Partnerships for PMTCT in Uganda

A presentation to the IAS conferenceAVSI Side Event - Washington 25 July 2012

May Anyabolu Deputy Representative

UNICEF Uganda

Introduction – Current Situation

• In 2009, 370 000 children became newly infected with HIV globally of which about 25,000 were from Uganda

• Globally, an estimated, 42 000 - 60 000 pregnant women died because of HIV in the same year.

• In high-income countries the number of new HIV infections among children and maternal and child deaths due to HIV is virtually zero.

• In low- and middle-income countries, Uganda inclusive, too few women are receiving HIV prevention and treatment services to protect themselves or their children.

• This inequity must change. The life of a child and a mother has the same value, irrespective of where she or he is born and lives.

Global Partnerships for PMTCT

• The global community has called for the elimination of new paediatric HIV infections as well as improvement of maternal, newborn and child survival and health in the context of HIV by 2015

• This calls for increasing global collaboration, commitment and consensus among with various stakeholders including the private sector

• At the global level: Inter-Agency Task Team Members: WHO, UNICEF, UNFPA, USAID, CDC, Elizabeth Glazer Pediatric AIDS Foundation, Clinton Health Access Initiative, M2M etc. In Uganda a similar task team is in place – chaired by Ministry of Health.

• In 1998, UN agencies through the Inter Agency Task Team initiated pilot projects to demonstrate the feasibility of integrating PMTCT within the existing health care delivery system in 11 countries, including Uganda.

PMTCT Program Partnerships in Uganda

• Late 90s Uganda participated in research for alternative affordable therapeutic regimens for low-income countries

• PMTCT implementation in Uganda started as a pilot in 4 sites in 2000 with UNICEF support directly to Govt.

• Scale up started in 2001 and covered all the districts by end 2004 (over 224 active sites)

• This was with support from EGPAF, Boeringer Ingelheim, Abbot, WHO, UNICEF, US Govt. and Gov’t of Uganda

• AVSI participation in the scale up of PMTCT started in 2002

PMTCT Program Partnerships in Uganda

Major Funding partners include:

• Government of Uganda: staff, health centres, drugs with increasing support to the provision ARVs

• PEPFAR (USAID/CDC): over 80% of PMTCT services are supported through PEPFAR.

• UN Joint Program on AIDS: UNICEF, WHO, UNFPA & UNAIDS

• Clinton Health Access Initiative: for the Pediatric component: Drugs and supplies in kind

• Global Fund Round 7

PMTCT Program Partnerships in Uganda

Major Implementing Partners:

• Government• International NGOs - 14• National NGOs - 4• FBOs - 3• Academia - 3

UNICEF support to PMTCT in Uganda

Mubende

Gulu

Kitgum

Kotido

Moroto

Nakapiripirit

Pader

AbimAmuru

Kaabong

Bundibugy o

Kabarole Ky enjojo

• To date there are implementing partners of PMTCT across all 112 districts

• UNICEF supports implementing partners in 20 of the 112 districts in western, northern and north eastern Uganda.

• PEPFAR (USAID/CDC) supports partners in the remaining 92 districts

• UNICEF and AVSI partnership is in central northern Uganda covering 7 districts

UNICEF Partnerships for PMTCT in Uganda

• UNICEF provides support for PMTCT through:

– Govt ministries– Districts– 3 FBOs– 4 INGOs – 1 Academia

UNICEF Uganda - Strategic partner selection strategy

Work with and strengthen existing government systems

Capacity building and linkage to CBOs

Value addition by partner – comparative advantage

Training directed through public service system

Performance monitoring by partners

Government is part of program decisions

Partnership principles

Type of UNICEF Partnership agreements

1. Memorandum of Understanding – Joint Pursuit of identified common goals, without the transfer of resources

2. Small Scale Funding Agreement - Limited support provided to CSOs, not to exceed US $ 20,000

3. Program Cooperation Agreement (PCA):– PCA (No.1) for value above US$100,000– PCA (No.2) for value below US$100,000 but above US$20,000– AVSI one of 33 UNICEF supported NGO partners through PCA of which 8

are for PMTCT

• Greater geographic coverage of the national programs

• Harmonization: Helps to harness the benefits of synergy and reduce duplication.

• Alignment: more unified and optimal joint action support of a scaled up of national PMTCT services.

• Simplification: a comprehensive package is offered by a participating agency in a geographical area. This is to avoid duplication.

• Accountability: a collective performance instrument in support of agreed common outcomes and outputs.

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What we have achieved through PMTCT partnerships

In the last many years of the partnerships, we have realized: • Standardization of formats and guidelines clarified PCA process.

• Sustainability of UNICEF funding Vs NGOs capacity to continue when UNICEF funding ceases.

• Varying capacities to prepare program documents & quality of partners' cooperation agreements.

• Short term vision of partnership making it operate towards “emergency mode” programming.

• Challenge of integration. Not all partners can work inter-sectorally.

• Partners’ concerns regarding reporting and monitoring requirements

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Challenges and Lessons

Conclusion

• While there are concerted efforts of partners to increase accessibility to PMTCT and Paediatric AIDS services :– Mother to child HIV transmission still

remains the second major mode of transmission of HIV accounting for up to 18% of new infections and the main source of HIV infection to children less than 5 years old.

– Without PMTCT the risk of transmission of HIV is estimated at 30%.

– Ministry of Health data show that just over 50% of HIV+ pregnant mothers receive ARVs for prevention

– A concerted effort is required by all partners

Uganda therefore still needs support

Thank you for your support & partnership

Together will ensure children are born FREE from HIV in Uganda!