ACTION FRAMEWORK No child born with HIV by 2015 and improving the health and well being of Mothers, partners and Babies in South Africa Precious Robinson,Deputy Director National Dept of Health South Africa ICASA December 7 th 2011

LET’S ANSWER SOME QUESTIONS….

QUESTION 1: WHAT IS THE ACTION FRAMEWORK FOR PMTCT INTEGRATED WITH MCH?

Direct link between current policy and implementation of PMTCT services integrated with MNCWH services Built from nine provincial and 52 district frameworks. Reinforces linkages for a multi sectoral response in the country with clear targets for the next five years. Costed, time bound, results oriented operational plan to facilitate systematic implementation in synergy with National Strategic Plan for HIV and AIDS, STIs and TB ( ).

ACTION FRAMEWORK (NSP ) No child born with HIV by 2015 and improving health and wellbeing of mothers, partners and babies in South Africa

Strategic objective, targets, costing

AIMS of the action framework Identify key gaps in policy and programme implementation for achieving the elimination targets in PMTCT and Paediatric AIDS programmes integrated with MNCHW. Provide a simple monitoring framework to track progress and measure results towards virtual elimination of new HIV Paediatric infections at national, provincial, district and facility levels ensuring alignment with existing plans (NSDA, APP, NSP) Serve as a guide for the development of annual elimination work plans at the national, provincial, district from

QUESTION 2: HOW DID WE DEVELOP THE ACTION FRAMEWORK?

Action based on evidence Thorough review of data for national, nine provinces and all 52 districts (trend analysis as well as detail for 2010) Data understanding of bottlenecks to key priority actions Data from different sources (programme, laboratory, research studies) Setting targets at district level 52 Action frameworks + and nine provincial action frameworks + WORKSHOPS WITH PROVINCIAL AND DISTRICT STAKEHOLDERS Addressing issues related to MCH, SRH and PMTCT service delivery

Bottleneck analysis completed at provincial and district levels Data used as the starting point Review of issues related to availability of services, access, coverage, human resource, systems (supply) completed Participation of all key Stakeholders Result: Priority actions/cost/responsible person/timeline agreed and included in the action frameworks at district and provincial levels. The bottleneck analysis will be ongoing in 2012: done each quarter based on the Data for Action reports.

TASKS FOR GROUP WORK IN WORKSHOPS Task 1: Review the baseline for the key indicators for your district and work out the targets upto 2016 Task 2: Identify key issues in your district that need to be addressed to reach the elimination targets by 2015, and identify bottlenecks and key actions for each issue with timelines, cost and responsible person to achieve the targets. Task 3: Complete the partnership framework for each prong under the five pillars of the action framework Task 4: Review the draft action framework and provide feedback (ok, changes suggested etc) Task 5: Complete the checklist for the social mobilization program for your district

Template for bottleneck analysis at national, provincial and district levels NoKey IssueBottlenec k Actio n TimelineCostResponsibl e person Expect ed result New/already present in current years work plan

QUESTION 3:WHAT IS THE STRUCTURE OF THE FRAMEWORK?

ACTION FRAMEWORK FOR eMTCT Key components

Five key areas Operational framework

Activities and tasks identified for each of the five areas Key focus areas (Implementation drill activities) identified for inclusion in work plans each year

e MTCT TRACKER ROBOT DASHBOARD CASCADE INDICATORS

Indicator Baseline Antenatal client CD4 1 st test rate (T 100%) 64.07% Antenatal clients who received ARVs to reduce risk of MTC transmission (includes Women started on AZT, and women with already known positive status and on HAART) (T 100%) 77% Nevirapine uptake rate among babies born to HIV Infected women (T 100%) 87%95100 Baby PCR test around 6 weeks uptake rate (T 100%) 85.23% Antenatal client initiated on HAART rate (100%) 92%95100 Baby initiated on HAART under 18 months (T 100%) 11.55% ANC 1 st visit before 20 weeks (T 90%) 35.52% Post natal care mother within 6 days after delivery 28.57%

DASHBOARD: National (DHIS data) Baseline 2010 Target 2011 Jan to June 2011 ANC visit < 20 weeks36%50%41% ANC client CD 4 first test rate64%80%72% ANC initiated on AZT during antenatal care rate 79%85%84% ANC initiated on HAART rate92%90%73% Post natal follow up of mother within 6 days 29%50%65% ANC client retest at 32 weeks rate 25%40%38% Baby PCR test positive around 6 weeks rate 10% (DHIS) <57%

SYNERGIZING PROVINCIAL AND DISTRICT PRIORITIES AT NATIONAL LEVELS

PMTCT Cascade priorities Late booking Family planning ART/ARV for eligible women Retesting for negatives Post natal follow up Safer infant feeding Early infant ART Enabling + engaging community priorities Male partners Couple counseling Social mobilization Community engagement Clear Standards for operation Getting to scale Quality enhanced Data quality + capacity enhanced Foster innovation e-MTCT Targets achieved

Critical policy/programme issues to be addressed in ARV regimens + eligibility Post natal testing schedules for mother and child Data - quality + use regularly Need for SOPs for the PMTCT and Pediatric ART cascade Community involvement and engagement

QUESTION 4: HOW WILL WE KNOW AND MEASURE OUR PROGRESS?

DASHBOARDS: DATA FOR ACTION REPORTS Each quarter for national, provincial and all 52 districts Analyze DHIS and NHLS data Prioritize key issues and actions Focus on priority districts / underperforming districts and provinces

Monitoring and Mentoring System

QUESTION 5: HOW WILL WE MANAGE THE FRAMEWORK?

Management oversight - National PMTCT unit within MCH - Provincial Focal persons - District focal persons Technical oversight - PMTCT TWG (newly set up) - SANAC TTT Implementation oversight - PMTCT Steering committee (national) - Coordination/working group (provincial) - Coordination/working group (district) WORK WITH PARTNERS AT ALL LEVELS

PARTNER COORDINATION AT FIELD LEVEL: TOOL

Partnership Framework Tool Eg – district from Eastern Cape province PRONG 1 ( primary prevention) PRONG 2 (preventing unwanted pregnancies) PRONG 3 (PMTCT) PRONG 4 (Protection, care and support) Leadership, Management and coordination Broad reachX ESI project RTC X Coverage and quality (<2% at 6 weeks and <5% at 18 months) RTCXBroad reach ESI project RTC Broad reach PHCBroad reachX Monitoring and Evaluation Broad reach RTC XBroad reach ESI project RTC Broad reach RTC Social mobilizationXXXX

QUESTION 6: HOW WILL WE SET UP REGULAR MECHANISMS OF TRACKING PROGRESS AND ADDRESSING BOTTLENECKS?

Robot Dashboard Cascade Indicators Discussion/review at district/provincial/national level meetings (quarterly) Review partnership framework Discussions/review with all partners /shared accountability Review progress against work plan Review expenditure rates ACTION Response to robot dashboard (within a month) Data for Action – reports from national Quarterly

CHALLENGES Getting the buy – in at all levels Other competing priorities (NSP) DATA (quality, missing data) Taking the global vision/plan – tailoring it to the country context, needs and how it meets/fits with the priorities on the ground Getting all stakeholders together Set way of working (challenges with integration and role clarity)

What worked? Leadership at all levels Team committment Using data as the starting point Creating a space for learning and knowledge sharing in a participatory way Developing and using simple tools tailored to South Africa Leveraging partnerships to create synergy at all levels

SOUTH AFRICA IS COMMITTED TO ACHIEVING ELIMINATION OF NEW HIV INFECTIONS IN CHILDREN AND KEEPING THE MOTHERS AND BABIES ALIVE AND HEALTHY BY 2015 POLITICAL DRIVE AND RESPONSIBILITY + +

SUMMARY POINTS PMTCT integrated with MNCH PMTCT integrated with Primary Health Care Bringing together different elements – common vision – setting up mentoring and monitoring systems Building ownership and accountability at all levels

ACKNOWLEDGEMENTS PMTCT Technical working group PMTCT Steering committee All provincial and district stakeholders UNICEF CDC – South Africa UNFPA Clinton Health Access Initiative MAC AIDS Foundation PEPFAR Members of the civil society All partners working in PMTCT/MCH

THANK YOU