constraints
1.1.2 Guide districts in compiling integrated district work plans for PMTCT services
Districts (See 5.1.1)
Number and % of districts that have a comprehensive integrated PMTCT plan
Final PMTCT annual plans presented through MOH for funding
MOH
1.1.3 Provide performance based grants to districts
Districts PREFA Districts will account on time avoiding un-necessary delays in implementation
1.2.1 Procurement of buffer stocks of HIV testing kits, CD4 test consumables, and Cotrimoxazole.
Health facilities providing RH services
% of stocks of key PMTCT supplies procured as buffer stock
Internal audit reports; quarterly progress reports
PREFA The actual gap may be 30% or less.
1.2.2 Procurement of buffer stocks of ARVS, and STI screening kits for PMTCT sites
Health facilities providing RH services
% of stocks of key PMTCT supplies procured as buffer stock
Internal audit reports; quarterly progress reports
PREFA
Activity Target population Target OutputObjectively verifiable indicator
Sources and Means of verification
Timeline
Responsible / lead
Critical Assumptions
Q1
Q2
Q3
Q4
1.2.3 Remodelling of space for counselling and laboratory services
Health facilities in W/Nile and Eastern region
Number and % of facilities remodelled according to the work plan
Internal audit reports; district finance reports
Districts
1.3.1 Establish courier system for lab tests
Districts Number of functional courier systems by region
Internal audit reports
PREFA
1.3.2 Transport CD4 and DBS samples and results between PMTCT sites and the testing laboratory.
Health facilities providing PMTCT services
Number and % of facilities that submit CD4 samples and receive results per month
District progress reports; Quarterly joint supervision reports
Districts
1.4.1 Hire additional staff (Midwives, Lab Asst, Peer Counsellors) for PMTCT sites
Districts Number of staff hired per year
District progress reports; Quarterly joint supervision reports
Districts
1.4.2 Training Health Workers in comprehensive HIV/AIDS care using IMAI / IMPAC approach
Health workers at PMTCT sites
Number and % of health workers trained
Training reports; District progress reports; Quarterly joint supervision reports
PREFA
1.4.3 Training Health Workers in infant and young child feeding (IYCF).
Health workers at PMTCT sites
Number and % of health workers trained
Training reports; District progress reports; Quarterly joint supervision reports
PREFA
Activity Target population Target OutputObjectively verifiable indicator
Sources and Means of verification
Timeline
Responsible / lead
Critical Assumptions
Q1
Q2
Q3
Q4
1.4.4 Training Health Workers in rapid HIV testing and EID.
Health workers at PMTCT sites
Number and % of health workers trained
Training reports; District progress reports; Quarterly joint supervision reports
PREFA
1.4.5 Training of trainers in comprehensive PMTCT counselling, IYCF, EID, and RH/FP (using IMAI IMPACT approach)
District trainers/ health workers
Number and % of health workers trained
Training reports; District progress reports; Quarterly joint supervision reports
PREFA
1.4.6 Orientation of CCAs in PMTCT service delivery including provision of modern FP services
CCAs attached to PMTCT sites
Number and % of CCAs trained
Training reports; District progress reports; Quarterly joint supervision reports
PREFA
1.4.7 Training of health workers in data management
Health workers at PMTCT sites
Number and % of health workers trained
Training reports; District progress reports; Quarterly joint supervision reports
PREFA
1.4.8 Training of family support group members as peer mentors
Health workers at PMTCT sites
Number and % of FSG members trained
Training reports; District progress reports; Quarterly joint supervision reports
PREFA
1.4.9 Conduct post-training supervision
Health workers at PMTCT sites
Number and % of health workers supervised within 3
Post-training supervision report
PREFA
Activity Target population Target OutputObjectively verifiable indicator
Sources and Means of verification
Timeline
Responsible / lead
Critical Assumptions
Q1
Q2
Q3
Q4
months of completion of training
1.4.10 DHT Conduct quarterly monitoring visits of PMTCT sites
PMTCT sites Number and % of facilities supervised by DHT at least once / quarter
District progress reports; Quarterly joint supervision reports
Districts This is an integrated activity
1.4.11 HSD Conduct monthly monitoring visits of PMTCT sites
PMTCT sites Number and % of facilities supervised by HSD team at least once / month
District progress reports; Quarterly joint supervision reports
Districts Funds reach HSDs in time
1.4.12 Conduct monthly technical support sessions (CMEs, mentoring, coaching) for Health Workers at PMTCT sites
Health workers at PMTCT sites
Number or % of facilities conducting at least one CME session per quarter
District progress reports; Quarterly joint supervision reports
Districts
Objective 2: Increase uptake of comprehensive PMTCT services from 65% to 80% of all expected pregnant women in the 40 districts.
