CHAI Update, February 2013

Transcription

1 GLOBAL PROGRAM S CHAI UPDATE February2013 Essential Medicines/zinc/ORS CHAI secured $9 millin USD frm NORAD/the Gvernment f Nrway t supprt its zinc-ors scale up prgram in Nigeria. In Uganda, CHAI successfully advcated fr Ministry f Health s (MOH) apprval fr the intrductin f a zinc-ors c-pack int the public sectr. CHAI als received a cmmitment frm the Natinal Medical Stres (the warehuse YOU visited n yur last Africa trip) t guarantee an adequate supply in all public health facilities. With CHAI s supprt, Kenya launched its first zinc-ors c-pack in December In India, CHAI signed an MOU with the MOH f Madhya Pradesh State, which demnstrated the MOH s cmmitment t invest in zinc-ors prcurement, training f health wrkers, and caregiver utreach activities. Open Health Initiative in the East African Cmmunity CHAI has been wrking clsely with the East African Cmmunity (EAC), a reginal ecnmic blck cnsisting f Tanzania, Kenya, Uganda, Rwanda, and Burundi, t develp the Open Health Initiative. The Open Health Initiative t Imprve Reprductive, Maternal, Newbrn, and Child Health aims t supprt the five EAC Partner States reach their gals fr wmen s and children s health and cntinue t accelerate prgress in cuntries past the 2015 Millennium Develpment Gal deadline. The bjectives f the Open Health Initiative are t prmte innvative interventins and prvide strnger versight and increased accuntability f results and resurces fr wmen's and children's health thrugh leveraging the cllective market size and knwledge f the Partner States. The Open Health Initiative was signed by the five Heads f State n Nvember 30, 2012 and fllwing this high level endrsement was featured in Glbal Health and Diplmacy in an article entitled Hw Greater Accuntability Can Save Lives: The Open Health Initiative t Imprve Reprductive, Maternal, Newbrn, and Child Health in the East African Cmmunity Partner States. 1

2 Upn the request f the EAC, CHAI is cntinuing t prvide technical assistance t mve frward the implementatin phase f this lng-term prject starting with supprting Ministries f Health t mve frward resurce tracking capabilities and develping the innvative Acceleratin Fund that will reward cuntries fr their imprvement in maternal and child health utcme indicatrs and nt their inputs. COUNTRY PROGRAMS Malawi Health Financing The CHAI Health Financing team, in cllabratin with the Malawi MOH, cnducted its first rund f cmprehensive resurce mapping, which allws the MOH t understand the ttal budget, bth fr gvernment and develpment partners, dedicated t health. The MOH will use this data t supprt the develpment f a large dnr business case fr a 30 millin investment in HIV. The CHAI team created a detailed gap analysis and helped prvide evidence fr the reallcatin f 7 millin frm behavir change cmmunicatin t PMTCT and additinal reallcatin t vluntary male circumcisin, cndm prcurement, and HIV testing and cunseling. CHAI and the MOH cllabratively kicked ff their secnd-rund f resurce mapping in Nvember and t date have cllected submissins frm 154 rganizatins (up frm 44 submissins last year). Cnslidatin and analysis is taking place in February and March and will feed directly int the gvernment's budgeting cycle fr the next financial year. PMTCT After a successful implementatin f a Preventin f Mther t Child Transmissin (PMTCT) pilt prgram in Machinga District f Malawi, which tk place frm , the best practices f the prgram have been shared with the cuntry s Technical Wrking Grup and at the MOH s Senir Management meetings. As a result, the Malawi gvernment asked CHAI t supprt Optin B+ implementatin which is where just the mther takes ARVs during pregnancy, at birth, and fr life versus Optin A where the mther and newbrn are put n ARVs and then eventually taken ff r due t their CD4 cunt by cnducting an peratinal research prgram in Mangchi district f Malawi t test innvative strategies that have the ptential t imprve retentin f bth the HIV pregnant and lactating mthers and their expsed infants. 2

3 Labratry Services CHAI will initiate its scale-up f Pint-f-Care (POC) HIV testing in Malawi in February, fllwing the recent sign-ff f its MOU with the MOH and finalizatin f the POC Implementatin Guidelines CHAI develped with the MOH and partners. As a result there will be $1.7 millin USD in POC prducts prcured and deplyed acrss the cuntry in 2013, which will drastically increase the availability and accessibility f initiatin t ART. Since the deplyment f POC technlgy des nt ensure the scaling up initiatin and imprvement f retentin f patients, the team has been wrking with MOH and partners t revitalize natin-wide mentrship f early-infant diagnsis (EID) and ART/PMTCT mentrship t imprve the quality and access t life-saving ART services fr all HIV+ Malawians. Swaziland The CHAI Malaria team and ther partners have supprted the MOH t establish mlecular testing fr malaria in Swaziland. This testing invlves Lp-mediated isthermal DNA amplificatin (LAMP), a nvel mlecular diagnstic technlgy which is highly sensitive and specific, faster than the currently used PCR, requires minimal prcessing and instrumentatin, and allws result detectin with the naked eye. With this, the Natinal Malaria Cntrl Prgram will be able t identify and treat peple infected with lw-level parasitemia, wh may cntribute t nging malaria transmissin in the cuntry but are difficult t diagnse with rapid diagnstic tests and ther prducts. This will help Swaziland eliminate sme f the remaining transmissin f malaria that can persist due infectins in the ppulatin that were previusly undetectable. Zambia ART Wrk HIV prevalence in Zambia is amng the highest in the wrld at an estimated 14.3 percent fr adults. While significant prgress has been made t cmbat the disease, the Gvernment wants t d mre t fight it. In July 2012, the gvernment decided it wanted t prvide ARV treatment fr all HIV psitive patients, regardless f their CD4 cunt. Since then Zambia has taken the fllwing steps twards this gal: PMTCT: Adptin f ptin B+ fr HIV psitive pregnant wmen in 2013, which prvides ART fr them fr life, regardless f CD4 cunt. CHAI estimates that an additinal 20,000 HIV psitive wmen will cme n treatment in 2013, 40,000 in 2014 and 50,000 in CHAI als assisted in develping a business case fr B+, including its csts and benefits versus Optin A. Finally, CHAI is wrking n the develpment f an implementatin plan fr B+, including cst estimates. 3

