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USAID ASSIST Project: Burundi Country Report FY15

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USAID ASSIST Project: Burundi Country Report FY15 USAID ASSIST Project Burundi Country Report FY15 Cooperative Agreement Number: AID-OAA-A-12-00101 Performance Period: October 1, 2014 – September 30, 2015 DECEMBER 2015 This annual country report was prepared by University Research Co., LLC for review by the United States Agency for International Development (USAID). The USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project is made possible by the generous support of the American people through USAID. USAID ASSIST Project Applying Science to Strengthen and Improve Systems Burundi Country Report FY15 Cooperative Agreement Number AID-OAA-A-12-00101 Performance Period: October 1, 2014 - September 30, 2015 December 2015 DISCLAIMER This country report was authored by University Research Co., LLC (URC). The views expressed do not necessarily reflect the views of the United States Agency for International Development or the United States Government. Acknowledgements This country report was prepared by University Research Co., LLC (URC) for review by the United States Agency for International Development (USAID) under the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, which is funded by the American people through USAID’s Bureau for Global Health, Office of Health Systems. The project is managed by URC under the terms of Cooperative Agreement Number AID-OAA-A-12-00101. URC's global partners for USAID ASSIST include: EnCompass LLC; FHI 360; Harvard University School of Public Health; HEALTHQUAL International; Initiatives Inc.; Institute for Healthcare Improvement; Johns Hopkins Center for Communication Programs; and WI-HER LLC. For more information on the work of the USAID ASSIST Project, please visit www.usaidassist.org or write [email protected]. Recommended citation USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project. 2015. Burundi Country Report FY15. Published by the USAID ASSIST Project. Bethesda, MD: University Research Co., LLC (URC). Table of Contents List of Figures ............................................................................................................................................. i Abbreviations ............................................................................................................................................. ii 1 INTRODUCTION ....................................................................................................................................... 1 2 PROGRAM OVERVIEW ............................................................................................................................ 2 3 KEY ACTIVITIES, ACCOMPLISHMENTS, AND RESULTS .................................................................... 2 Activity 1. Implementing a PMTCT improvement intervention in eight provinces ..................................... 2 4 SUSTAINABILITY AND INSTITUTIONALIZATION ................................................................................. 9 5 KNOWLEDGE MANAGEMENT PRODUCTS AND ACTIVITIES ............................................................. 9 6 GENDER INTEGRATION ACTIVITIES ................................................................................................... 10 7 DIRECTIONS FOR FY16 ........................................................................................................................ 10 List of Figures Figure 1: Percentage of pregnant women attending first ANC visits before 14 weeks of pregnancy, six facilities, Giteranyi District (July 2012 – Aug 2015) ..................................................................................... 5 Figure 2: Percentage of pregnant women tested for ANC whose partners are also tested, 6 facilities, Giteranyi Health District (July 2012 – July 2015) .......................................................................................... 6 Figure 3: Proportion of pregnant women identified and being referred at community level, Butihinda Health Center (Sept 2014 – Aug 2015) ......................................................................................................... 7 Figure 4: HIV testing of pregnant women and their partners, 69 Phase 1 sites (May 2013 – Aug 2015) .... 7 Figure 5: Percentage of pregnant women going to ANC, 28 spread sites, Kirundo Province (March – Aug 2015) ............................................................................................................................................................. 8 Figure 6: Percentage of pregnant women and their partners tested for HIV during their first ANC visit, 28 spread sites, Kirundo Province (March – Aug 2015) .................................................................................... 