2.1.1 Conduct radio talk shows
Adults of child bearing age in community
Number of radio sessions conducted
District progress reports
Districts
2.1.2 Conduct community education sessions on PMTCT by CCAs
Adults of child bearing age in community
Number of sessions conducted by each CCA
District progress reports
Districts
2.1.3 Facilitate PHA groups for PWP activities in the community.
PHA groups in community
Number of events conducted per quarter; Number and % of active PHA groups
District progress reports
Districts
2.1.4 Funding and technical Male peer groups Number of events District progress Districts Reviewed every 6
Activity Target population Target OutputObjectively verifiable indicator
Sources and Means of verification
Timeline
Responsible / lead
Critical Assumptions
Q1
Q2
Q3
Q4
guidance to male peer-group activities
in community conducted per quarter; Number and % of active male groups
reports
months this year. There is one group per district
2.2.1 Conduct referral of pregnant women to health facilities by CCAs
Pregnant women in community
Number and % of pregnant women referred by CCAs for RH services
District progress reports
Districts
2.2.2 Establish notice of community rights to service
Adults of child bearing age in community
Number and % of facilities with notices on community rights
District supervision reports
PREFA
3.1.1 Conduct monthly integrated PMTCT outreaches to HC IIs
Health facilities without PMTCT services
Number and % of lower facilities receive monthly visits from higher level facilities
District progress reports
Districts Hospitals and HC IV will build capacity for static PMTCT services at lower levels
3.1.2 Pre-test counselling of pregnant women
Pregnant women attending ANC
Number and % of pregnant women who receive pre-test counselling
Monthly HMIS and PMTCT reports
Districts 98% of 620,642 pregnant women attend ANC at least once at a public facility
3.1.3 Conduct rapid HIV tests for pregnant women and give them test results
Pregnant women attending ANC
Number and % of pregnant women who receive pre-test
Monthly HMIS and PMTCT
Districts 95% of new ANC clients will test for
Activity Target population Target OutputObjectively verifiable indicator
Sources and Means of verification
Timeline
Responsible / lead
Critical Assumptions
Q1
Q2
Q3
Q4
counselling reports HIV
3.1.4 Conduct Hb, Syphilis and urine tests
Pregnant women attending ANC
Number and % of pregnant women who receive Hb, urine and syphilis screening
Monthly HMIS and PMTCT reports
Districts As a minimum, all women who test HIV positive also get other routine tests.
3.1.5 Identify HIV positive mothers for further care and support.
Pregnant women attending ANC who test for HIV
Number and % of pregnant women who test HIV positive
Monthly HMIS and PMTCT reports
Districts 90% of expected HIV infected pregnant women attend ANC and take the HIV test.
3.2.1 Collection of blood samples for CD4 test from HIV positive women and document HIV clinical stage.
Pregnant HIV-infected women
Number and % of HIV positive pregnant women who have a blood sample taken for CD4 testing
Monthly HMIS and PMTCT reports
Districts 100% HIV positive women attending ANC
3.2.2 Provide ARV prophylaxis to HIV positive women
Pregnant HIV-infected women
Number and % of HIV positive pregnant women who receive ARVs for PMTCT, by regimen.
Monthly HMIS and PMTCT reports
Districts 100% HIV positive women attending ANC
3.2.3 Conduct delivery of HIV infected women under skilled care
Pregnant HIV-infected women
Number and % of HIV positive pregnant women who deliver under skilled care.
