By Elizabeth Walsh, Management Sciences for Health, and Lourdes de la Peza, Senior Technical Advisor, LMG Project
Challenge
More than 85,000 infants in Nigeria are exposed to the risk of mother-to-child transmission of HIV every year.[1] While the number of HIV positive pregnant women who receive antiretroviral treatment (ART) is increasing, robust efforts to improve coverage are needed if national targets for Prevention of Mother to Child Transmission of HIV (PMTCT) are to be met in 2015.[2]
Initiative
Over the past year, the USAID-funded Leadership, Management and Governance (LMG) Project helped support the USAID-funded PLAN-Health Nigeria project, both managed by Management Sciences for Health (MSH), to pilot a new Leadership Development Program Plus (LDP+) program specifically focused on PMTCT. The new LDP+ builds on 10 years of lessons learned by MSH while implementing its original Leadership Development Program (LDP) in 40 countries. The new program retains its emphasis on empowering teams to face challenges and achieve results; and complements them with new approaches tied in to country ownership, national health priorities, and specific health indicators. The LDP+ also has a new emphasis on governance, with participating teams forming a governing body that works to scale up the LDP+ process into the country’s larger health system.
The new program was piloted in the town of Gwagwalada, Nigeria, which has a population of 157,770. The Gwagwalada Council is one of the five Local Government Area Councils of the Federal Capital Territory (FCT) of Nigeria. LMG and PLAN-Health worked with the Gwagwalada Council, which selected 20 participants—two from each of the 10 facilities providing PMTCT services in the area—to form 10 teams to participate in the LDP+. Together, the teams decided to address PMTCT and focused on standard indicators such as number of new antenatal care (ANC) clients; number of pregnant women tested for HIV, counseled and received their results; and the number of HIV positive women. The program ran for six months from October 2012 to May 2013. During this time, the teams worked within their facilities to create a vision of improved results around PMTCT; align stakeholders around this vision; implement their action plans; and share learning with other teams to identify the most useful local interventions and activities. The teams also received coaching in the areas of monitoring, evaluation, and reporting.
Results
As part of the program, participants reported baseline performance indicated as an average of performance over the nine months preceding the program. Reports after the six-month program were encouraging for most of the facilities in their key indicators. For example, the Old Kutunku Health Center reported 17 new ANC clients per month in the nine months preceding the program. In the six months of the program, the clinic registered 61 new clients per month. At the Gwako health center, 59 of the 320 ANC clients (18%) delivered in a health facility in the nine months preceding the program. Over the course of the program, 110 of 256 ANC clients (42%) delivered in a health facility. The Township clinic counseled and tested only 19 partners out of 706 (3%) of pregnant women appearing at the clinic for ANC before the program. After the 6-month program 86 partners out of 436 (20%) of pregnant women appearing at the clinic for ANC were counseled and tested for HIV.
Pleased with these initial results from the Gwagwalada LDP+ pilot program, another MSH project in Nigeria, the ProACT Project introduced the LDP+ program in April 2013 in Kwara state and the results are equally as good: 100% (3,590) of all pregnant women attending ANC were counseled, tested and know their status; out of those who tested positive for HIV, 100% (47) received ARV prophylaxis triple regimen; and 66% (31 out of 47) of partners of HIV-positive pregnant women were counseled, tested, and know their status. In addition, the Gwagwalada Council’s oversight committee plans to continue the program with its own resources, expanding it to another eight facilities in the area. Through these efforts, this local government agency is furthering Nigeria’s national efforts to reduce mother-to-child transmission of HIV, which includes increasing the number of PMTCT centers from 533 in 2008 to 800 in 2012.
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The Program to Build Leadership and Accountability in Nigeria’s Health System (PLAN-Health) is a five-year U.S. $25 million PEPFAR-funded development project funded by USAID and implemented by Management Sciences for Health (MSH) in Gombe, Akwa Ibom, and the Federal Capital Territory, Abuja. PLAN-Health is helping to foster sustainable change in the Nigerian health system by building strong and viable organizations, developing stronger managers and leaders, and creating mechanisms for efficient, coordinated systems and processes. It is also facilitating continuous increase in partner institution commitment to positive change and the ownership of processes and outcomes. The project envisions civil society organizations (CSOs) and state/national agencies that have grown more adept at developing and maintaining health services needed to overcome Nigeria’s challenges by 2015.
The Prevention Organizational Systems AIDS Care and Treatment (ProACT) Project, funded by USAID, provides HIV & AIDS treatment, care and community outreach with a full complement of laboratory services in 25 comprehensive care and treatment centers in six Nigerian States: Adamawa, Kogi, Kwara, Kebbi, Niger and Taraba States.The ProACT Laboratory program helps to strengthen public laboratory institutions by supporting immunology, hematology, clinical chemistry, malaria, tuberculosis, HIV-testing and counseling services; strengthening quality management systems; and facilitating training and capacity-building for laboratory staff.
The Leadership, Management, and Governance (LMG) Project is a five-year, U.S. $200 million development project funded by USAID. The LMG Project is building innovative strategies for smarter leadership, management, and governance to enhance health system performance and promote better health outcomes for all, including vulnerable populations worldwide. The LMG Project consortium of partners is led by Management Sciences for Health (MSH) and includes: African Medical and Research Foundation (AMREF); International Planned Parenthood Federation (IPPF); Johns Hopkins University Bloomberg School of Public Health (JHSPH); Medic Mobile; and the Yale Global Health Leadership Institute (GHLI).Visit the LMG Project website: www.lmgforhealth.org. For more information about the LMG project, please contact: [email protected].
Related Links:
See the Technical Brief on the Leadership Development Program Plus (LDP+)
Read a two-page overview of the Senior Leadership Program (SLP)
MSH’s support of health leadership.
See “Flying Halfway Around the World and Creating a Real Fundamental Change,” a blog on the LDP+ program in Nigeria by Lourdes de la Peza:
[1] Source: The National Agency for the Control of AIDS (NACA), the Principal Recipient (PR) for HIV/AIDS programs in Nigeria under the Global Fund project: http://naca.gov.ng/#.
[2] See the Nigeria Federal Ministry of Health’s National Guidelines for Prevention of Mother-to-Child Transmission, p. 4 to see national targets: http://www.emtct-iatt.org/wp-content/uploads/2013/04/Nigeria_National-PMTCT-Guidelines_2010.pdf.