HEALTH AND NUTRITION. Immunization Maternal health PMTCT and paediatric HIV Nutrition Health systems Health and nutrition in emergencies.

HEALTH AND NUTRITION

Immunization Maternal health PMTCT and paediatric HIV Nutrition Health systems Health and nutrition in emergencies

◦ DHOs◦ NGO partners

ACF (Kaabong, Moroto) AFLI (Karamoja) CESVI (Abim, Kaabong) Concern (Nakapiripirit) CUAMM (Karamoja) IRC (Kotido, Moroto, Nakapiripirit) MSF (Moroto, Nakapiripirit) URCS (Karamoja)

◦ Bridging plan (Jan-Jun 2010) Maintain / consolidate VHTs Sponsorship Nutrition coordination / quality care Data / evidence base

◦ Annual work plan 2010/11 Maternal and newborn health IYCF Integration and best practices

Health, nutrition and CAA

• Since 2005/06 when Kaabong become a district, it became apparent that access to basic health care services was a big challenge to contributing to achieving the 4th, 5th and 6th MDGs.• The major gaps were identified in the maternal and child health and nutrition and HIV/AIDS

• The intervention activities implemented during the year under review therefore, were aimed at improving access to basic health care services in these areas. • These activities were implemented by the district in partnership with NGOs; CUAM, CESVI, ACF and MSF

DPT3 coverage improved from 50% in 2007/08 to 63% against 80% target

ANC 1st visit at 45% and 4th visit reduced from 33% to 20.4% against 60% target.

Institutional deliveries have improved from 5% during 2007/08 to 6.7% this year against a national average of 34%.

Pregnant women tested for HIV have improved from 22% last year to 34%.

HIV prevalence among pregnant mothers has reduced from 2.6% last year to 1,6%.

71% of HIV exposed children have been tested for HIV against a target of 50%.

90.9% of these children have been started on co-trimoxazole against a target of 10%.

The number of HC IIIs and above providing PMTCT services have risen from 29% last year to 60% against a target of 100% (CESVI & MSF).

Under nutrition, the district GAM has reduced from 15% in 2007 to 9.5% to date.

Under infrastructure, CUAM has constructed three staff houses and fenced two health facilities.

Staffing for midwives has improved from 5 to 10 with support from CUAM.

Involvement of VHTs in mobilization activities.

Ringing of bells at the out post as a mobilization strategy.

Use of a mobile public address system as a mobilization strategy during implementation (use of police vehicles).

Engagement of operational partners (NGOs).

Institutional out reaches for Albendazole and TT in schools

Inadequate human resource. Lack of infrastructure and equipment

leading to poor access. Poor data capture and management. Unrealistic population estimates. Poor quality of available health services. Insecurity Poor referral system

Increase access to quality health care through;

Task shifting. Recruitment and training of health

workers. Establish and equip service centers. Improve mobilization strategies. Establish a strong monitoring and

evaluation framework.

Health, nutrition and CAAKotido district

1 HSD-District with 17 health unitsTotal district population of 188,10038,561 under fives.9,405 pregnant women38,000 WCBA.8,088 infants

Health, nutrition and CAA

1 HSD-District with 17 health unitsTotal district population of 188,10038,561 under fives.9,405 pregnant women38,000 WCBA.8,088 infants

EPI Mass polio activities. Support to routine outreaches. Sunday TTV non pregnant WCBA. Build capacity of health units to plan for catchment pop.

Maternal health Integrated PMTCT/ANC outreaches. Build capacity for commodity management to ensure no

stock-outs of commodities for ANC in all HC 3 and 4'sC.A.A

Support establishment of ART clinic and monthly Paediatric ART outreaches .

Procure supplies and logistics for PMTCT and pediatric care services.

PMTCT outreaches

Nutrition Opening of TFC in Kotido H.C.4 Provision of supplies to the TFC and OTP. Trained 3 H/W’s from Kotido H.C.4 on mgt of acute

malnutrition. Child days plus activities

Strengthening community based systems Rollout of the VHT system in the district Production of monthly reports.

Strengthening facility based health systems Promotion of the retention and usage of all LLITNs in the

district Community Education/ campaign about ITN

DPT 3 5,278 (65.3%) TTV 2 non pregnant 12,473 (32.8%) TTV 2 Pregnant 5,509 (58.6%) TTV 2 Non Pregnant 5,509 (43.6%) ANC 4th visit 2,193 (23.3%) IPT 2 2,783 (29.8%) Deliveries 1,034 (11.3%) PMTCT 4,737 (50.4%) VHT ,330(100%) Coverage Vit A(1st round- 111% , 2rd round -106%) Deworming(1st round- 75% , 2rd round -66%)

Use of VHT’s in mobilize of the population(mass polio & measles campaigns.