Monthly HMIS and PMTCT reports
Districts 80% HIV positive women deliver under skilled care with good follow-up
3.2.4 Provide ARV prophylaxis to HIV exposed babies
Pregnant HIV-infected women
Number and % of HIV exposed babies who receive ARV prophylaxis
Monthly HMIS and PMTCT reports
Districts 100% of babies born to HIV positive women under skilled care
3.2.5 Provide Pregnant HIV- Number and % of HIV Monthly HMIS Districts 100% of HIV positive
Activity Target population Target OutputObjectively verifiable indicator
Sources and Means of verification
Timeline
Responsible / lead
Critical Assumptions
Q1
Q2
Q3
Q4
Cotrimoxazole prophylaxis for HIV positive pregnant women as part of a basic care package (BCP)
infected women positive pregnant women who receive Cotrim tablets
and PMTCT reports
women attending ANC
3.2.6 Provide Cotrimoxazole prophylaxis for HIV exposed babies
Pregnant HIV-infected women
Number and % of HIV exposed babies who receive Cotrim
Monthly HMIS and PMTCT reports
Districts 80% of babies born to HIV positive women are tracked for more services
3.2.7 Provide funds and technical guidance to family support group meetings
Pregnant HIV-infected women
Number and % of pregnant women who test HIV positive
District progress reports
Districts Each HSD will have one group to support intensively
3.3.1 Establish and maintain system of referral to care and support within PMTCT site and to external ART sites
PMTCT and ART sites
Number and % of HSDs with documented referral network; Number and % of health facilities linked to network
District progress reports; Quarterly joint supervision reports
Districts Each of 53 HSDs will have at least one ART site
3.3.2 Track HIV infected mothers and their babies at facility and community level
Pregnant HIV-infected women
Number and % of HIV positive mothers tracked; Number and % of HIV exposed babies tracked
District progress reports; Quarterly joint supervision reports
Districts CCAs and health workers will keep track of at least 80% of HIV infected women identified at PMTCT sites.
3.3.3 Conduct referral of HIV positive pregnant women/ their babies to ART and HIV care services
Pregnant HIV-infected women
Number and % of HIV positive mothers referred; Number and % of HIV exposed
District progress reports; Quarterly joint supervision reports
Districts
Activity Target population Target OutputObjectively verifiable indicator
Sources and Means of verification
Timeline
Responsible / lead
Critical Assumptions
Q1
Q2
Q3
Q4
babies referred
Objective 3: Provide early infant HIV testing to 80% of all HIV-exposed babies.
4.1.1 Health workers conduct (integrated) EID outreaches
Health facilities without PMTCT services
3.1.1 3.1.1
Districts
4.1.2 Mentoring health workers in EID for HIV exposed babies
Health workers at PMTCT sites
Number of sessions conducted per facility per year; % of facilities receiving a session per quarter
District progress reports; Monthly PMTCT reports
Districts This is combined under 1.4.12
4.1.3 Identify HIV exposed infants in postnatal, immunization and outpatient clinics
HIV exposed babies
Number and % of HIV exposed babies who are identified
District progress reports; Monthly PMTCT reports
Districts All babies will have a code on their immunization cards
4.1.4 Collect DBS specimens from HIV exposed infants
HIV exposed babies
Number and % of HIV exposed babies who have a DBS taken for HIV testing within 12 months of birth
District progress reports; Monthly PMTCT reports
Districts At least 80% of exposed babies are delivered under skilled care and tracked for further services
4.1.5 Transport DBS (together with CD4) specimens and test results to and from the reference laboratory
Health facilities that provide PMTCT/MCH services
Number and % of facilities that submit DBS samples and receive PCR results per month
District progress reports
Districts
4.2.1 Conduct referral of HIV exposed infants from
HIV exposed babies
Number and % of HIV exposed babies
District progress reports
Districts 70% of babies are referred by the CCAs
Activity Target population Target OutputObjectively verifiable indicator
Sources and Means of verification
Timeline
Responsible / lead
Critical Assumptions
Q1
Q2
Q3
Q4
the community by CCAs referred from the community by CCAs
4.2.2 Conduct referral of HIV positive babies to ART and HIV care services
HIV exposed babies
Number and % of HIV infected babies referred for ART and HIV care
District progress reports; Monthly PMTCT reports
Districts 5.4% of babies tested may be infected with HIV
Objective 4: Promote integration of PMTCT with RH, nutrition, and HIV care and treatment service at 628 PMTCT sites in 40 districts.
5.1.1 Develop district plans integrating PHC and RH gaps
Districts Number and % of districts with comprehensive integrated PMTCT workplans
Plans presented through MOH for funding
Districts
5.1.2 District technical teams conduct supervision of integrated PMTCT/RH/PHC activities
PMTCT sites (see 1.4.10)
Number of visits per facility per year; % of facilities receiving a visit per year
District progress reports; Quarterly joint supervision reports
Districts 1.4.10
5.1.3 Procurement of buffer stock of Infection control supplies and delivery care equipment
Health facilities providing PMTCT services
Number and % of buffer stocks of infection control supplies and delivery care equipment procured, by type
Internal audit reports; quarterly progress reports
PREFA Need will be 25% or less
5.1.4 Procurement of therapeutic foods (RUFTs or RUTAFA) for treatment of acute malnutrition of
Health facilities providing RH services
Proportion of budgeted funds used to procure therapeutic foods (RUFTs)
Internal audit reports; quarterly progress reports
PREFA All hospitals and HC IV will be able to treat these clients
Activity Target population Target OutputObjectively verifiable indicator
Sources and Means of verification
Timeline
Responsible / lead
Critical Assumptions
Q1
Q2
Q3
Q4
HIV exposed clients.
