Summary of Key Findings mothers2mothers Internal Programme Evaluation 2012 August 2013 Department of Programmes and Technical Support mothers2mothers The 2012 mothers2mothers Internal Programme Evaluation was made possible due to financial support from the Elton John AIDS Foundation (2010-2012) and the UBS Optimus Foundation (2012-2013). Myers, A., Okonji E., Besser, M., and Schmitz, K. (2013). 2012 mothers2mothers (m2m) Internal evaluation of the Prevention of Mother-to-Child Transmission (PMTCT), Peer Education and Psychosocial Support Services in Kenya, Lesotho, Malawi, South Africa, Swaziland, Tanzania and Uganda in 2012. Cape Town: Department of Programmes and Technical Support. About mothers2mothers mothers2mothers (m2m) trains, employs, and empowers women living with HIV to eliminate the transmission of HIV from mothers to babies, keep HIV-positive mothers alive, and improve the health of women, their partners, and families. Working alongside doctors and nurses in understaffed health centres as members of the healthcare team, Mentor Mothers provide essential health education and psychosocial support to HIV-positive pregnant women and new mothers. Their first-hand knowledge of HIV and the power of shared experience make them highly effective at mentoring and supporting these women. Mentor Mothers are paid and rigorously trained, which benefits their respective families and the community as a whole, as well as reducing stigma associated with HIV. Since m2m was founded in 2001 with a single site in Cape Town, South Africa, the organisation has grown to reach more than one million mothers in nine countries, and helped establish affiliated Mentor Mother programmes in two additional countries. m2m is a leader in the global effort to eliminate new HIV infections among children and protect the health of mothers. The Challenge Paediatric AIDS has been virtually eliminated in the developed world. Yet, UNAIDS estimates that 330,000 children were newly infected with HIV worldwide in 2011 1. Most of these children live in sub-Saharan Africa, and nearly all of them acquire HIV from their mothers during pregnancy, childbirth, or breastfeeding. Approximately half of these children will die before the age of two if their HIV infection is untreated. Moreover, HIV/AIDS is a leading cause of maternal mortality in sub-Saharan Africa, with an estimated 37,000 maternal deaths in 2011 attributable to HIV/AIDS 2. This situation is both tragic and unnecessary. Effective and inexpensive medical interventions that can prevent the spread of HIV to babies and keep mothers alive are widely available. However, there is a severe shortage of medical personnel in sub-Saharan Africa, which makes it difficult for women to access the medical care they need. Doctors and nurses frequently do not have the time, language, or shared experience to adequately counsel mothers on preventing transmission of HIV to their babies and address other serious healthcare issues prevalent in the region. Pregnant women and mothers diagnosed with HIV continue to face crippling stigma and discrimination in many regions of Africa, leaving them too frightened to access services and creating another barrier to care. For example, recent data indicate that of the women tested and found to be HIV positive, only 61% received an antiretroviral (ARV) regimen to prevent mother-to-child transmission of HIV 3. The Opportunity In June 2011, UNAIDS released the Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive, signifying a renewed international commitment to create an HIV-free generation and acknowledging the critical need to better address maternal health challenges. The Global Plan identified 22 priority countries that contain 90% of the world’s HIV-infected children. It set ambitious new goals to halve the number of maternal deaths and achieve the virtual elimination of new HIV infections in children by 2015. 3 Summary of Key Findings | 2012 mothers2mothers Internal Programme Evaluation The Global Plan identified m2m’s Mentor Mother model as a key strategy in achieving its goals, and stated that women living with HIV should be at the centre of the response. Nearly two years later, the Global Plan has been successful in galvanising international support for eliminating mother-to-child transmission of HIV (eMTCT) and spurring countries to scale up their HIV/AIDS care and prevention efforts. The UNAIDS Global Plan Progress Report, released in June 2013, shows that significant progress has been made in reducing paediatric AIDS. The numbers of new HIV infections among children between 2009 and 2012 dropped 38% in 21 of the Global Plan priority countries 4. However, numerous challenges remain in order to protect the health of more mothers and