1. 1 Strengthening the community system to improve quality services at the community level Isac Tsambe, Improvement Advisor Luke Dausse, Chief of Party USAID ASSIST Project

2. USAID Applying Science to Strengthen and Improve Systems Quality improvement aims 2 Identify all pregnant women in the bairros (village). Increase percentage of pregnant women who receive ANC to 100%. Increase percentage of pregnant women who receive HIV testing to 100%. Increase percentage of HIV+ pregnant women who are put on treatment.

3. USAID Applying Science to Strengthen and Improve Systems Community QI teams 3 Gaza Province Chissano Health Center Incaia HP 1 Nurse Coach Chissano HP 1 Nurse Coach Licilo HP 1 Nurse Coach 11 Bairros 11 QI teams 13 Bairros 13 QI teams 15 Bairros 15 QI teams Bilene District; 11 Health Centers Macia Hospital

4. USAID Applying Science to Strengthen and Improve Systems Community Health Systems Strengthening Model 4 Schools Religious Community Women’s Group Local Health Clinic $ Savings & Credit Group Local Government CHW Community Health System Ram Shrestha

5. USAID Applying Science to Strengthen and Improve Systems Results: Community health volunteers (CHVs) identified more pregnant women working with the community system 5

6. USAID Applying Science to Strengthen and Improve Systems Results: Pregnant women are receiving ANC services earlier 6

7. USAID Applying Science to Strengthen and Improve Systems Summary of Results Between March and October 2014, a total of 763 pregnant women were identified. In Licilo, percentage of pregnant women receiving their 1 st ANC in the same month as identification increased from 36% in March to 87% in October. In Licilo, percentage of identified pregnant women tested for HIV increased from 36% to 78% in October. While all sites consistently started 100% of women found to HIV positive on treatment, the number of women found to be HIV positive has increased, as have the number put on treatment. 7

8. USAID Applying Science to Strengthen and Improve Systems Changes tested 1.Addressing mother in laws through community groups to encourage ANC 2.Using religious leaders to pass on information to encourage ANC and testing 3.Using school children to enter information in group registers as a way to overcome barriers to numeracy and literacy skills by elderly, non-literate members 4.Involvement of male partners in ANC upon return from working in mines in South Africa 8

9. USAID Applying Science to Strengthen and Improve Systems Key lessons learned Community health system can expand the reach of community health workers through spreading messages and identifying cases and referrals. Community health system can play a vital role in connecting pregnant women with services early in their pregnancy, increasing likelihood of early treatment and follow-up. Community QI teams can creatively find ways to collect and report data getting beyond literacy and numeracy barriers. 9

10. USAID Applying Science to Strengthen and Improve Systems New directions 10 Community groups are mapping all possible service referrals in the area in order to refer and support pregnant women and for the information of the community health workers. Community groups are looking to see how they can support all breastfeeding mothers to help support retention.

11. USAID Applying Science to Strengthen and Improve Systems Thank you! 11 Email: ldausse@urc-chs.comldausse@urc-chs.com USAID ASSIST Website: www.usaidassist.orgwww.usaidassist.org