Supporting Women and Children Access to HIV Services to Prevent Vertical Transmission of the Virus and to Improve Adherence to Antiretroviral Therapy in Mozambique
Project location: MOZAMBIQUE, Beira
Project start date: July 2013 - Project end date: July 2014
Project number: 2013-073
Beneficiary: Fondazione di Religione Opera San Francesco Saverio C.U.A.M.M.
The project "Improving The Quality Of Prevention Of Mother-To-Child HIV Transmission In Mozambique - Year II" aims to realize the right of the most vulnerable categories, namely women and children under five affected by HIV/AIDS and most exposed to marginalization and poverty because of their status, to affordable, quality healthcare services. The project factor of success lays on the community-centred approach, based on peer-to-peer groups to provide support in a resource-limited setting such as Africa, and especially Mozambique. The project was implemented in partnership with the Association Kuplumussana (literally, "to help each other"), a peer-to-peer network of HIV-positive mothers. The group, with the assistance of Doctors with Africa CUAMM, started its activities as a formal association of HIV-positive mothers in 2009 and has been working together ever since.
Project activities were implemented between May and December 2016.
Activity 1.1. Support counselling and sensitization sessions to HIV positive patients (mainly women and children) accessing the targeted 4 health centres during the ANC visits, visits for children exposed to the virus (CCR) and paediatric ARV.
Each month, 4 members of Kuplumussana were present in the targeted health centres and the Central Hospital from 7H30 to 11H, from Monday to Friday, providing support, counselling and doing sensitization sessions to HIV+ patients and families (i.e. pregnant women, children, mothers and their partners), as they accessed services of Ante-Natal Care visits (ANC),visits for children exposed to the virus (CCR) and paediatric ARV therapy.
Activities were run both on a one-on-one basis as well as group sessions. The members of the association held 1441 group counselling sessions in the format of small seminar or Q&A sessions, with an average of 6 sessions per day, and each session reaching 37 people. Through these activities 61140 beneficiaries were reached.
Individual counselling was provided during ANC, the Maternity (both before and after child delivery), CCR and pediatric ARV therapy.
- Table 1. Individual Counselling Sessions held during the project duration in 4 Targeted Health Centres
HIV+ Pregnant Women
"At Risk child"
Activity 1.2. - Support weekly sensitization and mobilization sessions at community level through drama sessions.
With an average of 5 theatre shows per month performed between May and December 2016, Kuplumussana reached 5273 patients (1337 children, 3094 mothers and 842 fathers) in the targeted Health Centres the Maternity Area of Beira Central Hospital and the communities living in the catchment areas. Topics of the shows included HIV (prevention, transmission, and discrimination), HIV ARV treatment and paediatric ARVT, involvement of fathers in ante-natal and post-natal care, family planning, exclusive breastfeeding and balanced nutritious feeding, STDs and malaria.
This activity has always been carried out in the presence of the staff of the Health Centre who introduced the group to the patients; after the show, Kuplumussana's activists addressed the public to ensure that the message was understood as well as remaining available to answer questions and provide counselling.
Activity 1.3 - Support to weekly culinary demonstrations involving parents/caregivers of children under 5 and pregnant women and taking place in 4 health units and at hospital level during the newborn care;
This nutrition component is highly relevant as this is considered a national priority due to the high levels of chronic malnutrition often associated with HIV status. The objective of the activity was to improve knowledge on healthy nutritional practices, especially among mothers (also HIV) and caregivers.
At the beginning of this activity, in May 2016, a refreshment training was held for 36 members of the CBO Kuplumussana on good nutritional practices and on how to hold a culinary demonstrations. The staff of the Nutrition Department of the District Health Services of Beira facilitated the training.
Divided into two teams, the members of Kuplumussana held 26 culinary demonstrations each month in nutritional and maternity services of the targeted health centres and the Nutritional Rehabilitation Centre of Beira Central Hospital. They focused on healthy eating habits for children and newborn, encouraging diet diversification using products available in the community (kale, pumpkin, baobab fruit, moringa, etc.).
In the site of the demonstration, the "cooking team" hung a banner presenting food groups, their difference and importance, as well as distributing some fliers about nutrition and new-born and children feeding. Over the duration of the project, 2704 and 3432 children benefitted from, respectively, the porridge and the soups prepared by Kuplumussana during the demonstrations.
Activity 1.4. Support M&E activities carried out by the management team of the Association Kuplumussana in order to effectively monitor and programme activities.
All these activities, along with monitoring by CUAMM's Community officer and M&A staff, were also supervised by the management team of the Association Kuplumussana, who ensured internal control and monitoring as well as mentoring to its members to ensure quality in the delivery of programme activities. The management team of the Association is composed of 6 members of the association, during the project duration, they performed weekly visits to all activities and monthly submitted their feedback together with the Activity reports.
This activity has proven crucial for overall performance of the project it further built the capacity of the Association to deliver results as per timetable/schedule agreed while strengthening ownership of the project. Further to this, the activity contributed to keeping an open channel of communication among members and CUAMM and to monitor progress against results agreed more effectively and re orient activities where needed in order to respond to bottlenecks/challenges in the delivery of services with the technical assistance of CUAMM staff to the management team of the association.
This has been possible only thanks to the longstanding experience between CUAMM and the association and it further underlined in the attention and professionalism with which the management team followed the work of its members.
The current management structure of the organization has made efforts to build its organizational sustainability beyond the support provided by CUAMM and other partners. Latest initiatives to independently mobilize additional means of funding include small income generating activities (i.e the purchase of a printer for their office, to be made available to the inhabitants of the neighbourhoods for a fee) or the participation to a "Healthy Fair"), taking place once a month in the park of the UCM (Catholic University of Mozambique), where they can sell some of the food they learned to make for the nutritional/culinary demonstration. Both these activities will contribute to covering the running costs of Kuplumussana office.
Kuplumussana showed improvement in the capacity to carry out this type of activities and was highly motivated after realizing that they implemented more activities than those paid by the project budget (e.g. in December they performed 9 theatre pieces). Building on these achievements, they took concrete steps to find further financial coverage and CUAMM is confident that they are on the path of becoming self-sustainable.
Activity 2.1 - Sponsor a scholarship for a medical student from the Medical faculty of Beira in order to increase availability of qualified medical staff.
Fernando Jaime Chipindulo, 25 years old (05.02.1992), from the district of Chemba, was assigned a full scholarship to attend the Medicine Course of the Faculty of Health Science of UCM (Catholic University of Mozambique) from 2017 to 2022. Fernando proved to be an excellent and motivated student, graduating with 16/20 from the Secondary School "Santa Teresinha do Menino Jesus" of Machanga, a rural and impoverished district of Sofala Province. In agreement with the University management, in December 2016 the scholarship was paid in full to the University, granting Mr. Chipindulo' access to the full course of studies (6 years) as well as the preparatory year.