Plenary Presentation_EMRO regional Meeting 29 April

11
Twitter @HRPresearch
RMNCH and CRG Technical
considerations in TGF Concept
Note development
Dr Stephen Nurse-Findlay
25-26 April
Djibouti, Djibouti
Technical Officer, Department of Reproductive Health and Research

22 Twitter @HRPresearch
The Major Issue…
Although much progress has been made
against infectious diseases such as HIV, TB and malaria, the
burden of these diseases, including
related deaths, is still substantial and disproportionately
affects women and children.
The majority
of the burden borne by women, adolescent girls, newborns
and children occurs among the poorest
and most vulnerable individuals, especially in sub-Saharan
Africa and South Asia.
In spite of this, 92% of TGF Concept notes
submitted thus far include MINIMAL RMNCAH
focused programming
WHO is committed to increasing the 8% of CNs that include RMNCH
programming and can offer
• Facilitation with TGF
• Technical support
• Consultants
• Normative/Guideline information development
• Other support as needed

Key Discussion Points
 RMNCAH IS a strategic priority for TGF
– TGF strongly advocates integrating RMNCAH
services as a vehicle to improving coverage of
HIV/AIDS, TB, malaria interventions.
 TGF CN templates do not explicitly
request data for RMNCAH integration
in CNs
– Key RMNCAH analytics may be de-prioritized
by a time-crunched, disease oriented, CN
development team working with a complex
and specific template
– RMNCAH struggles to build the
comprehensive situation and gap analytic
elements required for CN template
– This is reflected in the feedback on the
quality of RMNCH integration in CNs
 RMNCAH focal points are encouraged to be
more proactive and creative in working
within the existing Template
– PROACTIVE: Advocate from “Top Down” (request
RMNCAH inclusion in the CCM) as well as “Bottom
Up” (stress importance of RMNCAH with disease
experts) to integrate RMNCAH from the start
– CREATIVE: Position RMNCAH as a complementary
expansion of disease specific services, as opposed to
a competing “vertical” service delivery platform
– CREATIVE: Use proven interventions to provide
catalytic RMNCAH services
– CREATIVE: Integrate RMNCAH services (where
possible) after TRP review/during grant making
 WHO HQ/RO can support Countries in their
efforts in Concept Note development AND
Grant Making
– WHO HQ/RO can support Strategic plan
development, TA or other activities to integrate
RMNCH into disease specific (and HSS) CN’s
– TA requests must be supported by MoH and CCM

 In spite of some progress, targets for reducing
maternal and child morbidity and mortality due to
HIV/AIDS, TB and malaria have not been met in
many countries.
 In response, The Global Fund Strategy 2012–2016,
includes Strategic Action 1.4: Maximize the impact
of Global Fund investments on improving the
health of mothers and children.
 TGF’s new funding model strongly encourages
applicants to include reproductive, maternal,
newborn and child health (RMNCH) interventions
relevant to HIV/AIDS, TB and malaria in their
concept notes.
 TGF is especially interested in evidence-based, cost-
effective, integrated service packages that
maximize impact with minimum additional
investments that lead to more effective coverage of
HIV/AIDS, TB, malaria and RMNCH interventions.
RMNCAH IS a Strategic Priority for TGF

REGIONAL TRENDS IN MATERNAL MORTALITY
1990–2013
340 330
300
240
190 170
160
85
0
50
100
150
200
250
300
350
400
1990 1995 2000 2005 2010 2013 2015
80 mothers still die every day
Reduction in maternal
mortality: 50%
MDG 5 target

REGIONAL TRENDS IN U-5 MORTALITY
1990–2013
101
80
52
55
34
0
20
40
60
80
100
120
1990 2000 2013 2015
Reduction in Under 5 child mortality: 46%
2360 Children die every day
MDG 4 target

• Continue implementation of the
MCH plans
• Strengthen health systems/HR
• Lifesaving MCH interventions
9 MDG priority
countries
(AFG, DJI, EGY, IRQ,
MOR, PAK, SOM, SUD &
YEM)
• MCH situation analysis and
targeted interventions
• MCH in crises situation
Borderline MS
(JOR, LIY, PAL, SYR and
TUN)
• Focus on neonatal mortality
• Hereditary and genetic
diseases
• Preconception care
Countries with
low mortality
• SDH and
Equity
• Quality of care
• MDSR
• Early Child
Development
PRIORITY ACTIONS FOR ALL EMRO MEMBER STATES FOR
2015 AND BEYOND…