babies, such as ensuring that more HIV-positive pregnant women and breastfeeding mothers and their infants receive ARVs to prevent mother-to-child transmission, and enrolling more HIV-positive children in treatment. m2m currently operates in seven of the 22 Global Plan priority countries (Kenya, Lesotho, Malawi, South Africa, Swaziland, Tanzania, and Uganda) and is exploring expansion to several additional priority countries. Its work is focused on eliminating paediatric AIDS and improving maternal health in the Global Plan’s priority countries by providing mentoring and education services that are the hallmark of its Mentor Mother programme. There is a proven link between peer mentoring and improved health outcomes for diseases such as diabetes 5 and substance abuse 6, as well as HIV 7‚8 . For example, research shows that peer mentoring can increase adherence to HIV medication, which is critical to preventing paediatric AIDS 9. m2m’s Footprint in 2012 In 2012, m2m operated Mentor Mother programmes in seven countries at more than 600 sites. Mentor Mothers and Site Coordinators enrolled close to 152,400 pregnant women and new mothers living with HIV into the programme over the course of the year. m2m trained 1,938 site staff to provide Mentor Mother services — that included basic training for 312 new Mentor Mothers and Site Coordinators, and additional training for 1,626 experienced site staff. In addition to directly providing Mentor Mother services, m2m began expanding its role to provide technical assistance and capacity building to Ministries of Health so that governments can integrate Mentor Mother programmes in their national health systems. In 2012, the governments of Kenya and South Africa, with m2m’s technical assistance, began establishing national Mentor Mother programmes. This is in line with the Global Plan which encourages national accountability and country-driven initiatives to achieve its goals. Integration will make the Mentor Mother model more sustainable and, over the long term, reach even more pregnant women and new mothers with peer support to eliminate mother-to-child transmission of HIV. As part of this transition, m2m has begun to scale down its direct service operations in South Africa in 2012. One- hundred (100) sites in South Africa, as well as 30 sites in Kenya, now serve as model sites for teaching, service innovation and demonstrating the Mentor Mother model to government and implementing partners. Once national programmes are fully rolled-out in both countries, Mentor Mothers will be in a position to reach even more women and families with quality care than in the past. 4 Summary of Key Findings | 2012 mothers2mothers Internal Programme Evaluation The Goal of the 2012 Evaluation To provide the highest quality services at all of its sites, m2m conducts an annual internal evaluation to assess how its country programmes supported clients in the uptake of and adherence to PMTCT services and behaviours. More specifically, the evaluation looks at whether m2m country programmes have accomplished m2m’s three strategic objectives, as outlined in the organisation’s Results Framework: • Availability of quality PMTCT and maternal, newborn, and child health (MNCH) services for women and their infants • Increased uptake of PMTCT services and improved health behaviours • m2m clients who have disclosed their HIV status • Empowerment of women living with HIV The evaluation also analyses m2m’s progress in meeting annual targets set by the organisation’s country directors and management team. Finally, it identifies programme gaps that can be improved to strengthen m2m’s peer education and psychosocial support outcomes. Data Quality Improvements In response to previous evaluation findings, m2m rolled out two major evaluation and performance tools across the organisation in 2012 — Strengthening Outcomes by Analysing Results (SOAR) and Active Client Follow Up (ACFU). Close to 100% of sites in Kenya, Lesotho, Malawi, Swaziland and Uganda are operating SOAR and ACFU. These initiatives have improved m2m’s ability to collect data, track programme results and link Mentor Mother activities to final health outcomes. • Strengthening Outcomes by Analysing Results (SOAR): In recent years, m2m has placed great emphasis on Monitoring and Evaluation (M&E) to better assess and improve the quality of its services. SOAR is a quality improvement programme designed to build the capacity of Site Coordinators to collect and analyse their own data. Every three months, Site Coordinators in the same district meet, review data collected from their sites, identify key problems and develop action plans to address them. SOAR empowers site staff to both understand and use data to make informed decisions