‘Keeping mothers
and children
alive and healthy in
South Africa‘
Dr Sanjana Bhardwaj, MD, MPH
UNICEF, South Africa
Precious Robinson,
DD, NDoH
Lerato Lesole, CDC South Africa
Maryet Mogashoa, CDC South Africa
• Action Framework
• Monitoring +
• Coordination +
NDOH: MCH Directorate
PMTCT unit
PMTCT TWG
CCMT meeting
HIV/AIDS
Provincial DOH:
PMTCT
coordinator
MCH
District PHC managers
MCH manager, HIV
manager
Pediatric HIV
TWG
Provincial PMTCT
Steering
committee
meeting
District MCH meetings
Sub district coordinators,
MCH coordinators, HIV
coordinators
Sub district MCH
meetings
Facility manager
Facility meetings
Community outreach,
workers
Community
engagement
PMTCT Steering
committee
Partner
coordination
MCH coordination
meetings
Civil society
consultations
Joint UN
EMTCT
working group
SANAC TTT
LEADERSHIP
VISION
GOAL
TORs
PLANS
PRIORITY SETTING
IMPLEMENTATION DRILL
AREAS
MONITORING
FEEDBACK LOOP
LINKAGES
ENGAGEMENT
National Guidelines +
Policy +
Resources +
Action Framework: ‘No child born with HIV by 2015
and improving the health and well being of mothers,
partners and babies in South Africa’, 2012-2016
9 Provincial Action Frameworks
52 district Action Frameworks
Business work plans
IMPLEMENTATION
MONITORING
4 PRONGS
5 Strategic objectives
EMTCT Tracker
Priority actions based
on bottleneck analysis
Shared accountability
National
Health
Insurance
CARMMA campaign
MCH strategy
Robot Dashboard (7indicators)
Data for Action reports (all 9 provinces
and 52 districts each quarter
Cascade indicators
Primary Health
Care reengineering
Keeping children alive and healthy in South Africa: Blue Print for action for
pediatric and adolescent (0-15 years) HIV integrating prevention, early
identification of HIV and link to treatment, care and support 2012-2016
National
Strategic Plan
for HIV/AIDS,
STI, TB 20122016
Leadership,
management and
coordination
Coverage and
quality of services
Integration with
Primary Health
Care
Monitoring and
evaluation
Community
involvement and
social mobilization
Partnership Framework Tool
Eg – district from Eastern Cape province
PRONG 1
(primary
PRONG 2
PRONG 3
PRONG 4
(PMTCT)
prevention)
(preventing
unwanted
pregnancies)
(Protection, care and
support)
Leadership,
Management and
coordination
Broad reach
X
Broad reach
ESI project
RTC
X
Coverage and quality
(<2% at 6 weeks and
<5% at 18 months)
RTC
X
Broad reach
ESI project
RTC
Broad reach
PHC
Broad reach
X
Broad reach
Broad reach
Monitoring and
Evaluation
Broad reach
RTC
X
Broad reach
ESI project
RTC
Broad reach
RTC
Social mobilization
X
X
X
X
• EMTCT Tracker
• Robot Dashboard
• Cascade indicators
•
•
•
•
NHLS data
SAPMTCT Impact study
ANC HIV prevalence survey
Saving Mothers report 2008-2010
Quarterly from national (monthly at
provincial and district and sub district levels
Highlights progress in key indicators
Analyzes DHIS data and Lab data
Prioritizes actions
Data for Action reports:
PMTCT/MCH
National
Province
District
Subdistrict
ROBOT DASHBOARD
Linked to activities and
targets in the EMTCT action
framework 2012-2016
Stock Taking exercise
Facility
Key 7 indicators
PMTCT
MCH
Tracks progress
over time
Has given programme managers and
implementers an easy to use and understand
tool to track progress and prioritize actions
Has also helped in linking data from different
sources (DHIS and Lab)
Data for Action – reports
national/provincial/district
Cascade Indicators + interlinked
indicators
Robot Dashboard
Discussion/review at
district/provincial/national
level meetings (quarterly/
monthly)