• Bigger impact: focus on countries with the highest disease
burden and lowest ability to pay, while keeping the portfolio
global
• Predictable funding: process and financing levels become
more predictable, with higher success rate of applications
• Ambitious vision: ability to elicit full expressions of demand
and reward ambition
• Flexible timing: in line with country schedules, context, and
priorities
• More streamlined: for both implementers and the Global Fund
Principles
of the new
funding
model
THE GLOBAL FUND (NEW) FUNDING MODEL

10
 Weak ANC services are a barrier to
scaling up interventions against
HIV/AIDS, TB and Malaria
 Community health services that
streamline comprehensive child illness
packages are used more than disease-
specific services
Investing in children and mothers has a large
impact on a country’s economy and future
Ambitious service integration streamlines the
delivery of key interventions for
HIV/AIDS, TB and Malaria
ATM key
interventions
Synergistic RMNCH
interventions
Successful
service
integration
Higher service utilization
Effective coverage of both ATM and
RMNCH interventions
Better Health
More Wealth
 Childhood health and nutrition has a
substantial impact on both physical and
cognitive development, and eventual health
status and productivity as an adult
 Health investments in children and mothers
(fetal growth) most important for human
capital
 Economic development leads to better
health of the population, while better health
contributes to economic development
1 2
INVESTING IN CHILDREN AND MOTHERS IS IMPACTFUL, AMBITIOUS
AND STREAMLINED

Given the previous experience of country needs, the support for Grant making
will be aimed at helping countries with the following:
 Responding to TRP and GAC clarifications and assistance with any technical conditions
defined by GAC and TRP
 Updating the programme implementation plan
 Enhancing efficiency gains (e.g. between TB, HIV and HSS) to integrate RMNCAH
interventions into disease specific intervention plans
 National Monitoring and evaluation plans or specific M&E plans or MESS workshops
 Development of the Performance framework, clarifying indicators and targets and…
 Updating the Procurement and Supply Management Plan
Update of the WHO/Global Fund Cooperation
Agreement

12
Country Window 2
(Jun 2014)
Window 3
(Aug 2014)
Window 4
(Oct 2014)
Window 5
(Jan 2015)
Window 6
(Jan 2015)
Afghanistan TB
HSS
Malaria HIV
Djibouti Malaria TB/HIV
Egypt TB
Pakistan Malaria* Malaria2 TB2 HSS, HIV
Palestine HV, TB
Somalia Malaria TB
HIV
Malaria
Sudan HSS Malaria2
TB/HIV2
HSS2
Syrian Rep. HSS, HIV
Yemen Malaria HIV
TGF CONCEPT NOTE SUBMISSIONS FROM EMRO

13
 Linkages with reproductive, maternal, newborn and child health
 As in previous windows, the TRP noted the low quality of integration of reproductive, maternal,
newborn and child health (RMNCH), CSS and HSS issues across disease-specific concept notes. There
were also several missed opportunities for synergies and cost-effective interventions that will
further help countries attain Millennium Development Goals.
 The TRP recommends the level of involvement and representation from HSS, CSS and RMNCH
communities increases at the Country Coordinating Mechanism level. This involvement should go
beyond disease advisers in order to help provide a full disease and HSS view in the country dialogue
and concept note development processes.
 The TRP recommends the Secretariat provide more emphatic guidance for applicants with low
MNCH indicators on the need to demonstrate how proposed HSS and/or disease-specific
intervention will address RMNCH issues and strengthen these indicators. This will help applicants
demonstrate and fund linkages with the RMNCH platforms for service provisions for greater access
to health care for women and children.
.
TRP Feedback from 3rd and 4th Application
Windows

14
Service delivery
• The TRP found the integration of key strategic service delivery components was not clearly
laid out in many concept notes. There were missed opportunities to invest in cross-cutting
human resources for health, health management information systems, procurement
systems and community systems integration in service delivery across disease-specific and
HSS concept notes from the same applicant.
• Most programs described by applicants tend to work in “silos” and, as a consequence, the
impact is seen in terms of fragmented service delivery at the field level.
• The TRP recommends the Secretariat, technical partners and stakeholders consider cost
effective approaches that can help make connections in service delivery, such as between
human resources for health, infection control, supervision, quality assurance (including
service quality beyond external quality assessment for labs and data quality audits) and
referral systems.
Windows

