Download Zimbabwe - icasa 2011

ZIMBABWE COUNTRY EXPERIENCE ON SRH AND HIV
LINKAGES / INTEGRATION LEVERAGE BY CARMMA
(Campaign for Accelerated Reduction of Maternal
Mortality in Africa)
PRESENTED AT
ICASA Addis Ababa, Ethiopia 6 December 2011
BY
Dr. Owen Mugurungi: Director AIDS and TB Unit
Ministry of Health and Child Welfare – Zimbabwe
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Outline of the Presentation
• Zimbabwean HIV and SRH context
• Rationale for SRH and HIV in Zimbabwe
• Brief Presentation on a Good Practice in
SRH and HIV integration
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Zimbabwe
Total pp
PLHIV:
12 million
1.1 million
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• Adult HIV prevalence 13.7%
• ANC sero-prevalence 16.1%
• An estimated 1,1m
Zimbabweans are HIV +ve *
• Of these, 151, 749 are
children 0-14years*
• New pediatric HIV infections
are estimated at 14,976*
(90% from MTCT)
• 1,090 patients dying weekly
due to AIDS
Source: DHS 2005/6 & MOHCW HIV estimates 2009*
Context (SRH)
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Fertility rate among 15 – 19 yr olds rose from 99/1000 women in
1994 to 112/1000 in 1999, and then declined to 99/1000 women
in 2005/6 (ZDHS 2005/6)
CPR increased from 38% in 1984 to 60% in 2006 (ZDHS 1988,
2005/6); latest 65% according to MIMS 2009
Unmet need for contraception is 13% (ZDHS 2005/6)
Institutional Delivery declined from 72% in 1999 to 68% in 2006
(ZDHS 1999, 2005/6) and currently stands at 61% (MIMS 2009)
ANC coverage increased from 81% in 1999 to 94% in 2006 (ZDHS
1999, 2005/6); currently 93% (MIMS 2009)
Skilled Attendance at Birth declined from 73% in 1999 to 69% in
2006 (ZDHS 1999, 2005/6), currently 60% (MIMS 2009).
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Zimbabwe Maternal and Perinatal Mortality Study:
2007
• Maternal Mortality Ratio = 725 per 100 000 live births
• Perinatal Mortality rate = 29 per 1000 births
Key Causes of Maternal Deaths
%
AIDS Defining conditions
25.5
Post Partum Haemorrhage
14.4
Hypertension/Eclampsia
13.1
Puerperal Sepsis
7.8
Abortion complication
5.8
Malaria
5.8
Obstructed Labour
3.3
Ectopic Pregnancy
2.0
Key Causes of Perinatal Deaths
%
Unexplained intrauterine
death
Preterm birth
17.4
Intrapartum asphyxia and
birth trauma
Infection
26.0
Intrauterine growth restriction
1.3
Antepartum haemorrhage
1.5
Congenital abnormality
1.6
Maternal Hypertension
3.6
33.6
3.3
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Integrating SRH & HIV in Zimbabwe
Rationale
 Achievement of universal access to RH and HIV prevention,
treatment, care and support by 2015 (MDGs 4, 5 and 6)
 In the spirit of CARMMA, promote and advocate for renewed
and intensified implementation of the Maputo Plan of Action for
Reduction of Maternal Mortality in Africa and for the attainment
of MDG 5 by 2015
Growing understanding on benefits of integration of SRH and
HIV programmes and services e.g.
Improved access to SRH and HIV services
Reduction in duplication of efforts
Reduced competition for scarce resources and
Greater support for dual protection
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Progress Made Towards SRH and HIV
Integration
1. Launched the CARMMA on the 30th of June
2010, under the theme “Zimbabwe Cares: No
Woman Should Die While Giving Life!”
– Objective: Trigger renewed national and
stakeholder efforts to accelerate the
availability, accessibility and utilisation of
quality health services, including those
related to sexual and reproductive health,
critical for the reduction of maternal and
neonatal mortality.
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Progress Made Towards SRH and HIV
Integration
2. Undertook a Rapid Needs Assessment on status of SRH and
HIV integration in 2010 and validated in March 2011
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Obj: To assess HIV and SRH bi-directional linkages at the policy,
systems, and service-delivery and community levels and identify
current critical gaps in policies, programmes and services that would
inform comprehensive programme on advancing SRH and HIV
Linkages
Developed a workplan and mobilised resource for scale up of efforts
on linkages.
Among the activities on the workplan is to increase of capacity of
health care service providers to implement integrated SRH and HIV
services
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The Good Practice: Integrated SRH and
HIV Training
The Initiative
• Training of health care providers in Integrated
Maternal and Neonatal Care and Comprehensive
PMTCT 2010 to date
Purpose
• To equip health care service providers with the
knowledge and life-saving skills in integrated maternal
and neonatal care services, HIV prevention and ART to
prevent MTCT.
Rationale for Training
• The absence of integrated training for health care
workers
• Severe shortage of human and financial resources,
has led to missed opportunities in providing
comprehensive services to mothers and children and
reduced the effectiveness of both MCH and HIV
interventions.
• Parallel SRH and HIV training programmes targeting
the same care provider
• High staff attrition for experienced personnel
brought about the need for continuous training.
Objectives of the Training
• Update health care service providers on good ANC,
labour and delivery, postpartum, and essential newborn care.
• Train health service providers on integrating
management of pregnancy, labour, delivery, and the
postpartum care and new-born with prevention of
MTCT.
• To strengthen the monitoring and evaluation of
integrated maternal, neonatal and PMTCT services
by training health workers in proper completion of
MCH and HIV registers.
Major Implementation Activities
• Collaboration between PMTCT programme
within the AIDS and TB Unit and the RH Unit of
the Ministry of Health and Child Welfare
• Merging and adaptation of selected PMTCT, HIV
care, antenatal care and emergency obstetric
care leading to the development of an
Integrated Training manual on Maternal,
Neonatal and Comprehensive PMTCT,
• Training of health care workers using the manual
Achievements
• Collaboration between the RH and AIDS/TB units in the
Division of Preventive Services to develop the integrated
training manual.
• 30 national level health service providers and 300
provincial level health service providers received
training, and roll-out of training to the district level ongoing.
• Training program has optimized use of human and
financial resources and reduced diversion of health
workers from service provision for training.
• Training enhanced the capacity of the health delivery
system for integrated MNH and PMTCT services,
supervision, planning and monitoring and evaluation.
Achievements cont…..
• Placement of a SRH and HIV linkages focal
person in the Department of Preventive Services
crucial in achieving the coordination between
HIV and SRH programmes
• Advocacy and support from partners important
in the initiation and implementation of training
program
• Integrated training allowed the optimal use of
limited resources and reduced diversion of
health workers from their normal activities.
Challenge
• Operational norms and physical set-up of
health facilities which have been oriented
towards vertical provision of services and
weak supervision systems remain challenges
to be overcome.
acknowledgements
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Ministry of health and Child Welfare
UNFPA
WHO
Bilateral organisations
Zimbabwe National Family Planning Council
National AIDS Council
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Siyabonga
Thank you!
Mazvita!
Merci!