Birthing HeaIthy

Babies, Mukuru,
Kenya
Alexis Coppola - Kate Jackson - Amihan
Jones - Apostolos Kalantzis
MUKURU
600,000-700,000 residents in 8 sub villages
Slum area in industrial Nairobi
Lack of electricity & water
HV rate is 10%
Half the population is under age 15
16 clinics: already working on HV related initiatives
ProbIem Tree
ResuIts Framework
Components
Community-LeveI Programmatic
Activities
1. Community Health Worker program (CHW)
Design of the CHW curriculum and tools
Members of the community and doulas are trained in outreach
services, as well as proper adherence to AZTs
Doulas receive Doula kits (birthing kits complete with nutritional
supplements)
2. Community Groups
Community mother support, theatre, and radio groups
3. Counselors
Community counselors trained
*AZT regimen that we are basing programming around is oral medications 2
weeks before due date and every 3 hours during labor
CIinic-LeveI Programmatic Activities
1. Clinic upgrades
Create standards for birthing centers
Needs assessment of birthing centers
Assess needs with funding and make 3 year plan
2. Create network clinics for collaboration and data sharing
Qualitative work
Stakeholder engagement and input
M & E
Sustainability
Management training of clinic professionals
Cross-Sector
1. SMS mother reminder system:
Paper-based registration process
CHW's uses a guided questionnaire to be put into a central database
nformation to be collected: mother , phone , days since last menses
Kenyan Gov pays for incoming messages; Safaricom pays for
outgoing messages
Mother's receive text messages about proper drug adherence
Government-LeveI Programmatic
Activities
Advocate for subsidized cost of AZT drugs
Govt distribution of AZT drugs
Reduced tax/free incoming SMS messaging
Support of central healthcare database system
ScaIe, SustainabiIity & Exit
Scale:
1. 3-year pilot for can work in other slums
2. M&E will determine programmatic activities that need redesign
Exit: (Phase Down & Phase Over)
1. Government handover (including server for SMS-entire SMS system at the ministry)
a. Government of Kenya will manage CHWs
b. All programmatic activities will be developed as a collaborative undertaking between
government of Kenya, UNCEF, and Birthing Healthy Babies and USAD (CDC) and
will be handed over to the government after a 3-year period
2. Community handover
a. Training
b. Clinic healthcare network
c. Community groups
Sustainability:
1. Project has been designed with collaboration as a main component
2. Project has been designed to work off of already infrastructure and community resources
1. Name and number of Strategic Objective: SO1: mproved prevention of mother to child HV transmission
2. Name and number of Intermediate ResuIt: R1: mproved child feeding practices for mothers with HV
3. Indicator (state in QQTP terms): An 80% increase in HV positive mothers in Mukuru exclusively abstaining from breastfeeding
over the next 3 years
Is this an AnnuaI Report indicator? Yes
5. Precise definitions of terms incIuded in the indicator:
HIV positive mothers: mothers that have tested positive for HV
Abstaining from breastfeeding: mothers who are 100% abstaining from breastfeeding any child
6. Unit of measure: % increase of HV positive mothers in Mukuru exclusively abstaining from breastfeeding
7. Disaggregated by gender, HV status, mother
8. Indicator Justification and Management UtiIity: The abstention of breastfeeding of HV positive moms is proven to reduce
MCT transmission.
9. Data coIIection method: Surveys, individuals interviews, and clinic records
10. Data source: nternal data collected through surveys and individual interviews conducted by community healthcare workers
and aggregated data from clinic records
11. Data anaIysis: Aggregate and analysis quantitative and qualitative data in SAS and MaxQDA
12. Presentation of Data:Annual report, charts and PowerPoint presentation
13. Review of data (how and by whom will data quality be safeguarded?):
Survey information will be collected by healthcare workers (anonymous).
Data will be collected and aggregated by organization
14. Reporting of data (how, by whom and to whom will data be reported?):
n an annual report and through in-person presentations, by non profit organization to all stakeholder groups, including clinicians,
community healthcare workers, the Government of Kenya and Safaricom
1. Name and number of Strategic Objective: SO1: mproved prevention of mother to child HV transmission
2. Name and number of Intermediate ResuIt: ncreased HV testing women and mothers
3. Indicator (state in QQTP terms):
100% increase in pregnant women in Mukuru being tested by a healthcare worker over the next 3 years
4. Is this an AnnuaI Report indicator?
Yes
5. Precise definitions of terms incIuded in the indicator:
Pregnant: all pregnant women
being tested: given an official standard HV test
heaIthcare worker: an employee or volunteer of a clinic that is certified to administer HV testing and counseling
6. Unit of measure: % increase of pregnant women in Makuru that are tested for HV by a healthcare worker
7. Disaggregated by: gender, location, pregnancy status, HV status
8. Indicator Justification and Management UtiIity:
The testing of HV positive moms leads to improved practices to reduce MCT transmission.
9. Data coIIection method: Surveys, individuals interviews, and clinic records
10. Data source: nternal data collected through surveys and individual interviews conducted by community healthcare workers and aggregated data from clinic records
11. Data anaIysis: Aggregate and analysis quantitative and qualitative data in SAS and MaxQDA
12. Presentation of Data: Annual report, charts and PowerPoint presentation
13. Review of data (how and by whom will data quality be safeguarded?):
Survey information will be collected by healthcare workers (anonymous).
Data will be collected and aggregated by organization
14. Reporting of data (how, by whom and to whom will data be reported?):
n an annual report and through in-person presentations, by non profit organization to all stakeholder groups, including clinicians, community healthcare workers, the Government
of Kenya and Safaricom
1. Name and number of Strategic Objective:
SO1: mproved prevention of mother to child HV transmission
2. Name and number of Intermediate ResuIt:
ncreased access to AZT drugs for mothers with HV
3. Indicator (state in QQTP terms):
100% increase in HV positive pregnant women in Makuru receiving AZT treatment from a healthcare worker, 2 weeks before due date or every 3 hours during delivery over the next 3 years
4. Is this an AnnuaI Report indicator? YES
5. Precise definitions of terms incIuded in the indicator:
HIV positive pregnant women: all women that have tested HV positive and are pregnant
receiving AZT treatment: has been provided AZT and drug information, as well as adherence consultations
heaIthcare worker: an employee or volunteer of a clinic that is certified to administer HV testing and counseling
6. Unit of measure: % in of HV positive pregnant women in Makuru receiving AZT treatment
7. Disaggregated by: Gender, HV status, Pregnancy Status, Location
8. Indicator Justification and Management UtiIity: The use of AZT of HV positive moms during labor is proven to reduce MTC transmission.
9. Data coIIection method: Surveys, individuals interviews, and clinic records
10. Data source: nternal data collected through surveys and individual interviews conducted by community healthcare workers and aggregated data from clinic records
11. Data anaIysis: Aggregate and analysis quantitative and qualitative data in SAS and MaxQDA
12. Presentation of Data:Annual report, charts and PowerPoint presentation
13. Review of data (how and by whom will data quality be safeguarded?):
Survey information will be collected by healthcare workers (anonymous).
Data will be collected and aggregated by organization
14. Reporting of data (how, by whom and to whom will data be reported?):
n an annual report and through in-person presentations, by non profit organization to all stakeholder groups, including clinicians, community healthcare workers, the Government of Kenya and Safaricom