1. ‘Keeping mothers and children alive and healthy in South Africa‘ Dr Sanjana Bhardwaj, MD, MPH UNICEF, South Africa Precious Robinson, DD, NDoH Lerato Lesole, CDC South Africa Maryet Mogashoa, CDC South Africa

2. Action Framework Monitoring + Coordination +

3. NDOH: MCH Directorate PMTCT unit Provincial DOH: PMTCT coordinator HIV/AIDS MCH District PHC managers MCH manager, HIV manager Sub district coordinators, MCH coordinators, HIV coordinators Facility manager Community outreach, workers PMTCT TWG PMTCT Steering committee CCMT meeting MCH coordination meetings Pediatric HIV TWG Provincial PMTCT Steering committee meeting District MCH meetings Sub district MCH meetings Facility meetings LEADERSHIP VISION GOAL TORs PLANS PRIORITY SETTING IMPLEMENTATION DRILL AREAS MONITORING FEEDBACK LOOP LINKAGES ENGAGEMENT Partner coordination Joint UN EMTCT working group Civil society consultations SANAC TTT Community engagement

4. National Guidelines + Policy + Resources + IMPLEMENTATIONMONITORING Action Framework: ‘No child born with HIV by 2015 and improving the health and well being of mothers, partners and babies in South Africa’, 2012-2016 4 PRONGS 5 Strategic objectives Priority actions based on bottleneck analysis Shared accountability Robot Dashboard (7indicators) Data for Action reports (all 9 provinces and 52 districts each quarter Cascade indicators EMTCT Tracker National Health Insurance CARMMA campaign MCH strategy Primary Health Care reengineering National Strategic Plan for HIV/AIDS, STI, TB 2012- 2016 9 Provincial Action Frameworks52 district Action Frameworks Business work plans Keeping children alive and healthy in South Africa: Blue Print for action for pediatric and adolescent (0-15 years) HIV integrating prevention, early identification of HIV and link to treatment, care and support 2012-2016

6. 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

7. EMTCT Tracker Robot Dashboard Cascade indicators NHLS data SAPMTCT Impact study ANC HIV prevalence survey Saving Mothers report 2008-2010

8. Data for Action reports: PMTCT/MCH National Province District Subdistrict Facility Quarterly from national (monthly at provincial and district and sub district levels Highlights progress in key indicators Analyzes DHIS data and Lab data Prioritizes actions ROBOT DASHBOARD Key 7 indicators PMTCT MCH Tracks progress over time Linked to activities and targets in the EMTCT action framework 2012-2016 Has given programme managers and implementers an easy to use and understand tool to track progress and prioritize actions Has also helped in linking data from different sources (DHIS and Lab) Stock Taking exercise

9. Robot Dashboard Cascade Indicators + interlinked indicators Discussion/review at district/provincial/national level meetings (quarterly/ monthly) Review partnership framework Discussions/review with all partners /shared accountability + Community linkages + civil society + traditional leaders + academic partners + innovation (MOMCONNECT) Review progress against work plan Management framework Review expenditure rates ACTION Response to robot dashboard (within a month) Data for Action – reports national/provincial/district Quarterly

10. Indicators (to interpret with an understanding of each numerator and denominator) Apr 10 - Mar 11 Apr 11- Mar 12 Scoring National Target 2011-2012 National Target 2012-2013 1 ANC 1 st visit <20 weeks37%40%50%60% 2 ANC client CD4 test rate69%76%80%85% 3 ANC initiated on AZT during antenatal care rate 84%88%85%90% 4 ANC initiated on HAART rate83%78%90%95% 5 ANC clients 32 weeks or later retesting rate 31%41%50%70% 6 Baby PCR test around 6 weeks positive rate 8%3.5%< 7%<3.5% 7 Postnatal care mother visits within 6 days rate 27%60%40%70% NATIONAL

11. PHASED APPROACH PHASE 1 (July 2011 to June 2012) PHASE 2 (July 2012 to June 2013) Bottleneck analysis +

12. Strong evidence base + + Review data from different sources Identify best practices Identify lessons learned Improve coordination amongst all stakeholders

13. EXAMPLE

17. SAPMTCT Study National: 2010: 3.5 (2.9 – 4.1) 2011: 2.7 (2.1-3.2)

18. KEY PRIORITIES ANC early registration + + ANC CD4 testing ANC HAART initiation and on treatment Quality ANC care Postnatal care and follow up EID (PCR positive) PCR + linked to treatment Family planning + TB Impact on maternal health outcomes (deaths) Impact on child health outcomes

19. Action Framework : strategic direction Data for action reports (quarterly) Dashboards + Lab data (monthly) Special surveys + (Beyond percentages to numbers) Use data at all levels Ensure feedback loop Quality Improvement Health care worker for change QI workshops – tools + SOPs + Communication plan + -Community awareness -Social mobilization -Materials Partnerships + Coordination (programs and partners, civil society) Key priority areas+

21. Variability + Provinces and districts

23. WE ALWAYS HAVE TIME ENOUGH, IF WE WILL BUT USE IT ARIGHT Johann Wolfgang Von Goethe

24. COUNTDOWN TO ZERO Believe It Do It

25. THANK YOU