15
Human resources for health
• Applicants continue to address insufficient skills almost always with capacity building (in-service
training) for human resources are already in the field with little attention given to quality of training
with almost no attention to the quality of pre-service training.
• Furthermore, while concept notes include incentive strategies to improve retention, often these are
not evidence based and sustainable. It is well known that monetary incentives alone have a short-
term impact on motivation.
• The TRP strongly recommends that human resources issues be based on national human resources
for health policies and that human resources for health interventions across specific concept notes
for different diseases and HSS are well coordinated, complementary and do not overlap.
• The TRP is concerned about the long-term sustainability when funding for core personnel is donor-
dependent. Applicants should be sure that they can independently maintain these costs, rather than
increasing their reliance on Global Fund and other donor funding.
Windows

POLICY LESSONS LEARNED FROM 3RD AND 4TH TRP
REVIEW WINDOW (AUG-OCT 2014)

CRG LESSONS LEARNED FROM JULY 2014 TRP REVIEW
WINDOW

Choosing appropriate RMNCAH Interventions
for Concept Notes
Countries should focus on cost-effective and evidence-based RMNCH interventions
that have clear potential for synergy (either within a disease-specific concept note or
within a cross-cutting HSS concept note). The interventions should:
• Address a problem amenable to improvement in a short- to medium-term time
frame.
• Have natural synergy between specific interventions and routine RMNCH
services.
• Have evidence of effectiveness that can be easily assessed and measured
• Address access to commodities and improvement in quality of care, especially for
facility-based interventions.
• Be complementary; i.e., a modest investment will result in significant gains for
both disease-infected populations and for the women and children living in the
same communities.
• Address missing links in service delivery that are commonly described in gap
analyses.

RMNCAH AS COMPLIMENTARY SERVICE DELIVERY:
INVESTING IN ANC/CHWS TO SUPPORT SCREENING AND TREATMENT OF
SYPHILIS IN PREGNANCY
• Both are:
– sexually transmitted infections that
cause substantial health burden on
mothers and infants
– have evidence-based, scalable
interventions using ANC platform
– tested using serology and have
existing, widely-used single point-of-
care tests
– infections that require
management of partners
• Detection of syphilis-positive, HIV-positive
(or HIV-negative) women identifies
women at increased risk of HIV
transmission
How is Syphilis relevant to HIV in
pregnancy?
 Cost-saving, increased efficiencies
 Common processes for QA and QC
 Improve quality of antenatal care
 Facilitate uptake of HIV testing
and/or syphilis testing
 Facilitate procurement processes
What is the added value of dual
testing for Syphilis and HIV?

Febrile Children
often have overlapping Symptoms
• RDT introduction showed majority of suspected malaria
fever cases were actually malaria negative
• RDT rollout through CHWs, without the appropriate
skills or medicines for comprehensive management,
can lead to:
- More sick children receiving inappropriate
treatment (or no treatment)
- ACT wastage (and therefore wastage of malaria
resources)
- Drug pressure on malaria parasites
• Even for RDT+ children, further assessment is required
due to significant overlap of symptoms and high rates
of co-infection in many countries
Investing in ANC/CHWs for management of febrile children can improve health
outcomes and create system efficiencies
INVESTING IN ANC/CHWS TO SUPPORT MANAGEMENT OF THE FEBRILE
CHILD
Diarrhea
PneumoniaMalaria
All ARI
ARI: Acute Respiratory
Infections

INVESTING IN ANC/CHWS CAN IMPROVE THE FIGHT AGAINST MALARIA
DURING PREGNANCY AND CHILDHOOD
 Most countries have not achieved
country or global targets for IPTp or IPTi
uptake, LLIN use or effective case
management.
 Most countries do not have disaggregate
reliable data on case management for
pregnant women.
 An underpinning of MIP programming is
still the lack of harmonization of RH and
malaria control policies.
 Globally, a median of 20%–50% of children
were not brought for care for a recent fever at
a health facility.
 Malaria is more frequent and more
complicated during pregnancy
 In malaria-endemic areas, malaria during
pregnancy accounts for:
 Up to 15% of maternal anaemia
 8-14% of low birth weight
 30% of "preventable" low birth weight
 3-8% of infant death
Expanding diagnostic testing and treatment through iCCM/ANC investment can
significantly reduce the need for ACTs and expenditures on antimalarial drugs

