1
1
Rapid Access Expansion of Integrated Community Case Management of Malaria, Pneumonia and Diarrhoea RAcE 2015 – Mozambique
AFRO/GMP Joint Coordination and
Planning Meeting
19 September 2013
Eva de Carvalho MD,MPH
2
2
Outline of the presentation
Background
Status of APE programme in the country
iCCM in Mozambique
Country implementation process
How was the project area chosen
RAcE in Mozambique
WHO country office workplan
Achievement
Challenges
3
3
Background 1
Total population estimated in
2013: 24,366,112 inhabitants
Urban population: 40%
Rural population: 60%
Under five population: 17.1%
Health care coverage: 52%
In 1978, the APEs Program
(elementary polyvalent agent)
was implemented
iCCM policy adopted in 2010,
allow APEs to treat (malaria,
pneumonia & diarrhoea)
4
4
Background 2
Care seeking and treatment
for (DHS2011)
Pneumonia: 50.2%
12.1% treated with AB
Diarrhoea: 56%
55% treated with ORS
Fever: 56%
29.9% antimalarials
17.9% received ACTs
5
5
Status of APE programme in the country
1,950 APEs trained until June
2013
Out of those 1,213 APEs
deployed in 117 out of 128
districts
Total APEs expected until
2014: 3,827
Minsterio da Saude
Direccao Nacional de Saude PublicaPrograma de Agentes Polivalentes Elementares
Distribuicao de Parceirosde Formacao por Distrito
Ronda 1 a 3 (2010 a 2012)
UNICEF
Banco Mundial
Banco Mundial/UNICEF
Visao Mundial
Malaria Consortium
Save the Children
HelpAge International
PNGGorongosa/UNICEF
6
6
Implemente
r /Partner
Donors / Partner Deadline
MoH / CMAM HSDP (World Bank, CIDA, Russia, Suisse) Fev 2014
USAID Tempo indefinido
PMI (President’s Malaria Initiative) - CMAM Ano por ano
UNICEF
USAID Agosto 2013 (Renovável)
CIDA Catalytic Initiative Maio 2013
UNICEF Funds Indefinido
Malária
Consortium
CIDA Fim de Marco 2013 (extensao)
Gates Foundation Outubro 2014
Planet Wheeler Foundation Dez 2013
Save the Children AMREF/GSK (Gaza-Chicualacuala,
Mabalane, Guijá, Chigubo)
Mar 2015
Italian Government (Gaza) Dez 2015 (only incentives)
Crown Foundation (Zambezia-Morrumbala,
Mopeia e Milange)
Dez 2014
World Vision–
Tete
USAID Abril 2013
World Vision/
Zambézia
USAID Junho 2014
Gorongosa
Parque (Sofala)
USAID, Mount Sinai School of Medicine Agosto 2014
SC & MC WHO/CIDA (Nampula, Zambezia, Manica
&Inhambane)
2017
7
7
RAcE-Country implementation process
18-20 July 2012 : 1st WHO mission (HQ & AFRO)
o a) Discuss the CIDA-funded iCCM interventions with WCO, MOH and learn
about partners implementing iCCM in the country (their experiences, difficulties,
lessons learned).
28 September 2012: Letter of Interest submitted by Save the children +
Malaria consortium, World vision + Aga Khan + CISM, AMREF & Red
cross.
31 Oct – 2 Nov 2012: Guidance workshop facilitated by
WHO/HQ/AFRO/IST/WCO and by MoH : Dr Laura Mavote (head of health
promotion department ) & Ms Teresa Mapasse (National coordinator of APE
program).
1-5 March 2013: in-country negotiation with the grantee (SC & MC), MoH
and WCO to agree on the next steps to roll out the program, coordination
mechanism, programmatic & operational issues, administrative & financial
procedures & coordination of the RAcE project with other iCCM
programmes.
1 April 2013: Grant Agreement Letter (GALs) signed
8
8
How was the project area chosen?
In consultation with MoH and partners few criteria were defined:
o Existence of a main implementing partner
o Availability of funds at provincial level
o Burden of diseases
o Alignment with the MoH’s APEs training plan in order to fill the gap
9
9
RAcE in Mozambique
Grantee: Save the Children (SC)
o Partner: Malaria Consortium (MC)
51 districts in 4 provinces
(Nampula, Zambezia, Manica (SC)
& Inhambane / MC)
Targeted population in the 4
provinces: 12,581,788 this include
7,218,300 inhabitants living in rural
areas without access to health
services
The 1451 APE supported by RAcE
project are expected to reach
approximately 308,338 children
under-five (based on a catchment
population of 1,250 people / APE)
Niassa
Cabo Delgado
Nampula Tete
Manica
Sofala
Gaza Inhambane
Maputo Provincia Maputo
Cidade
Zambézia
10
10
Objective of the RAcE Project in Mozambique
Increase access to iCCM services
o Train APEs to provide iCCM services
Improve quality of iCCM services
o Provide technical support for implementation
o Ensure Supportive supervision
Strengthen links between iCCM services and communities
o Mapping of existing APEs
o Behaviour change communication to improve timely and appropriate
care
Strengthen the national system to support, sustain and scale up
iCCM
o Revitalize the WG
o Review and revise M&E tools and indicators
11
11
RAcE implementation package
Kit for treatment (Kit C)
o RDT : HRP2/Pf
o Antimalarial: Arthemeter-
Lumefantrine (AL)
o Antibiotic: Amoxiciline caps 125
mg and 250 mg
o ORS & Zinc for diarrhoea
o Rectal artesunate for pre-referral
treatment for severe malaria
o Screening of malnutrition with
MUAC
Working Kit: bicycle, vest, bag, ID
card, flashlight, register book,
referral form, MUAC tape & timer
RAcE-WHO country office workplan
Main Objective: to provide support to iCCM implementation in
Mozambique through the RAcE project
Main activities:
o Technical support for capacity building and OR
o Support M&E activities
o Facilitate dialogue on policies, strategies and guidelines to facilitate
iCCM implementation
o Facilitate coordination between the differents actors involved in the
implementation.
o Supervise the implementation of iCCM
Budget: $100,000 for activities and $100,00 for salary
Staff involved: Mal/iCCM/NPO
13
13
Achievements
Revised the M&E tools including register book and indicators to
accommodate RAcE indicators – waiting for approval
Baseline survey protocol submitted to the bio-ethical (IRB)
committee - waiting for approval approval
TOR for recruitment of M&E, data manager and national
supervisor to be posted at MoH approved
Process of recruitment: on-going for the 1st two and waiting for
formal request from MoH for the last one
Launch of the APE program (23 August 2013)
Coordination meetings
14
14
Challenges – 1
Sustainability of the APEs programme
o Subsidy/Salary for the APEs
Continuous Availability of the kits
Supervision (HR, funds, transport)
Coordination (many donors different projects with different ending
time)
Inclusion of APEs data on HMIS
15
15
Challenges – 2
As RAcE / iCCM is part of APEs program any changes required for
RAcE have Implication in the APE program as a whole and suffers
often a long & heavy bureaucratic process. (e.g. add/change of
indicators).
15
