A reminder of why we do this work and the results it can yield – story of how young girl was effectively diagnosed, treated, and discharged with appropriate management for HIV and malnutrition
A foundation of community based work that manage patients, educate, prevent, etc. This foundation supports the direct nutritional support, to ensure that it happens and that people transition off of it. One cannot exist without the other!
VHW visit Patients twice a Day every day to remind them taking the treatment as prescribed, conduct one on one conseling on Condom use, Family Planning methods as well as providing accompaniment during monthly appointments.
Note - VHWs have catchment area averaging 20-40 households, fill out household chart 1/month. Am going to speak about the Direct nutrition support later in the presentation.
Mention MUAC and referral sections.
Sam. Just showing this to show how feedback loop works with household chart. How we use it rather than specific. information. In reference to yesterdays presentation on Data use PIH and MOH (DEHO, EHO and HAS’s) conducts Monthly and Quarterly meetings to analyze the Household Chart consolidated reports and use the outcomes as trigger points.
In reference to what was asked yesterday about linking Agriculture to Nutrition we advice and train Support Groups of PLWHIV and CBO’s to practice Compost manure making in addition to the Permaculture practices in order to transition from using chemical fertilizer to Manure.
Funds for TB patients come from unrestricted fundingHIV- patients with TB are supportedAnticipate question of why support HIV+ adults who are not malnourished
POSER Program helps groups of vulnerable women with HIV by providing microfinance business to help them meet their needs. PIH in collaboration with the Ministry of Local Government public sector (DSWO) conducts Trainings and Orientations for such type of business interventions. Opening of Restaurant Business for commercial Sex workers.
Solution to the Challenges: Rab Processors Company by discussing with them not to raise their prices for a longer business relationship. Two Degrees we provide Quarterly and monthly reports of how the Nutrition Donations has been used. Made a commitment to cover costs of Likuni Phala over II,160ml.
-investing further in local community
Partners In HealthAbwenzi Pa Za Umoyo (APZU) Improving HIV and Nutrition Outcomes in Rural Malawi
CASE STUDY – The power of an integrated approachhttp://www.pih.org/blog/entry/a-healthy-child-in-just-two-weeks/
Three innovative components of anintegrated, community-based approach 1. Village Health Workers 2. Community Engagement 3. Direct Nutritional Support At the Hospital/health Center
Community-based Integrated Model NENO HOSPITAL Direct Nutritional Support - Corn/soy blend (Likuni Phala) and Ready to Use Therapeutic Food (RUTF) - All HIV, TB, and malnourished patients - Mothers on PMTCT, exposed infants Relies on Relies on for CE VHWs for Identify education, community monitoring Refer reinforced well- and follow up being, prevention Village Health Workers Community Engagement- Case finding - Health education and outreach- Active follow-up and - Community reinforced emphasis monitoring of health on positive living status - Backbone of Support Groups- One-on-one health and Community-Based education Organizations
Village Health Workers (VHWs) • Trained and supervised by Partners In Health to identify and report cases of malnutrition within community. • Assess all children for malnutrition and determine severity using MUAC and clinical indication (edema, etc.) • Trained to monitor health status of EVERY community member including-PLHIV with an emphasisJanet, a village health worker on nutrition. in remote Nsambe district.
VHWs and People Living With HIV (PLHIV)• PLHIV identified at clinic – begin antiretroviral therapy (ART), VHW assigned.• Visit from VHW every day, accompaniment to clinic• Receive four months of direct nutritional support.• Household Chart - a simple tool to monitor health status and track follow-up care.• Data compiled quarterly for assessments of community VHW visiting patients at home in health indicators. Lower Neno
SECTION1 OF HHC• Name:_____________________________ Village:__________________ TA:___________________ HSA Name:__________________________ Date Chart Opened:_____________________• SECTION 1 LIST ALL HOUSEHOLD MEMBERS AND FILL IN THE REQUESTED INFORMATION• First Name Last Name Male/Female Date of Birth Over 15? Ever tested for HIV? ...in the past 6 months? Joined Household Left Household Died• Male Female ________/________/________ Day Month Year __________/__________ Day Month __________/__________ Day Month __________/__________ Day Month• Male Female ________/________/________ Day Month Year __________/__________ Day Month __________/__________ Day Month __________/__________ Day Month• Male Female
Community Engagement• Nutrition Counseling • Community events • Outpatient clinics • Inpatient• Nutrition Health Education • By VHWs, ART Clerks, Health Surveillance Assistants A Community Based Organization • Occurs at monthly patient meetings • Topics: causes of malnutrition, early/late signs, six food groups, etc.• Biannual outreach campaigns assist case finding.• Accompaniment to Community Based Organizations, Support MUAC being measured at an outreach Groups. event.
Community Engagement for PLHIV • Positive living education specific to PLHIV: • how to eat during different malnutrition diagnoses • Opportunistic infections andDramas, poetry, song, dance, and more areused to emphasize lessons on positive living preventable diseasesat community events (malaria, diarrhea, cholera, et c.) • Water and sanitation, prevention of waterborne diseases • Personal nutrition • Crop diversificationCommunity members are trained torecognize signs of malnutrition on a doll.
Direct Nutritional Support• Malnutrition cases referred for Direct Nutritional Support • Moderate – Corn Soy Blend (called Likuni Phala) • Severe – Ready-to-Use Therapeutic Food (RUTF)• All patients with HIV and/or TB are provided with nutritional supported for four months • Mothers on PMTCT program supported throughout and after pregnancy. • HIV-exposed children supported after six months old.
DIRECT NUTRITION SUPPORT CONT….• Partnerships with Private Sector – Two Degrees assists with Likuni Phala• Program on Social and Economic Rights (POSER) assists underserved patients with non-clinical needs• After support reliance on VHW, Community Engagement, POSER to monitor health status• Prevents graduated and malnutrition cases from coming back to Direct Nutrition Support.
Scale up of Model in Neno since 2006• 1000x increase in 2500 ART Patients on Food Support patients on ART.• 10x increase in 2000 number of clinics 1500 managed by APZU 1000 500 0 2006 2007 2008 2009 2010 2011
June 2006, Neno ART clinic opened with 5 patients
Challenges of Scale Up• Logistics – complicated /uncertain supply chains – Solution: finding corporate local partners- Rab Processors.• Funding – Budget cuts force reduced support – Solution: finding/strengthening partnerships• Human Resources – finding versatile, capable staff to manage many health centers over large, rural area. – Solution: utilizing local ART clerks at health centers as food suppliers• Changing ministry guidelines = changing demand on local resources
Looking forward• Empowering local Likuni Phala production• Maintaining nutritional support all the way to 24 months for HIV-exposed children