Essential iCCM Components Global Fund Supported?
Training and salary costs for community health
workers
Yes, provided that these community health
workers are also directly involved in malaria
management
RDTs for malaria diagnosis Yes
ACTs for malaria treatment Yes
Respiratory timers for pneumonia diagnosis No*
Antibiotics for pneumonia treatment and ORS
and zinc for diarrhoea treatment
No*
Supportive supervision Yes
Supply chain system strengthening Yes
Health information system strengthening Yes
* Commodities not funded by the Global Fund provide a co-funding opportunity for governments or
other development partners to invest into the iCCM platform
Source: 2014 Roll Back Malaria Harmonization Working Group Country Briefing Note
Guidance on GFATM Funding for iCCM

PROVEN RMNCAH DELIVERY PLATFORMS:
Characteristics of Behvarz in I.R of Iran
17000 Health Houses run by 33000
Behvarzes (>95% Rural Areas)
 Community ownership in selection
 Two years task oriented training
 Effective health information system
 Mobility of CHWs to satellite villages
 Annual census & family folders
 Active follow up mechanism/ home visits
 Integration of health programmes
 Supportive Supervision by the RHCs

Marwo Caafimaad Somalia: Bringing health related decision
making process to the community
• The program initiated in 2011.
• Training of master trainers (one Supervisor for 20
FHWs)
• 200 FHWs trained and recruited to deliver EHSP.
• Visiting 5-7 households per day.
• Recording & reporting all births, deaths, migration
• Registering catchment Population
• Ownership of the Gov +ve
Expansion Plan: Goal 8000
Phase i: 200 trained in 2012-15 through GAVI-HSS
Phase II a: 400 trained in 2014-16 through JHNP
Phase II b: 400 trained in 2015-16 through JHNP
Phase II c: 400 trained in 2016 through JHNP

Performance of Lady Health Workers in Pakistan
Indicators Baseline
1994
National
PDHS 2007
LHWs MIS
2010
National
PDHS
2013
MDG
Targets
MMR 500 276 180 NA 140
IMR 105 78 50 74 40
CPR 11% 33% 38% 35.4% 55%
EPI 75% 47% 80% 54% > 90%
SBA 22% 39% 55% 52% 90%
PDHS: Pakistan Demographic Health Survey MIS: Management Information System

Challenges and Future Actions for CHWs
Challenges
1. Lack of national commitment for
promoting CHWs
2. Continuous increase in the CHWs
workloads that affect quality of
services
3. Limited linkages with the nearest
health facilities and irregular
supervision
4. Too much paper works
5. Low incentives and irregular
payment of salaries
6. Lack of mechanisms for job
promotion
Future Actions
1. Mapping of hard to reach areas,
evidence building/ incorporating
CHWs in NHP
2. PHC unit/ cell in MoH should lead
integration process
3. S & M/ training supervisors of CHWs
should be assigned to the PHC
centers
4. Promoting e-filing system
5. Institutionalization of CHWs as part
of the health system
6. Review rules and regulation for staff
promotion

Possible RMNCAH Interventions
Service Delivery Country Example
Strengthening antenatal care (ANC) for:
 PMTCT
 Prevention/treatment of congenital
syphilis, Prevention/case
management of maternal malaria
 Prevention of maternal anemia and
malnutrition
In Kenya, the Global Fund provided
funding for:
 Integration of PMTCT services into ANC
 Provision of intermittent preventive
treatment in pregnancy (IPTp)
 Integration of TB screening services
into PMTCT services.
To address demand-side barriers, the Global Fund
supports the waiving of fees for skilled-care
deliveries, encouraging poor women to give birth at
health facilities.

Procurement and supply chain
management (PSCM)
Country Example
Strengthening and integrating supply
chain management to ensure reliable
availability of essential RMNCH and
disease-specific commodities at the
point of treatment
In Zimbabwe, Global Fund supports a
“whole supply chain” approach
(integrated supply chain strengthening)
and the development of a supply chain
action plan.

Health management information
systems (HMIS) and monitoring
and evaluation (M&E)
Country Example
Ensuring health information systems
capture service delivery and health
outcomes for women and children
In Ghana, the Global Fund supports the
District Health Management Information
System (DHMIS) – online software that
allows reporting of unified routine health
information, including RMNCH outcomes.

