Pilot Phase (2015-2017)
In 2015 the University of California Los Angeles (UCLA), Partners in Hope-Malawi (PIH), and the DST-NRF Centre of Excellence in Human Development at the University of the Witwatersrand in South Africa joined with The Conrad N. Hilton Foundation on a two year pilot programme to assess the feasibility and acceptability, as well as initial outcomes, of supporting Option B+ mothers in Malawi to increase their responsiveness to their children and, thereby, enhance their children’s early development.
We focused on Option B+ mothers in the pilot in recognition of the fact that these mothers have multiple vulnerabilities in addition to their HIV infection. Our pilot work further defined and documented these vulnerabilities: Option B+ mothers were often not supported by their partners; they felt unable to disclose their HIV status to partners or other family members; they remained burdened by providing support and care for other sick family members, which hampered their ability to collect their medications and attend other clinic services; they struggled to pay for transport and to provide proper nutrition for their children; and they suffered from community level stigma and discrimination.
Our focus on the HIV-exposed infant was in line with studies pointing to the risk of developmental delays among HIV exposed uninfected (HEU) children. In addition to the physiological aspects of exposure to HIV in utero and in the post-natal environment, these children, like their mothers, are at increased vulnerability in nearly every aspect of life, particularly in a low income environment which is extreme in rural areas. Although Malawi has successfully decreased the mother to child transmission rates to less than 4%, many mothers and children are not enrolled or drop out of care early and it is unlikely this will change unless new programmes to support HIV positive mothers and their children are developed.
Expansion Phase (2018-2020)
Experience from our pilot project clearly shows the need for ECD services to be located near the homes of the mother-infant pairs, and the need for access to broader health services including antenatal care, family planning and under 5 child health. In 2018, PIH will expand access to ECD in clinics within 16 facilities in Lilongwe District comprised of health centers, CHAM hospitals as well as community outreach clinics and expand to additional facilities in the original two districts (Kasungu and Nkhotakota).
The project will build on the existing infrastructure of PIH’s Care and Treatment grant including the use of Expert Clients to support the mothers and their infants. Expert Clients are HIV+ individuals who provide support to other community members to support disclosure, retention and prevention. Expert Clients are widely used in Malawi and other countries to support HIV+ patients and thus are a sustainable cadre of healthcare workers. The Expert Clients, supported by Lead Expert Clients, will form small teams (with supervision) focused on supporting Option B+ mothers to remain in care and to provide ECD services during facility and outreach clinic visits. They will also be trained in community care in order to do follow-ups for women who default from the programme.
We will focus on infants up to 24 months in line with the Option B+ programme but older siblings are almost always present in the clinics and at community outreach health programmes. Our field teams are trained on the full range of ages under the Care for Child Development programme, which covers from birth through 2 years and older children. As our work in health facilities has expanded to include antenatal clinics, our teams will continue to advise pregnant women and their partners on the importance of stimulation and communication with the baby in the womb. The project will work with village headmen to drive demand for ECD services and to improve community level support for women. This will include specific strategies to encourage men to support their partners and participate in child development activities.
The project will also incorporate a cost-benefit analysis to determine the cost of overlaying ECD on an existing Option B+ programme. This cost data will then be used in advocacy efforts with government around the cost-benefit of adding ECD into standard health programmes as part of the national strategy.
- Integration of ECD sessions with existing mother infant pair clinics in facilities mentioned above.
- ECD skills transfer sessions with caregivers (mothers and fathers) to encourage early stimulation and responsiveness at the hospital and communities. This will be done during routine clinic visits by using the Care for Child Development package as a primary tool and customized flipcharts & hand-outs for outreach clinics.
- Demonstration and assisting care givers in toy making using local resources
- Conduct morning health talks at the MIP clinics integrating ECD messages with basic HIV information, ECD messages, EID, Nutrition, Family planning
- Encourage males to attend the ECD sessions
- Distributing pamphlets with ECD messages during health talks
- Refer caregivers to appropriate clinics when requested i.e. family planning, HCT.
- Link ECD Expert Clients to MCH, under 5, reproductive health and ART clinics at all project sites to provide follow up support to Option B+ mothers and their children