4 A large scale study HPTN 071 (PpART) funded by the Gates Fundatin and USG will cmmence in 2013 t trial the test and treat methd, which has all HIV psitive patients put n treatment regardless f their CD4 cunt, as well as ther preventin strategies, in 12 cmmunities in Zambia. It is expected that an additinal 22,000 patients will cme n treatment in 2013 thrugh this study. Treatment f discrdant partners, which is ne psitive partner and ne negative, regardless f CD4 cunt, leading t 13,000 additinal patients in In Zambia there is currently nt enugh funding available t implement test & treat and scale up ARV treatments, in line with the gvernment s ambitins, as there is an estimated funding gap f $35 millin USD in 2013, clse t $97 millin USD in 2014, and apprximately $116 millin USD in CHAI Zambia, thrugh its effective and efficient (E2) wrk, is intrducing cheaper and mre effective ARV treatments, supprting the rll ut f Pint f Care devices, addressing retentin issues, and lking at ways t increase testing fr children. Hwever, CHAI s cntinued advcacy at the glbal level is needed t make enugh resurces available fr cuntries like Zambia wanting t mve t test & treat. HRH Wrk Zambia is suffering frm a severe Human Resurces fr Health (HRH) crisis, as it is perating at nly 45 percent f its clinical healthcare wrker funded establishment (FE) target f 39,360. CHAI has been supprting the Gvernment f Zambia since 2007 in estimating shrtages, scaling up training f health care wrkers, intrducing new shrter training curriculums, assisting a better distributin f the available wrkers and retaining wrkers in hard t reach areas. In 2008 CHAI supprted the gvernment t develp a Natinal Training Operatinal Plan (NTOP) t scale up a number f critical healthcare wrkers and vercme bttlenecks in infrastructure, tutrs, and student funding. In 2012 CHAI supprted the MOH in carrying ut an assessment f that 2008 NTOP t identify hw, and by hw much, training enrlments have been scaled up since. The assessment identified that ver the past five years enrlments have increased by 55 percent. Hwever, a further 15,445 frntline health prviders will be needed t serve the expected ppulatin f T reach these targets training enrlments needs t mre than duble. In an effrt t address sme f the shrtages, CHAI is wrking with the MOH t scale up mid-level healthcare wrkers with midwifery skills and a new cadre f Cmmunity Health Assistants. Over the next five years CHAI will supprt the training f 1,235 new skilled birth attendants and arund 3,000 Cmmunity Health Assistants. The new recruits 4

5 will be practively recruited frm remte /rural areas f the cuntry s that they can be subsequently deplyed back t these areas t address the critical healthcare wrker shrtages and retentin issues that exist there. When Ira Magaziner visited Zambia in Nvember 2012 he met with the Minister f Health and briefed him n the ambitius plans f Rwanda t drastically scale up training capacity. The Minister f Health expressed Zambia s interest fr CHAI t supprt the Ministry t develp and implement similar plans. Mzambique ART: The Gvernment f Mzambique has set a target f 80 percent cverage rates fr Pediatric HIV by While the current cverage rates are 30 percent, CHAI is wrking with the MOH and partners t significantly increase the cverage rates thrugh new initiatives and new technlgies that rapidly identify children that require treatment. In additin, the EID prgram cntinues t expand: As f the end f 2012, 51,296 PCR samples had been prcessed a 26 percent increase in the number f samples prcessed cmpared t Testing cverage f infants whse mthers received PMTCT is 65 percent fr 2012, cmpared t 55 percent in 2011 and cverage f ttal infants in need f PCR testing is 51 percent, cmpared t 40 percent in Imprving stcks f medicines at Health facility Level: CHAI Mzambique and Cca Cla are develping an expansin plan t supprt natinal level netwrk ptimizatin and cntinue leveraging their distributin netwrk at the request f the MOH. Currently the prgram distributes all essential medicines (except fr vaccines this will be phase 2) t fur prvinces that represent 50 percent f the ppulatin f patients. UNITAID visit: March 11-15, 2013: A delegatin frm UNITAID including the Chairman f the Bard, Philippe Duste-Blazy, will be visiting Mzambique t see the prgrams they supprt and meet with the MOH and partners. CHAI Mzambique is crdinating the visit and will be presenting the POCT, Pediatric and Supply Chain prgrams. UNITAID is als in discussins with the Gvernment f Mzambique t add a levy n all airline tickets t supprt the UNITAID financing mechanism. Preliminary discussins have been psitive. 5