Ethiopia: Strengthening Systems
and Services to Prevent Mother-to-Child Transmission
of HIV
Provided by PRIME II VOICES
“I first heard of PMTCT during an educational
talk at the health center. Now I know that I can
live positively and do things to prevent my baby
from becoming infected with HIV.”
Abyot, a young woman in Addis Ababa, Ethiopia, learned
about prevention of mother-to-child transmission
(PMTCT) of HIV/AIDS during her initial prenatal care
visit to Addis Ketema Health Center. After receiving
PMTCT services including voluntary counseling and
testing for HIV, Abyot found out that she is HIV-positive.
She is grateful that the health center staff will
help her adjust to her diagnosis and minimize the
chances of passing the virus to her child during
delivery and infancy.
Addis Ketema is one of 23 facilities that began
offering a full range of PMTCT services in February
2004 through the Hareg Project, the United States
Government’s Presidential Initiative to prevent
mother-to-child transmission of HIV in Ethiopia.
The PRIME II Project is a lead implementer and coordinator
of Hareg activities for the United States Agency
for International Development and the Centers for
Disease Control, in collaboration with the Ministry
of Health, Ethiopia’s HIV/AIDS Prevention Control
Office, UNICEF and other partners.
Hareg, or “vine” in Amharic, represents
the intergenerational linkages and support that are
critical in the fight against HIV/AIDS. According
to the Ministry of Health, an estimated 200,000 children
are infected with HIV in Ethiopia. More than 90 percent
of HIV/AIDS infections in children are transmitted
during pregnancy, delivery and breastfeeding. And
while Ethiopia’s overall HIV prevalence is
6.6 percent, the rate of infection for women ages 15 to
24 is estimated at 21.1 percent. Launched in September 2003,
the Hareg Project targets prenatal care as the entry
point for women to receive PMTCT services and strengthens
the connections between communities and health care
facilities to increase the use of preventive measures
and services.
Regional stakeholders prepared for project implementation
through workshops at which they formalized commitments
and developed action plans to ensure that all systems
would be in place to provide prompt and confidential
services. System strengthening is a critical component
of the Hareg strategy, including the establishment
of regional and community teams and a national PMTCT
health management information system, along with
steps to ensure health worker knowledge and skills,
drug supplies and logistics, and optimal client flow.
“We discovered that our facility was poorly
arranged in relation to voluntary counseling and
testing, prenatal care and family planning services,” confirms
Dr. Mesfin, the Medical Director for Assosa Hospital. “This
was all due to lack of awareness about optimal client
flow. The workshop gave us the opportunity to look
back and revise our approaches for the betterment
of client satisfaction.”
In a country where two thirds of mothers currently
have no access to prenatal care services, the Hareg
partners are integrating PMTCT services with broader
efforts to improve safe motherhood. In addition to
nevirapine prophylaxis to HIV-positive mothers and
their infants, key PMTCT services include strengthening
prenatal, intrapartum and postpartum care, family
planning counseling and services, and counseling
on infant feeding options and nutrition.
"'Clients’ main requests are psychological
support and medication,” says Dr. Yonas, the
head of Addis Ketema Health Center. “But even
more, stigma in the community is the largest challenge
that women face outside the health center.” Taking
this into account, the Hareg partners are helping
to create stigma alleviation and advocacy linkages
through a Community Action for Behavioral Change
(CABC) initiative, which also works to prevent HIV/AIDS,
generate demand for PMTCT services, promote better
nutrition, and involve men in reproductive health.
For each facility, teams of health care providers
and community leaders have been trained together
to carry out CABC activities.
With her appointment card in hand, Abyot returned
to Addis Ketema for her next scheduled visit. “I
will follow-up like I should and deliver my baby
here,” she affirms. “I am reassured that
the health center staff will support and care for
me.”
The PRIME II Project, funded by USAID and implemented
by IntraHealth International and the PRIME partners,
works around the world to strengthen the performance
of primary providers as they strive to improve family
planning and reproductive health services in their
communities.
For more success stories, visit
Prime
II Voices.
May 2008
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