Doctors with Africa CUAMM

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2 Doctors with Africa CUAMM Founded in 1950 by prof. Canova Doctors with Africa CUAMM was the first NGO operating in the health field recognized by Italy 1300 people sent in Africa throughout the years 4330 years of service in Africa 40 countries of intervention MISSION: Carrying out long term projects to guarantee that everyone has access to quality health services. Committed in capacity-building and training of human resouces in Italy and in Africa, in the reaserch and scientific popularization fields. Promoting Health as a foundamental and universal human.

3 Doctors with Africa CUAMM Doctors with Africa CUAMM is present in 7 African countries (Angola, Ethiopia, Mozambique, Sierra Leone, South Sudan, Tanzania, Uganda) with: 78 volonteers 37 principal cooperation projects and about a hundred of support initiatives that offer backing for the activities of: 15 hospitals 25 districts (public health activities, maternal-child health care, Aids, TB and malaria, training and capacity-building) 3 rehabilitation centers 4 nursing schools 3 universities (in Uganda, Mozambique and Ethiopia) Sierra Leone

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5 Strengthening health system Health System Strengthening Framework, WHO, Policy and programs - Human resources - Infrastructures - Financing - Heath information system - Innovation and operational research

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7 Continuum of care Referal to higher level Demand of care Decentr. treatment Follow up

8 Doctors with Africa CUAMM Tuberculosis care and treatment

9 The continuum of care approach - TB Community and families: Promotion of sustainable Community based DOT. Decentralization of TB services (health extension workers) Primary and secondary level: Management of Smear negative cases Integration of Tb/HIV services and management of treatment complication, Paediatric TB (diagnostic and treatment), Use of new technology (genexpert) in rural areas. Rural Hospital: Management of Smear negative cases Integration of Tb/HIV services and management of treatment complication, Paediatric TB (diagnostic and treatment), Use of new technology (genexpert) as predictor of MDR e referral to culture (Bactec) Management of MDR and 2 nd line treatment, Referral system: Avoid diagnostic delay Recover of defaulters

10 Case study: Angola TB control MAAEE: tb control programme in Uige and Luanda province Global fund R4: 11/18 provinces of Angola Global fund R9: 18/18 provinces of Angola PR CUAMM Expansion of DOT services in conflict and post conflict phase PR UNDP Expansion of DOT services in development phase Strengthening the PNCT at central, provincial and district level PR MINSA Expansion of DOT services Strengthening the PNCT at central, provincial and district level Promote community based DOT Unmet challenges: TB/HIV and MDR

11 Angola TB control

12 Angola TB control From 69% to 73% From a mean of 45% to 70% % of achievement of minimum standard for quarter report in each province supported

13 Angola TB control From 19% to 77% 46% of patient are delaying

14 Doctors with Africa CUAMM HIV / AIDS

15 The continuum of care approach HIV / AIDS Community and families: Awareness campaign for prevention Home based care and peer to peer support groups Primary and secondary level: Voluntary counselling and testing Management of HAART. Rural Hospital: Management HAART with CD4 monitoring Integration of Tb/HIV services and management of treatment complication, PMTCT Paediatric TB (early diagnosis PCR and treatment), Management of 2 nd line treatment Referral system: Improve access to services Recovery of defaulters

16 Case study: Mozambique peer to peer support Beira city, Mozambique Beira city has one of the highest HIV prevalence in Mozambique; up to 25% in pregnant women The reported prevalence on the group aged is 13% Access to HIV services, especially PMTCT has been described as a cascade *Graph form South Africa and Zambia

17 Case study: Mozambique peer to peer support Peer to peer support group Create in 2005 became a local association legally recognized in 2011 Kuplumussana links health service to communities ensuring support to HIV+ women, access to health services and adherence to treatment. Kuplumussana ensure the recovery of defaulters

18 Mozambique PMTCT and pediatric HIV Defaulters tracing and recovery Sample of home visits Children identified Children lost 544

19 Doctors with Africa CUAMM: Research and Innovation

20 CUAMM s approach to research

21 Innovation: technology / approach

22 Doctors with Africa CUAMM trends and new scenarios

23 The Urban vs Rural scenario

24 Communicable vs non communicable diseases

25 The double burden scenario

26 Thank you! Andrea Atzori