1. Optimizing PMTCT through community health system strengthening (Experience from Daloa District, Cote Ivoire) SIMANGA Munlondi Carine, MD Project Manager SANTE ESPOIR VIE COTE D’IVOIRE (SEV-CI)

2. Context Daloa is 1 of 8 priority districts identified in Cote d’Ivoire’s national eMTCT plan, due to high unmet need for PMTCT. From 2013-2015 the district has been pursuing enhanced community strategies to improve PMTCT uptake and transmission outcomes. Strategies include: – Enhanced community involvement promoted by community health workers and lay counsellors – Improved monitoring and evaluation of community-facility linkages

3. Actions to improve access and demand for MCH - HIV services: At community level o Build capacity of community actors on importance of ANC & PMTCT o Mass and one-on-one sensitization about maternal and child health o Referral – counter referral system between community and health center At health facility level o System to follow up on missed appointments including providing kits as an incentive o Reinforced support groups for women living with HIV/AIDS

4. To coordinate, monitor and evaluate community interventions (1) Improved planning and coordination: o Monthly district planning and monitoring meetings o Quarterly meetings with community actors and health facility staff o Quarterly supervision of community interventions by district health medical team o Leveraging of maternal and child health intervention

5. To coordinate, monitor and evaluate community interventions (2) Enhanced Monitoring and evaluation o Developed indicators to measure community interventions o Designed tools to collect community data, including a computerized data base for community interventions o Elaborated a M/E plan in collaboration with district health medical team (DHMT) o Produce monthly and quarterly report and validation and analysis of results with DHMT o Experience sharing with other districts and harmonization with other districts

6. Community Community health workers – community counselors Health center Nurses / social workers District District health medical team / SEV-CI Compilation and validation Pre validation Data collection Data flow Feedback Data flow

8. Results (Jan. 2014- Sept. 2015) 243 community actors trained on Essential Family Practices and PMTCT 13,370 women sensitized throughout mass sensitization and face to face discussions 3,120 pregnant women referred by CHW to health facility for ANC 80 among 106 HIV+ pregnant women who were lost-to-follow-up were traced and brought back into care by CHWs

9. Results

11. Next Steps  Agree on minimum set of key community indicators with stakeholders  Integrate community indicators into national health information system (SNIS) an integrate comunity indicators into national standard collection tools (in collaboration with PNLS and National Community Health Program )  Integrate of community health interventions into the national supervision grid for field monitoring  Scale up community health interventions that support improved HIV outcomes.  Improve collaboration between community actors, health facility staff and eMTCT implementing Partners

12. Meeting of community health workers

13. Using monitoring tools

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