1. Mbereko Groups: A Model For Improving Access To Health Services For Mothers And Babies In The First 2 Years Of Life Presented by: Priscilla Matyanga OPHID Trust Community Facilitator 2015 PSS Conference Victoria Falls

2. Background OPHID Trust is a local charitable trust that works closely with the Ministry of Health and Child Care (MOHCC) With a multidisciplinary team of professionals, and leading a consortium of implementing partners, OPHID supports the national PMTCT, pediatric and adult care & treatment program nationwide

3. What are Mbereko groups Community peer to peer groups of pregnant and lactating mothers and caregivers Irrespective of HIV status 10- 15 members of the same village Led by the Village Health Worker (VHW) Meeting at least once a month on agreed days

4. Why Mbereko groups Women who are marginalised in society Yet key decision makers in the home in health related issues Combine education in health matters and economic empowerment Empower women to access health services for the baby in the first 1000 days of life First 1000 days have been documented as “window of opportunity" that affects the life and health of an individual for their lifetime. 1 1 http://www.pncius.org/first-1000-days.aspx Where are we operating Currently in 35 clinics in 3 provinces of Manicaland, Mashonaland East and Central

5. VHW is key Established MOHCC community cadre Already responsible follow up of all pregnant and under 5 children in their village Already promoting health issues in the community Already trained to deliver health education talks Already in the government system

6. New responsibilities Skills to facilitate a participatory action meeting session Revision of key health topics and sessions (PMTCT, Care and treatment, data collection tools) Support to form Mbereko groups within their villages after training Support to deliver monthly health education sessions with actionable take home activities through supervised meetings Support to give further one on one adherence counselling sessions to mothers who disclose their HIV status

7. Tools Flip chart with key messages to aid them during discussions The women are given a Milestone card - hand held card that they complete as they go through each milestone Milestone card a discussion point within the home between couples and families

8. Lessons learnt - community Patience patience patience!!! Need consistency and patience as it takes time to change perceptions Build trust by being on time and develop good working relations with the stakeholders Respect the cultural and social traditions of the community Be willing to learn from the community

9. Lessons learnt -VHW Working with a cadre who is known on the ground is beneficial to ensure continuity beyond project funding Even though VHW are already working in the community, working with them empowers them and builds their facilitation and management skills

10. Lessons learnt- model Maximum benefit is derived from not just targeting the woman but including the husband and family Elderly women are most pivotal to initiating and supporting change within the home Husbands welcome their inclusion in health issues and accept new practises if they understand the reasons behind them Men only meetings as well as combined meetings have yielded the same results in behaviour change and acceptance

11. Lessons learnt- model Addition of a financial component through the use of trainings in Internal Savings and Lending Scheme (ISALs) gives an added component Helps women overcome financial barriers to health service access and cover other household needs It is also a sustainability strategy

12. Conclusion Utilising existing cadre strengthens a program as people will more accommodating to teachings Continued education yields results in the end Self reported statements from the women shows that communities are willing to learn and adopt recommended health practises

13. Thank You – Tatenda – Siyabonga Special mention goes to PEPFAR Zimbabwe thorough USAID OPHID FACE project Ministry of Health and Child Care Village Health Workers And women and men in the 35 clinics!