30
INTEGRATING CRG INTO TGF CONCEPT NOTES
CRG
 Does the country Include evidence-based interventions (with cost data and M+E
indicators) on:
• Gender-based violence?
• Inequalities, discrimination and other issues that reduce access/use of health
services and compromise health outcomes for men, women, vulnerable and
marginalized populations?
 Does the Country Facilitate coordination between the HIV, TB, Malaria and HSS
teams and those working on Gender and GBV at country level?
• How are these interventions funded and implemented?
 It is essential that HIV, TB, Malaria, HSS colleagues and consultants share
information with their CRG counterparts to ensure that these issues are reflected
in the concept notes
 The discussions on HSS, HIV, TB, Malaria cannot happen separately to those on
Gender, GBV, or Rights
 The CCM must also link appropriate interventions to State (or recognized non-
state) institutions established by law for civil, cultural, economic, political and
social rights

RMNCAH Key Reference Documents

Changing the context of the HQ/EMRO
interaction…
What WHO/HQ can do to support TGF CN development
in EMRO countries is….
What Can WHO/HQ do to support TGF CN
Development in EMRO Countries?
What do Countries need to ensure that RMNCAH are included in CNs?
• Facilitation with TGF?
• Technical support?
• Consultants?
• Normative/Guideline information development?
• Other?

The Global Health Initiative (GHI) /Regional HSS Focal Point Meeting (EMRO)
Djibouti, Djibouti | 25-26 April 2015|
HOW? CONFIRMING RMNCH INTERVENTIONS IN
THE CONCEPT NOTE
 Does the concept note describe the country supports RMNCH interventions that directly impact HIV/AIDS, TB and
malaria?
 PMTCT
 Intermittent preventive treatment in pregnancy (IPTp)
 integrated community case management (iCCM)?
 Does the concept note describe how HSS funding supports the key elements of effective RMNCH service integration
 e.g. service delivery integration through the antenatal care platform?
 Does the concept note contain synergistic, highly relevant RMNCH interventions (e.g. family planning, non-malaria
components of iCCM)?
 If yes, does it describe how are these synergistic RMNCH interventions funded and implemented?
 Does it identify potential overlaps with government allocations and similar donor RMNCAH investments?
 Does the country Include evidence-based interventions (with cost data and M+E indicators) on:
 Gender-based violence?
 Iinequalities, discrimination and other issues that reduce access/use and compromise outcomes for men, women,
vulnerable and marginalized populations?

 RMNCAH IS a strategic priority for TGF
– TGF strongly advocates integrating RMNCAH
services as a vehicle to improving coverage of
HIV/AIDS, TB, malaria interventions.
 TGF CN templates do not explicitly
request data for RMNCAH integration
in CNs
– Key RMNCAH analytics may be de-prioritized
by a time-crunched, disease oriented, CN
development team working with a complex
and specific template
– RMNCAH struggles to build the
comprehensive situation and gap analytic
elements required for CN template
– This is reflected in the feedback on the
quality of RMNCH integration in CNs
 RMNCAH focal points are encouraged to be
more proactive and creative in working
within the existing Template
– PROACTIVE: Advocate from “Top Down” (request
RMNCAH inclusion in the CCM) as well as “Bottom
Up” (stress importance of RMNCAH with disease
experts) to integrate RMNCAH from the start
– CREATIVE: Position RMNCAH as a complementary
expansion of disease specific services, as opposed to
a competing “vertical” service delivery platform
– CREATIVE: Use proven interventions to provide
catalytic RMNCAH services
– CREATIVE: Integrate RMNCAH services (where
possible) after TRP review/during grant making
 WHO HQ/RO can support Countries in their
efforts in Concept Note development AND
Grant Making
– WHO HQ/RO can support Strategic plan
development, TA or other activities to integrate
RMNCH into disease specific (and HSS) CN’s
– TA requests must be supported by MoH and CCM

Thank You
Merci Beaucoup
‫الشكر‬‫لك‬
WHO RMNCAH Focal Points
RO (Cairo):
Dr Khalid Siddeeg
Siddeegk@who.int
HQ (Geneva):
Dr Stephen NurseFindlay
nursefindlays@who.int

BACK UP SLIDES

WHY IS THIS IMPORTANT?
BECAUSE VAW IS A GLOBAL PROBLEM

HIV &STI
RMNCH
1.7 times
more likely to experience
pregnancy loss
RMNCH
41%
more likely to have
preterm birth
WHY IS THIS IMPORTANT?
BECAUSE VAW ADVERSELY AFFECTS HIV, STI AND RMNCH
OUTCOMES

HOW CAN COUNTRIES INTEGRATE PROGRAMMES TO FIGHT
VAW INTO RMNCH/ANC SERVICE PROVISION?

40
Contraception- A key interface between
Maternal Health and TGF
92
85
84
78
85
84
78
59
49
41
0
20
40
60
80
100
IRA TUN BAA KUW EGY JOR IRQ YEM AFG SOM
Need for contraception satisfied…
23 46 22 14 45 50 67
270
400
850
0
200
400
600
800
1000
IRA TUN BAA KUW EGY JOR IRQ YEM AFG SOM
MMR 2013

ANTENATAL CARE (ANC)
Investing in key challenges such as: late initial contact, low quality of care and
inadequate commodities will increase coverage and improve RMNCH outcomes
ANC
Offers tremendous opportunity to reach
pregnant women with HTM interventions
Main point of contact for pregnant women
within the health system
Across 22 countries in SSA, the median
coverage for at least 2 ANC visits is 85%
Appropriate ANC investments is an excellent opportunity to support the fight against
malaria, HIV and TB

INTEGRATED COMMUNITY CASE MANAGEMENT
(ICCM)
42
Source: GF TERG. Thematic Review of Global Fund’s Contribution to MDGs 4&5. November 2013
iCCM improves health outcomes and enhances program effectiveness and
efficiency
Access/coverage
• Increases care-seeking, service
uptake and treatment coverage for
malaria, diarrhea and pneumonia
Early and
appropriate
treatment
• Increases timely treatment for all
three conditions
Quality
• Improves health worker skills &
performance
Efficiency
• Reduces inappropriate prescribing of
ACTs
• Can reduce out-of-pocket expenses
for transport to health facility
iCCM

IS COMMUNITY, RIGHTS AND GENDER
PROGRAMMING IMPORTANT ?
 Nothing can replace the lived experience of people living with
or affected by TB and HIV/AIDS .
 Communities must be empowered through community
systems strengthening to play an effective role alongside
public health structures.
 Gender has a critical impact on the health seeking and
treatment behaviour of people living with or affected by TB
and HIV, largely determining:
– How men, women and transgender perceive their symptoms,
– How they regard and are enabled to access diagnosis
– How they are supported to accept and continue with
treatment
 Human rights violations continue to be a barrier to access to
preventative, diagnosis and treatment services for many
marginalised groups.

HOW? Mainstreaming Gender, Equity and
Rights into Country Dialogue
– Include evidence-based interventions (with cost data and M+E indicators) on:
• Gender-based violence
• Inequalities, discrimination and other issues that reduce access/use of health services
and compromise health outcomes for men, women, vulnerable and marginalized
populations
– Facilitate more coordination between the HIV, TB, Malaria and HSS teams and those working
on Gender and GBV at country level.
• It is essential that the HIV, TB, Malaria, HSS colleagues and writing team experts consult
and share information with their counterparts working on gender and GBV so that these
issues can be reflected in the concept notes
• The discussions on HSS, HIV, TB, Malaria cannot happen separately to those on Gender,
GBV, or Rights if the intention is to "mainstream" or integrate“
• This will also facilitate linking appropriate interventions, to State or recognized non-state
institutions established by law for civil, cultural, economic, political and social rights

How Health Systems are Diverted from PHC core
values
WHO, Primary Health Care- Now More than Ever
World Health Report , 2008

Appropriate ANC development is an excellent investment for the
fight against malaria, HIV and TB

Health volunteers contributing in safe delivery: experience of
Bouchiba, Morocco
 Bouchiba: located in Ben Ahmed district, mountainous area/
population 1015
 Joint project: WHO, MoH and Spanish NGO (Medicus Mondi)
initiated in Sep 2010
 68 volunteers trained, provided a mobile phone by MoH and
trained on timely antenatal care, screening high risk
pregnancies/ referrals of high risk groups
 MoH ensure access to trained midwives and safe home
delivery
 Municipality provided an ambulance and Spanish NGO
volunteers kits and printing training materials
Results: 30 Home delivery, 12 Referred to
Hospital No Maternal Death

Changing the context of the HQ/EMRO interaction…
What WHO/HQ can do to support TGF CN development
in EMRO countries is….
What Can WHO/HQ do to support TGF CN
Development in EMRO Countries?
What do you need to ensure that RMNCAH are included in CNs?
• Facilitation with TGF?
• Technical support?
• Consultants?
• Normative/Guideline information development?
• Other?

HOW? INTEGRATING VAW INTERVENTIONS
INTO TGF CONCEPT NOTES
 HIV and/or HIV/TB integrated CN’s
 HIV prevention (e.g. safety planning in risk-
reduction counselling,
edutainment/behaviour change
communication )
 Key populations (e.g. community
empowerment and safety planning with sex
workers)
 Adolescent interventions (e.g. school-based,
working boys and young men)
 HIV testing & counselling PMTCT, Treatment,
care and support services (e.g. WHO
recommendations for responding to partner
and sexual violence in health services)
 Health Systems Strengthening
 WHO recommendations for
responding to partner and sexual
violence in health services
 RMNCH interventions
 Family planning, STI and maternal
health interventions
 Community Systems Strengthening
 Gender and economic empowerment
of women and girls
 Community mobilization to change
harmful gender norms
 Community empowerment of sex
workers

WHAT? PROMISING OR EFFECTIVE VAW
INTERVENTIONS
Integrated gender and economic empowerment strategies
Cash transfers – conditional and unconditional
Integrated sex worker-led community empowerment
Promoting gender equitable attitudes & behaviours among men & boys
Changing unequal and harmful norms through community mobilization
Edutainment/behaviour change communication campaigns
School-based interventions (Dating violence & Sexuality Education)
Safety planning in risk-reduction counselling for key populations
HIVVAW

The 9 High Burden MCH Countries

HIV/AIDS
• Antenatal Care (ANC)
• PMTCT of HIV AND Syphilis
(Prong 1-4)
• Pediatric HIV treatment
• Targeting particularly vulnerable
women, adolescents and children
(migrants, nomads, IDPs,
refugees, those in disaster prone
areas, FSWs)
TB
• Antenatal Care (ANC)
• Case detection and diagnosis
(including women and children)
women, adolescents and
children (migrants, nomads,
IDPs, refugees, those in
disaster prone areas. FSWs)
Malaria
• LLINs distribution
children (migrants, nomads,
IDPs, refugees, those in
disaster prone areas, FSWs)
• Intermittent Preventative
Treatment in Infants (IPTp)
• Treatment of Malaria in
Pregnancy (MiP)
• Intermittent Preventative
Treatment in Infants (IPTi)
AMBITIOUS, STREAMLINED, “IMPACTFUL” RMNCH
INTERVENTIONS TO FIGHT THE THREE DISEASES
Fighting the Three Diseases will be more effective if interventions for HIV, TB, and malaria are INTEGRATED
with family planning, pregnancy, newborn, and child health services.

TECHNICAL CONSIDERATIONS IN CONCEPT NOTE
DEVELOPMENT- COMMUNITY, RIGHTS AND
GENDER

Characteristics of an ideal health center
with integrated MCH approach
 Availability of Essential Medicines for
MCH mainly life saving medicines
 Trained HWF with communication skills
 Quality & safety of care [indicators/
standards]
 Referral system/ feedback
 Clear financing mechanism [Social
protection for poor]
 Strong logistic system
 Functional and effective HIS
 Monitoring/supervisory mechanism and
tools

HIV/AIDS
• Initiatives to address violence
and discrimination against
particularly vulnerable
children migrants, nomads,
pastoralists, IDPs, refugees,
those in disaster prone areas,
FSWs (Sudan)
• A plan to review HR
interventions and strategies
(ALL)
TB
• Gender Specific service
delivery and disease burden
among women; Quality of
data from periphery
(Afghanistan)
• Food support for TB Patients
(Sudan)
Malaria
• Need for Risk mitigation
strategy, role of federal vs
Local government (Pakistan)
• Queries about Data, HIMS,
M&E and prioritisation for
key populations (Sudan)
• Stronger Links to
operationalise training
programmes; Need for
relevant indicators
(Afghanistan)
STRATEGIC GAPS IN RMNCAH INCLUSION IN
CONCEPT NOTES (TRP FEBRUARY 2015)