8 USAID ASSIST Burundi Country Report FY15 i Abbreviations AIDS Acquired immunodeficiency syndrome ANC Antenatal care ART Antiretroviral therapy ASSIST USAID Applying Science to Strengthen and Improve Systems Project CHW Community health worker CQIT Community quality improvement team FY Fiscal year GOB Government of Burundi HCI USAID Health Care Improvement Project HCT HIV counseling and testing HIV Human immunodeficiency virus MOH Ministry of Health PEPFAR U.S. President’s Emergency Plan for AIDS Relief PMTCT Prevention of mother-to-child transmission of HIV PNLS National Program for the Fight against AIDS and Sexually Transmitted Infections QI Quality improvement URC University Research Co., LLC USAID United States Agency for International Development ii USAID ASSIST Burundi Country Report FY15 1 Introduction With funding support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project began work in Burundi in January 2013. Activities were built around two assessments conducted in 2012 under the USAID Health Care Improvement Project (HCI). The first assessment centered on prevention of mother-to-child transmission of HIV (PMTCT) service delivery, and the second on human performance technology. ASSIST’s goal, in partnership with the Ministry of Health (MOH) and other USAID implementing partners, is to improve the uptake and quality of PMTCT services for mothers, their partners, and their infants and to increase retention of mothers and infants along the PMTCT cascade. ASSIST works in close collaboration in Burundi with FHI360, Pathfinder International, Management Sciences for Health (Supply Chain Management Systems), MEASURE Evaluation, Abt Associates, EngenderHealth, and local non- governmental organizations to address these health care gaps. In fiscal year (FY) 2015, ASSIST continued to support improvement work at Phase 1 sites in four provinces (Kirundo, Kayanza, Muyinga, Karuzi) that the project worked in during the previous fiscal year and began to scale up best-practice interventions to new sites in those provinces. In addition, as Phase 2, ASSIST expanded PMTCT improvement activities to four more USAID-supported provinces (Ngozi, Gitega, Bujumbura Rural, and Bujumbura Mairie) in FY15. During the course of the year, ASSIST organized a PMTCT experts’ meeting for validation of the Phase 2 improvement plans, developed based on gaps identified in baseline assessments. ASSIST also supported community quality improvement (QI) teams in Giteranyi District to improve the performance of community health workers (CHWs) in supporting PMTCT services at the community level. Scale of USAID ASSIST’s Work in Burundi USAID ASSIST Burundi Country Report FY15 1 2 Program Overview What are we trying to accomplish? At what scale? 1. Implement a PMTCT improvement intervention in eight provinces Improve uptake of PMTCT services Provinces: 8 out of 17 (Bujumbura, Bujumbira Rural, (by mothers, infants, and partners) Gitega, Ngozi, Kayanza, Kirundo, Muyinga, Kurusi) Districts: 25 out of 25 in the 8 provinces (25 out of 46 Improve retention of mothers and districts in the country) infants along the PMTCT cascade Facilities in selected districts: 100% (379 out of 379) Improve quality of PMTCT services PMTCT sites in the 25 health districts QI teams: 403 facility teams Catchment population facilities/communities served: 5,608,308 out of 10,557,259 inhabitants Strengthen community system to Communities: 24 sub-Collins surrounding 6 out of 15 improve the performance of peripheral facilities in Giteranyi District in Muyinga community health workers (CHWs) Province to provide quality of PMTCT QI teams: 24 community teams services at the community level Catchment population communities served in the target health district: 123,748 out of 292,967 inhabitants Improvement Activity 3 Key Activities, Accomplishments, and Results Activity 1. Implementing a PMTCT improvement intervention in eight provinces BACKGROUND As in many other sub-Saharan African countries, the HIV pandemic in Burundi continues to be a growing public health threat. The HIV prevalence among the general population is 1.4%, with infection rates higher among women than men (1.7% versus 1%), resulting in more than 80,000 people, including 19,000 children under the age of 15, living with HIV infection.1 Although the availability of PMTCT services has increased in recent years, coverage remains inadequate: in 2010, only 41% of health facilities had PMTCT services in the country, while the rate of transmission of HIV from mother to child was estimated at 24.7%. The challenges are severe: in 2010, only one in three antenatal care (ANC) facilities in the country offered PMTCT services; only 60% of women delivered in health facilities; and only
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