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Training & Mentoring of Health Providers: Malawi's Approach
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Training & Mentoring of Health Providers: Malawi's Approach



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    Aida Yemane Berhan
    Technical Advisor, Malawi
    Elizabeth Glaser Pediatric AIDS Foundation
    June 17, 2010
  • 2. Malawi Background
    Population: Approximately 13 million
    HIV prevalence: 12%
    90,000 new HIV infections each year among adults
    • Estimated 1 million people living with HIV(UNICEF 2008)
    102,000 HIV-infected children below 15 years
    Over 1 million children orphaned due to AIDS
  • 3. Status of HIV/AIDS Services in Malawi
    The PMTCT program has registered tremendous scale-up with respect to number of sites that are offering the service
    From 137 (28% ) of health facilities in 2006
    Up to 544 (100%) in 2009
    Increased percentage of pregnant women tested & counseled for HIV
    From 25% in 2006
    Up to 67% in 2009
    Coverage of HIV testing and ARV prophylaxis has been difficult to track due to the absence of standardized monitoring tools until the end of 2009. With this limitation:
    HIV positive pregnant women receiving complete course of ARV prophylaxis:
    From 50.5% in 2007
    Up to 81.7% in 2008
    Women receiving ARV PMTCT is reported to be 38.8%
    Using population-based data from: Population Census, 2008 & MoH PMTCT Program Data, 2009
  • 4. Status of HIV/AIDS Services in Malawi
    Number of HIV-exposed infants receiving ARV prophylaxis rose from 5,558 in 2006 to 20,058 in 2008
    Major strides in PMTCT also include the EID program in over 41 sites
    Rapid acceleration of the ART program. Tremendous progress has been registered:
    With only 10,761 people on ART in 2004, the figures have risen to 198,846 in 2009 (Adults: 181,482; Children: 17,364)
    ART sites have increased from 9 in 2003 to 377 (279 static clinics and 98 outreach/mobile clinics) as of December 2009
    Between July 2008 and June 2009, 1,079,598 first-time testers accessed HTC services and these constituted 63% of all the clients tested in the period
  • 5. EGPAF Malawi’s Program Progress
    In 2002 in collaboration with local partners , initiated one of Malawi’s first programs to provide PMTCT
    In 2005, received funding through the USAID Call to Action project to support PMTCT activities
    In 2006 , the foundation was supporting 54% of all PMTCT services available
    Established an office in 2008 with the request of MOH to:
    Support MOH at national level in building capacity to manage the PMTCT program , development of guideline, revision of policy, improvement of M & E system including zonal mentorship program
    Continue supporting implementing partner (LMRFT) which is currently providing TA to 41 sites in Lilongwe districts
    Expand TA to more districts in central west zone , Dedza and Ntcheu districts to 51 sites
  • 6. PMTCT Program in Malawi
    The program now focuses its efforts on:
    Improving access to comprehensive PMTCT services:
    Scale-up of TA from 4 sites in 2003 to 91 sites in 2010
    Building facility and staff capacity for PMTCT service provision
    Carry out assessment, TOT and training of service providers, mentorship and supportive supervision
    Increase efficacy of PMTCT programs nationwide
    EGPAF collaborates with MOH and other partners on zonal mentorship program , training of coordinators for safe motherhood, PMTCT, and RH to perform regular supervision and performance review
    Reducing HIV-related stigma and increasing community involvement
    EGPAF partners with organization to create supportive environment for mothers which includes support groups for HIV-positive lactating mothers, and counseling and testing of male partners
  • 7. EGPAF Malawi’s Program Progress
    More than 3,000 health care providers trained on PMTCT, adherence support, pediatric HIV care
    Increased uptake of PMTCT at 41 EGPAF-supported sites in 2009
    99% of women attending ANC receive counseling and testing
    95% HIV+ women receive ARVs
    60% of infants receive ARVs
    Expand technical support to an additional 51 sites in 2010
    Carried out a PMTCT capacity assessment in Dedza and Ntcheu districts where EGPAF is expanding TA for PMTCT services
  • 8. Rationale for Zonal Mentorship Program
    While the rapid scale up of PMTCT sites was a commendable success, quality of service delivery was a concern to MOH and partners including:
    Inadequate staff coordinating the PMTCT program at national level
    Relatively inadequate partners, funding for PMTCT program in the country
    Relatively poor M&E system
    Frequently changing data recording tools (e.g. 3 times in 2009 alone)
    Staff not oriented on the use of the tools
    Lack of standardized PMTCT supervision tool
    Inadequate supervision of PMTCT sites by district PMTCT coordinators
    Lack of coordination among the coordinators of HIV, ART, PMTCT, RH, FP, safe motherhood, laboratory and pharmacies at both national and district level
    Frequent stock out of PMTCT supplies
  • 9. Malawi’s Zonal Mentorship Program
    EGPAF formed a partnership with the MOH, MSH/BASICS, UNICEF and other HIV partner organizations to embark on a Zonal Mentorship Program for PMTCT nationwide
    The program goals are:
    To improve the quality of program implementation through joint and regular review of programs performance
    2. To build the capacity of the District Coordinators on PMTCT supervision
  • 10. Malawi’s Zonal Mentorship Program
    Carried out 3 rounds of zonal mentorship training in 2009
    The zonal mentorship training workshops are preceded by national PMTCT site supportive supervision visits
    3-4 teams comprising MOH PMTCT coordinators, district PMTCT coordinators and PMTCT partners are involved in supportive supervision
    From each district 3-4 PMTCT sites (90-120 sites at a time) are mentored and supervised with the focus on:
    Availability & capacity of human resources; integration of PMTCT into MCH; Linkage of PMTCT to ART; expansion of combination ARV prophylaxis provision; mother-baby pair follow-up; EID; supplies; BCC; IYCF; data recording & reporting
    Each supervision team provide feed back to the facilities and the districts, discuss on challenges & solutions
  • 11. Zonal Mentorship Program Achievements
    District PMTCT coordinators have improved their capacity to mentor and supervise PMTCT service providers
    There is good initiative in coordination of activities among PMTCT, safe motherhood and family planning coordinators in the integrated management of PMTCT
    The coordination will extend more to the other HIV programs, such as ART, HTC & STI
    • Increased motivation of service providers
  • 12. Zonal Mentorship Program Achievements
    PMTCT-related voices from remote health centers are now easily heard at the national level
    Improvement of M&E
    Expansion of sites providing combination ARV prophylaxis
    Updates on PMTCT, pediatric HIV, and other related issues were effectively disseminated to the facilities
    DHOs have recognized the need to improve quality of PMTCT services and have started to invest more in PMTCT
  • 13. Lessons Learned
    Strong MOH/NAC leadership and program ownership are vital for effective program implementation and sustainability
    Coordination of programs, services, and partners is the key for efficiency and effectiveness of program implementation
    Mentorship and supportive supervision motivates staff and they take the initiative to perform better and be creative
    Building the capacity of the Districts Coordinators and Zonal Supervisors in PMTCT would contribute to the improvement of access and quality of the service significantly
  • 14. Challenges
    Inadequate funds to support the zonal mentorship program
    Lack of adequate staff in MOH to coordinate PMTCT at national level
    Relatively few PMTCT partners in the country
    Poor infrastructure in health facilities
    Poor logistics and resources in the districts to maintain the program
    Poor community linkage of the program
    More resources and efforts required to ensure coordination among the coordinators of ART, HTC, FP, safe motherhood, RH, nutrition
  • 15. Newly renovated health center in central west zone in Malawi
    DISCLAIMER: This program was made possible through support provided by the Office of HIV/AIDS, Global Bureau Center for Population, Health and Nutrition, of the United States Agency for International Development (USAID), through the President’s Emergency Plan for AIDS Relief, as part of the Elizabeth Glaser Pediatric AIDS Foundation's International Family AIDS Initiatives (“Call To Action Project”/ Cooperative Agreement No. GPH-A-00-02-00011-00). Private donors also supported costs of activities in many countries. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID.