1 Addressing nutrition of mothers and babies in partnership for HIV – Free Survival (PHFS) sites to improve their well-being DR. STELLA KASINDI MWITA SENIOR QUALITY IMPROVEMENT ADVISOR URC-ASSIST 30 TH NOVEMBER 2014

TANZANIA Ministry of Health and Social Welfare

Background Partnership For HIV Free Survival (PHFS) is a collaborative effort by the PMTCT Inter-Agency Technical Teams Working Group on Child Survival & Infant Feeding, PEPFAR and other technical partners. PHFS is implemented in response to the ' Global Plan toward the Elimination of New HIV Infections among Children by 2015 and Keeping their Mothers Alive ' (eMTCT). Tanzania is among six countries that is implementing PHFS, main purpose is strengthening of the Post-partum care in 30 target districts (Mbeya Urban, Nzega and Mufindi); the initiative is led by PMTCT unit of MOHSW with support from USAID Other countries include Mozambique, Lesotho, South Africa, Uganda and Kenya. 3

Objectives and care path of PHFS To strengthen comprehensive postpartum care at facility with linkage to the community To strengthen nutrition services along the continuum of care (maternal nutrition, promotion of optimal infant and young child feeding practices through nutritional assessment counseling and support (NACS) To establish evidence on the effectiveness of the key selected interventions 4

Nutrition strategies/activities FANTA/TFNC have trained NACS Regional Trainers in all 3 regions PHFS have sensitized LGAs on roles and responsibilities in nutrition PHFS have strengthened oversight role of Regional Nutrition Officers, District Nutrition Officers/Focal persons to manage supportive supervision On-going supportive supervision and mentoring to all 30 PHFS sites FANTA/TFNC have distributed NACS job aids, wall charts, reference manuals, M&E tools to all 30 sites Implementing partners in target districts – Baylor, Deloitte-Tunajali and EGPAF have coached staff on use of M&E registers and forms TFNC has conducted training on IYCN to all districts implementing PHFS districts 5

QI implementation in the 3 pilot districts URC/ASSIST have trained Health workers on QI and assisted the process - QI teams at each site Each district has held 3 QI learning sessions. In addition three coaching visits have been conducted in all the three districts from Nov 2013 to September 2014 together with RHMT and CHMT A total of 10 indicators aligning to improvement areas of retention, nutrition, testing, ART for mother and babies are being monitored Out of these indicators 4 are monitoring nutritional activities

Results Improved documentation of information in NACS and in mother – child follow-up registers. Nutritional counselling and assessments have increased up to more than 50% in the districts. NACS platform contributed to improved PMTCT B+ and retention of babies and mothers in HIV services Community teams have been enacted and followed up to assist in ensuring retention to services for mothers and their babies in order to get all the appropriate care 7

Introduction of NACS in RCH has increased Nutrition Counseling in 10 sites each in Nzega, Mbeya urban and Mufindi Districts April 2013 – Aug 2014) 8 Changes Introduced Trained and oriented RCH staff on NACS and assessment using MUAC Introduced NACS tools at registers at RCH Assigned 1 staff at RCH responsible for nutrition assessment and counseling Attach NACS forms l to the CTC2 card Emphasis to health care workers on conducting nutritional assessments to all HIV Exposed Infants April 2013 Baseline assessment October 2013: First Learning Session: Introduction of indicators and plans for improvement

Progress: % of HEI < 6 months who are exclusively breastfeeding in the 3 districts in the reporting period April 2013 –August

Percentage of Mother baby pair attending HIV services each month 10

Percentage of HIV positive pregnant and Lactating mother taking ARVS each month 11

Observed Challenges and Way forward Challenges Consistent unavailability of NACS tools and registers Availability of supplementary feeding Capacity and consistency of HCW in providing nutrition services Way Forward Scale up of the nutritional activities to other districts District coaches to mentor HCW on nutrition as part of routine activities Nutritional information system to be part of HMIS 12

Acknowledgement MOHSW – PMTCT Unit All Tanzanian PHFS partners – EGPAF, Baylor - Tanzania, Deloitte - Tunajali, TFNC, FANTA, URC- ASSIST, JHEPEIGO, FHI360 USAID Tanzania 13