Elimination of Mother To Child Transmission Integration

Elimination of Mother To Child Transmission Integration

Location: LACRO

Language(s) required: English, Spanish, French

Closing date for applying to this consultancy: 31 July 2018

Estimated start date of this consultancy:  August 2018                   Estimated end date: December 2018

BACKGROUND:

The response to HIV has been executed primarily through vertical programmes at global, regional and national levels. The creation of these powerful vertical programmes was due in part to the elevated priority placed on HIV when it was a killer disease with devastating effects on affected population and always associated with death. The abundance of the financial resources   available and allocated to HIV at that time was tremendous and facilitated the vertical programmes approach. The adoption of this vertical way during three decades of the AIDS epidemic, created significant challenges for optimization of health care for clients, due to the lack of linkages, integration and communication between all the different services that the patient would require.  The specific case of maternal, neonatal and child health (MNCH) in relation to prevention of HIV mother to child transmission (PMTCT) is a concrete example of program fragmentation where, in the same ANC clinic or maternity ward services are divided. Women with HIV are separated from those with no HIV infection. Each group is attended by different category of health staff. This situation has also contributed to increase HIV stigma and discrimination among health professionals. Also, because more funds were allocated for salaries of health staff working on HIV in comparison to their colleagues resulted to create a negative competition among them losing the professionalism and devotion attributed to the medical profession.

Now, with the global push to fast track the elimination of HIV mother to child transmission, the linking of maternal neonatal and child health (MNCH) with eMTCT is essential for the sustainability of both. 

Linkages refer to the bi-directional synergies in policy, programmes, services and advocacy between MNCH and eMTCT.  Integration refers to how different kinds of HIV and MNCH services or operational programs can be joined together to ensure and maximize collective improved outcomes. Maternal, Neonatal and Child health refers to programmes and policies related to and including all services addressing the life cycle since conception, pregnancy period, partum and post-partum, newborn health and the development of the child. It also includes STIs and HIV prevention and treatment as well as management of gender-based violence, unwanted pregnancy, prevention of unsafe abortion and post-abortion care. 

Several frameworks have called for the integration of HIV/eMTCT and MNCH, labelling the strategy as critical to the sustainability of programmes and key to optimizing health outcomes. The “Preventing HIV and Unintended Pregnancies Strategic Framework: In support of the “Global Plan Towards Elimination of New HIV Infections in Children by 2015 and Keeping Their Mothers Alive” has as its first strategy to link MNCH and HIV at the policy, systems and service delivery levels.  The “Conceptual framework of the Regional Initiative for the Elimination of Mother-to-Child Transmission of HIV and Congenital Syphilis in Latin America and the Caribbean” also identifies in its strategy #3 the “Integration of HIV services, sexual and reproductive health, new-born care and family and community health services as key to realizing elimination”.