Use of religious leaders to help boost TTV non pregnant.

Setup of a coordination mechanism at the district health office to regulate the use of the village health teams by the different partners.

Frequent campaigns interfered with routine activities.

Difficulty in data capture as indicators are not present in HMIS(PMTCT & Nutrition).

VHT's not adequately involved in routine mobilisation and monitoring especially EPI.

The VHT reporting format requires serious review.

Train VHT’s in the different modules. Training members of the VHT's on use of child health card

as a monitoring tool for assessing EPI coverage in villages. continue the Sunday TTV non pregnant initiative and

expand to schools & institutions. Continue with integrated outreach activities Train 30 health workers in mgt of malnutrition at TFC and

OTP level. Organize a strategy to target the 6-14 year olds, especially

those to be found in the grazing areas(leave albendazole with the VHT's overnight for 3 days to continue administering the drugs)

Health, nutrition and CAA

Moroto District20thNov 2009

Population: 276,000 WCBA: 63,480 Preg. Women: 14,352 Children <5 Yrs: 56,580 Children <1 Yr: 11,868 3 HSDs with 2 Hospitals, 9 HC IIIs, 9 HC IIs and 2

Mobile Clinics

EPI Micro-planning for Outreaches Routine Outreaches Outreaches to the Hard to Reach Areas 5 rounds of Mass polio Immunisation campaigns. One round of Mass Measles Immunisation Child Days Plus activities in July

Maternal Health Training of Health Workers on ANC +. Support to the Supply Chain Management. Support to integrated Community Outreaches.

VHTs Involved in the community mobilisation in support

for the Mass Polio Immunisation campaigns.CAA Support for Early Infant Diagnosis through DBS. Support for Integrated Outreaches. Support Supervision and Monitoring of the PMTCT

and Paediatric HIV AIDS programmes.

VariablesVariables NumbersNumbers PercentagePercentage

DPT3DPT3 74417441 62.762.7

TT2 Non Preg WomenTT2 Non Preg Women 98669866 15.5415.54

TT2 Preg WomenTT2 Preg Women 63686368 44.344.3

ANC 4ANC 4ththVisitVisit 66706670 46.4746.47

IPT 2IPT 2 36153615 25.1925.19

Deliveries in HUsDeliveries in HUs 15101510 12.712.7

PMTCT Mothers HIV TestsPMTCT Mothers HIV Tests 53965396 97.397.3

VHTs TrainedVHTs Trained 481481 38.438.4

VHTs ActiveVHTs Active 110110 22.822.8

Involvement of Stakeholders in Routine Activities and campaigns

Involvement of VHTs in Community Health service delivery

Coordination of Health, Nutrition and HIV/AIDS SGs

The Numerous Polio Campaigns. Not all indicators are Captured in the HMIS, incomplete

and late reporting Low VHT coverage and the drop out rate is high for the

trained. Late release of funds Vs work plans. Excessive bureaucracy and paper work in requests and

reporting. Little or no involvement of LGs in partners proposal

reviews.

There is need to harmonise the selected indicators with the available data tools

HMIS strengthening at the District and the LLUs including appropriate HRs, Trainings, Support Supervision and Mentoring are very essential.

VHTs; An appropriate selection, Training, supply of tools, Motivation as well as support for the routine running costs should be catered for.

Timely release of funds! The bureaucracy; can the hassle be reduced?! It is important that the LGs are involved in reviewing the

Project Proposals of the District implementing partners

ALAKARANOOI

Health, nutrition and CAAABIM DISTRICT

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1 HSD-District with 18 HUs and a district hospital

Staffing position at 60.4% & technical at 44.6%

Doctor patient ratio, 1 to 30,328 people Midwives, 1 to 348 pregnant mothers Health system strengthening on track;

district league standing from 52 to 49 to 29 in the past three FYs

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◦5 rounds of mass polio-March to October◦Child days-April & October◦Trainings-HMIS, TT, full ANC package◦Setting up ORT corners in all the HUs◦Routine EPI outreach support to all HUs◦Radio messages on malaria, diarrhea and

pneumonia◦Training of pediatric core team/TOTs◦PMTCT outreaches + CESVI◦HSD/DHT/Integrated monitoring of CSD&CAA

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INDICATORS TARGET ACHIEVEMENT

EPI (Infant)