 Including RMNCAH in the CN’s will not
reduce the funding available for each
disease area
– The CN development process is an
opportunity to expand disease specific
service delivery platforms to cover vulnerable
women and children and strengthen disease
specific/HSS programmes
 RMNCAH must be more involved in the
decision making done at the CCM
– Most participants in the CCM mechanism are
disease specific experts and most decisions
solely concern HIV/AIDS, TB and Malaria
programming.
– RMNCH must advocate “Top Down”
(requesting MoH to invite RMNACH focal
points to the CCM) and “Bottom Up” (asking
WR’s to invite RMNCAH WHO Staff to the
CCM) for inclusion at CCM
 RMNCAH advocates must be prepared to work
around the system’s imperfections even as we try
to address them
– RMNCH not an explicit requirement in key elements
of the CN
– Key elements of the TGF template do not explicitly c:
Somalia (TB)
– September: Morocco (HSS), Yemen (TB)
 of the current system Several EMRO countries will
submit TGF Concept Notes in 2015
– July: Somalia (TB)
– September: Morocco (HSS), Yemen (TB)
 RMNCH may be integrated during Grant Making
for the EMRO countries who submitted CN’s in
April 2015
– Afghanistan
– Egypt
– Pakistan
– Palestine
– Syrian Arab Republic

Possible TB/RMNCAH Interventions
TB Interventions Importance for TB prevention and care for
women and children living with and
affected by TB
Benefit for women and children in
general
Routine TB symptom screening among women
with HIV at each visit for RMNCH services;
• Those who do not have a current cough,
fever, weight loss or night sweats are unlikely
to have active TB
Improved rate of early TB case detection among
women with HIV; these services also determine
eligibility for isoniazid preventive therapy (IPT)
Enhanced TB Case detection
Ensure early TB diagnosis and treatment during
ANC services for pregnant women who have
signs or symptoms of TB
• For women living with HIV or at risk of
multidrug resistant TB, the first test should
be Expert MTB/RIFa
• More TB cases among women diagnosed,
treated and cured
• Reduced risk of congenital TB
• Reduced risk of mother-to-child transmission of
HIV if the pregnant woman is living with HIV
• Reduced risk of TB transmission to the family and
within the community
Reduced risk of TB transmission to the family
and within the community
Improved case management of TB in children,
including TB screening for any child who has had
contact with TB-positive
patients, and referral for TB services as needed
More TB cases in children diagnosed,
treated and cured
Better survival for children with
TB
Effective and efficient healthcare services for
children

Possible Malaria/RMNCAH Interventions
Malaria Interventions Importance for Malaria prevention and
care for women and children living with
and affected by Malaria
Benefit for women and children in
general
Application of integrated malaria protocols in
ANC and child health services (e.g. IMCI,
iCCM, three- prongs of MiP)
• More malaria cases in women and children
promptly diagnosed and accurately treated
• More women with malaria know about
prevention measures for their families and
communities
• Fewer low-birth-weight infants, preterm births
and infant deaths
• Improved quality of management and care
within ANC and child health services, and
improved access
• Improved case management of malaria and
other major childhood illnesses
Education of community health workers and to
emphasize the links between malaria and
RMNCH through appropriate pre and in-service
training
• Improved quality of care for women and children
• Improved competence of Human Resources
• Fewer malaria cases with decreased severity
• Improved access to quality care provided by
competent human resources
• Improved acceptability and uptake of malaria
prevention
Provision of:
• Malaria Rapid diagnostic tests (RDTs)
• Artemisinin-based combination therapy
(ACT)
• Sulfadoxine-pyrimethamine (SP)
• Insecticide-treated mosquito nets (ITNs)
• Faster, more reliable diagnostic testing for
febrile women and children
• Regular and uninterrupted access to prompt and
appropriate treatment with quality-assured
medicines for women and children with malaria
Increased community trust in services, and
healthier community
Improved case management and treatment of
other major childhood illnesses such as diarrhoea
and pneumonia by leveraging complimentary
and additional funding from donors other than
the Global Fund

Follow us on Twitter @HRPresearch
Visit our website who.int/reproductivehealth

The Major Issue…
Although much progress has been made
against infectious diseases such as HIV, TB and malaria, the
burden of these diseases, including
related deaths, is still substantial and disproportionately
affects women and children.
The majority
of the burden borne by women, adolescent girls, newborns
and children occurs among the poorest
and most vulnerable individuals, especially in sub-Saharan
Africa and South Asia.
In spite of this, 92% of TGF Conceot notes
submitted thus far include NO RMNCAH
focused programming
WHO is committed to increasing the 8% of CNs that include RMNCH
programming and can offer
• Facilitation with TGF
• Technical support
• Consultants
• Normative/Guideline information development
• Other support as needed

Plenary Presentation_EMRO regional Meeting 29 April

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (19)

Similar to Plenary Presentation_EMRO regional Meeting 29 April

Similar to Plenary Presentation_EMRO regional Meeting 29 April (20)

Plenary Presentation_EMRO regional Meeting 29 April

Editor's Notes