5.2.1 Health workers conduct routine integrated PMTCT/RH/PHC outreaches
Health facilities without PMTCT services (see 3.1.1)
Number and % of lower facilities receive monthly visits from higher level facilities
District progress reports
Districts 3.1.1
5.2.2 Routine screening of HIV infected pregnant women for TB and referral for care and treatment
HIV infected pregnant women (see 3.1.5)
Number and % of pregnant women screened for TB
Monthly HMIS and PMTCT reports
Districts
5.2.3 Routine screening and management of STIs among pregnant women
Pregnant women attending ANC
Number and % of pregnant women screened/ managed for STIs
Monthly HMIS; District progress reports
Districts
5.2.4 Conduct routine nutritional assessment of HIV infected mothers and their babies, including nutrition counselling and education during ANC, maternity and PNC care
HIV infected pregnant women and their babies
Number and % of pregnant women screened for nutrition status
Monthly HMIS and PMTCT reports
MUJHU
5.2.5 Establish and maintain demonstration gardens and kitchens at HC IV and at community level
HSD Number of demonstration gardens established
District progress reports; Quarterly joint supervision reports
MUJHU
5.2.6 CCA, CDO, and Agric Officer visits to provide FP commodities, Cotrim refills, to PMTCT
Pregnant HIV-infected women and their babies
Proportion of mothers visited by a community worker
District progress reports; Quarterly joint supervision reports
MUJHU
Activity Target population Target OutputObjectively verifiable indicator
Sources and Means of verification
Timeline
Responsible / lead
Critical Assumptions
Q1
Q2
Q3
Q4
clients in the community
5.2.7 Treat HIV exposed Malnourished clients with RUTF
HIV exposed Malnourished children
Number and % of HIV exposed malnourished clients treated with RUTF
Monthly HMIS and PMTCT reports
MUJHU
5.2.8 Establish tracking system within HSD for clients between PMTCT and ART sites
PMTCT and ART sites (see 3.3.1)
Number and % of HSDs with documented referral network; Number and % of health facilities linked to network
District progress reports; Quarterly joint supervision reports
3.3.1
5.2.9 Conduct regular HSD coordination meetings involving all HIV service outlets in catchment area
PMTCT and ART sites
Number and % of monthly HSD coordination meetings held as planned
District progress reports; Quarterly joint supervision reports
5.2.10 Community mobilisation including messages addressing other PHC and RH issues
Adults of child bearing age in community (see 2.1.3)
Number of sessions conducted by each (of 330) CCAs per month
District progress reports
2.1.3
Objective 5: Strengthen administration, management, and information systems at all levels of the project.
6.1.1 Hire of project staff Project staff Number of staff hired- by category
Minutes of Project Management meetings
PREFA
6.1.2 Capacity (training and equipment) of staff
Project staff Number and % of staff trained as
Minutes of Project Management
PREFA
Activity Target population Target OutputObjectively verifiable indicator
Sources and Means of verification
Timeline
Responsible / lead
Critical Assumptions
Q1
Q2
Q3
Q4
planned meetings
6.2.1 District leaders sign agreements with PREFA
Districts Number of MOUs signed with the districts
Minutes of Project Management meetings
PREFA
6.2.2 Update of district and sub county leaders on the PMTCT project
District leaders Number of districts that conducted update sessions
Program reports PREFA
6.2.3 Conduct administrative support supervision by district leaders
PMTCT sites Number and % of visits by district leaders per facility per year
District progress reports; Quarterly joint supervision reports
Districts
6.2.4 Conduct joint PMTCT support supervision at district level by partners
PMTCT sites Number of joint supervision visits conducted by partners
District progress reports; Quarterly joint supervision reports
PREFA PREFA, MUJHU, MOH and HIV stakeholders at district level are represented on the team
6.2.5 Conduct district PMTCT stakeholders' meeting
HIV stakeholders in district
Number of stakeholder meetings held per district
District progress reports
PREFA Each district has more than one HIV stakeholder who need to meet for better coordination
6.2.6 Conduct quarterly HSD coordination meetings (health workers and CCAs)
Health workers and CCAs
Number of HSDs conducting coordination meetings per quarter
District progress reports
Districts Two meetings; one with CCAs and the other with In charges of PMTCT sites