Response to robot
dashboard (within a
month)
Quarterly
Review partnership framework
ACTION
Review expenditure
rates
Review progress
against work plan
Management
framework
Discussions/review with all
partners /shared accountability
+ Community linkages
+ civil society
+ traditional leaders
+ academic partners
+ innovation (MOMCONNECT)
NATIONAL
Indicators (to interpret with an
Apr 10 understanding of each numerator
Mar 11
and denominator)
Apr
11Mar
12
1
ANC 1st visit <20 weeks
37%
2
ANC client CD4 test rate
3
National
Target
2011-2012
National
Target
2012-2013
40%
50%
60%
69%
76%
80%
85%
ANC initiated on AZT during
antenatal care rate
84%
88%
85%
90%
4
ANC initiated on HAART rate
83%
78%
90%
95%
5
ANC clients 32 weeks or later
retesting rate
31%
41%
50%
70%
6
Baby PCR test around 6 weeks
positive rate
8%
3.5%
< 7%
<3.5%
7
Postnatal care mother visits within
6 days rate
27%
60%
40%
70%
Scoring
PHASE 1
(July 2011 to
June 2012)
PHASED APPROACH
PMTCT: Decentralized plans and monitoring
tools
improve systems
Bottleneck
analysis
++
PHASE 2
(July 2012 to
June 2013)
Review plans, data, key priority areas,
building in synergies with MCH, Social support/ECD
MID YEAR STOCK TAKE 2012
Strong evidence base + +
•
•
•
•
Review data from different sources
Identify best practices
Identify lessons learned
Improve coordination amongst all
stakeholders
EXAMPLE
90%
80%
Eastern Cape
70%
63%
60%
Gauteng
% coverage
54%
KwaZulu Natal
50%
Limpopo
47%
Mpumalanga
40%
North West
33%
Northern Cape
30%
Western Cape
21%
20%
South Africa
10%
10%
3%
0%
Free State
0%
2003
1%
2004
2005
2006
2007
2008
2009
2010
2011
PMTCT Cascade 2011-12
120
100
Axis Title
80
60
40
20
0
ANC
ANC
1st
visit
HIV
<20
test
weeks
rate
2010-11
2011-12
39
40
81
77
ANC
CD4
test
rate
71
76
ANC ANC
initiat initiat
ed on ed on
AZT HAART
81
88
71
78
ANC
32
weeks
or
later
retest
35
41
Post
NVP
natal
Cotrim PCR
within
visit
6
test 6
72
within
weeks weeks
hours
6 days
44
60
94
98
72
81
87
93
PCR positivity < 2 months: NHLS
8
7
6
Axis Title
5
4
3
2
1
0
Umgu Umkh
Amaju Ethek
Sisonk
Umzin Uthuk Uthun Zulula
Ilembe
Ugu ngundl anyak
ba
wini
e
yathi ela
gulu
nd
ovu
ude
Apr-12 2.5
1.4
1.5
2.1
1
1.8
3.1
0.9
2.9
2
2.6
May-12 2
2
3.3
3.3
2.5
1.1
2.5
2.7
1.7
2.1
3.2
Jun-12 1.9
3
2.7
1.5
3.2
1.9
4.9
1.9
2.7
0.9
5.1
Jul-12
5.7
2.4
1.8
7
1.9
1.4
1.6
2.5
1.9
2
2.7
KZN
1.8
2.3
2.8
2.4
SAPMTCT Study
National:
• 2010: 3.5 (2.9 – 4.1)
• 2011: 2.7 (2.1-3.2)
KEY PRIORITIES
•
•
•
•
•
•
•
•
•
ANC early registration + +
ANC CD4 testing
ANC HAART initiation and on treatment
Quality ANC care
Postnatal care and follow up
EID (PCR positive)
PCR + linked to treatment
Family planning +
TB
• Impact on maternal health outcomes (deaths)
• Impact on child health outcomes
Action Framework : strategic
direction
Data for action reports (quarterly)
Dashboards +
Lab data (monthly)
Special surveys +
(Beyond percentages to numbers)
Use data at
all levels
Ensure
feedback
loop
Quality Improvement
Health care worker for
change
QI workshops – tools +
SOPs +
Communication
plan +
- Community
awareness
- Social
mobilization
- Materials
Key
priority
areas+
Partnerships +
Coordination
(programs and
partners, civil
society)
COORDINATION
POLICY
PARTNERSHIPS
IMPLEMENTATION
MONITORING
INNOVATION
Infant PCR positive@ 6 weeks
9
8
Variability +
Provinces
and districts
7
Axis Title
6
5
4
3
2
1
0
PCR positive
2008
8
2010
3.5
2011
2.7
ENGAGEMENT
EVIDENCE
EMTCT
++
EXCITEMENT
WE ALWAYS HAVE TIME
ENOUGH, IF WE WILL
BUT USE IT ARIGHT
Johann Wolfgang Von Goethe
COUNTDOWN TO
ZERO
Believe It
Do It
THANK YOU