DPT3 100% 104%

Measles 100% 100%

TT2 Pregnant 70% 81%

Vitamin A 100% 96%

ANC

1st Visits 100% 94%

4th Visit 50% 38%

IPT2 60% 34%

HU deliveries 50% 30%

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INDICATORS TARGET

ACHIEVEMENT

TFC death <10% 19%

% of exposed children tested for HIV 50% 100%

% of exposed children on CTX prophylaxis 10% 93.4%

Functionality of H/C3 and HOSP 100% 100%

% of pregnancies tested for HIV 80% 90.1%

% of HIV+ women given ARVs for PMTCT 50% 69%

% Villages with functional VHTs 100% 30%

% of VHTs reporting monthly 100% 32%

% VHTs trained; mal, diarrhea & pneumonia

100% 0%

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Involvement of VHTs, Red Cross Volunteers, LCs, Parish chiefs & teachers

Through & through involvement of stakeholders & development partners

Strong supervision from HSD& DHT Mentoring/training on data management,

human resource for health Use of ICT for reminders on key issues Coordination meetings for CAA and CSD

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Data management incapacities Human resource inadequacy Medical supply management problems cf

gas/vaccines, medicines. Inadequate transport for referrals, outreaches &

follow up Numerous new settlements e.g. Kobulin &

Camkok Insecurity cf mass polio VHT functionality ????? Ownership and

facilitation Population (54,000-111,400) cf 90,713

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Strengthen community involvement and participation in health service delivery cf VHTs, TBAs, LCs, Parish chiefs and Development partners

Strengthening supervision by DHT/HSD and HCIIIs

Continuous training/mentoring on data and health logistics management

Harmonizing coordination of core teams for CAA and CSD

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Use of ICT for communication/data base set Human resources; recruitment and training of

new personnel e.g. midwives cf 32 New acceptable population figures Can UBOS

support be tapped? Facilitate monthly mobile clinics

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BDR VHTs Data collection and management Social mobilization for child survival School health (deworming, TT) Disaster risk reduction and emergency

preparedness / response Human resources

Health & nutrition CAA

by District Health Officer Nakapiripirit

Overview:3 HSDs2 HC IV, 1 HOSP, 6 HC III, 7 HC IIStaffing at least stands at about75%Most health facilities are with in 5km

from catchment populationsDoctor patient ratio is 1:46,0008 ANC/PMTCT/Paediatric sitesPartners:UNICEF, WFP, SAVE THE

CHILDREN, CUAMM, IRC,CONCERN

NUTRITION TargetAt least 50% of children with severe

acute malnutrition are identified and treated

2 TFCs and 10 OTCs operational in the district

U 5 Screened 58,502 and 740 treated

ITN coverage >90% 100% coverage of VHTs; 240 VHTs functionalDPT3 coverage 60%Measles coverage 85%TT2 coverage 34%

Category Results

Estimated no. of pregnant women (5% of total population) 11,538

No. and % of pregnant women counseled and tested for HIV (Target: 80% of all new ANC attendees)

3272(28%)

No. and % of HIV positive pregnant women identified. 48(11%)

No. and % of pregnant women who received ARV prophylaxis (Target: 50% of HIV positive women identified)

42(9.8%)

No. and % of HIV positive pregnant women accessing cotrimoxazole prophylaxis (Target: 70% of identified HIV positive pregnant women)

48(11%)

No. partners tested for HIV 811(7%)

No. and % of children born to HIV positive mothers who are tested for HIV using PCR. (Target: 50% of children born to HIV positive mothers)

48(15%)

No. and % of children born to HIV positive mothers who access ARVs for PMTCT. (Target: 40% of newborns to HIV positive women identified)

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Many mothers have learnt the nutritional program & can now mobilize others to bring their children to the program

Innovative approaches to reach highly pastoral/mobile communities

Use of pre-packed Nevirapine increases the ARV prophylactic uptake among children.

A few mothers still misuse plump nut Inconsistence fundingPoor health seeking behavior of the people Occasional stock out of gasHard to reach nature of the district and

some communities leaving in the mountain Inadquate space in most of the HusLong distance to be moved by mothers

Lack of transport in most of the health centres

Inadequate human resource in most health units

Strengthen integrated outreaches to hard to reach areas

Intensify routine EPI outreachesAvoid gas stock outsSupport child days planning and activitiesNeed for continuous sensitization at parish

level in ITN useNeed for monthly mobilization of

communities for ANC

Build capacity of VHTs to promote early ANC visits

Support health centre 2 to hard to reach to provide ANC services

Need for refresher training for health unit in charges and record assistants

Support sponsorship of studentsBuild maternity block and laboratory in

Karita HC III

Support monthly meeting btn HU in charges and VHTs

Refresher training for VHTs on mgt of fever , diarrhoea and pneumonia

Need for quarterly review meetings wit VHTs

Strengthen Paediatric care and treatment strengthen the community follow up and referral of HIV positive pregnant women and their children for comprehensive ART services

THANK YOU VERY MUCH