Campaign update: June-August 2006
In Mozambique, partners are united in placing children at the centre of HIV and AIDS interventions. Through the Unite for Children Unite against AIDS campaign, more is being done to actively involve children and young people in prevention activities, and increase treatment, care and protection for those children who are infected or affected by the virus.
Prevention among adolescents and young people
HIV prevention in schools, led by the Ministry of Education (MEC), is supported by the work of People Living with HIV/AIDS Associations (PLWHA) who develop school awareness programmes. Information from the Ministry’s Pacote Basico (basic package) is used to support prevention activities carried out at national, provincial and school level. Defining strategies for improved coordination mechanisms for the school awareness programme and exploring possible integration of the programme in the Ministry’s work plan for HIV/AIDS was the purpose of a workshop held in Maputo between MEC focal points from national and provincial levels and PLWHA associations. As a result of the workshop, coordination mechanisms for HIV/AIDS initiatives in schools will be created by the Ministry and life skills material used by PLWHA will be included in the Pacote Basico.
The national NGO N’weti which works in Health Communication (formally known as Soul City Mozambique), is developing a partnership with the Ministry of Education to increase information for young people on issues related to HIV and AIDS through the production and distribution of IEC materials. For the 12-14 age group, the organisation has produced the Buddyz workbook which approaches HIV prevention, reproductive health and life skills using an interactive and enjoyable way of learning. Discussions are taking place regarding inclusion of the Buddyz workbook in the Pacote Basico kit developed by the Ministry and distribution to primary schools within Mozambique. N’weti has also produced an accompanying book called “Your Children, Your Friends” to support parents when discussing the issues raised in Buddyz with their children.
By the end of June, 72,308 pregnant women had received counselling and testing, which is 76% of all pregnant women receiving antenatal care. A total of 10,319 pregnant women (10.9%) were found to be HIV positive and 8,728 of those (85%) received antiretroviral treatment (ART) for PMTCT prophylaxis.
The training of Ministry of Health Staff (MoH) on PMTCT/VCT continued in Cabo Delgado, Inhambane and Manica, and support to HIV mothers clubs in Manica, Sofala is also ongoing. In early August, 15 new PMTCT sites in Cabo Delgado, Gaza, Inhambane and Manica provinces that had received support from partners were functioning. By the end of June, there were 113 PMTCT sites in the country.
The MoH has initiated the implementation of new policies that facilitate the scaling up of PMTCT. An important step is the approval of the “opt out” approach for testing of pregnant women. In this approach, the HIV test is part of the package of tests that is routinely offered to all pregnant women, and women can “opt out” if they do not want the HIV test to be included. Under this approach, counselling and testing are still required to ensure that all women know the benefits of being tested.
In addition, a policy is being drafted to allow provinces to approve the establishment of new PMTCT sites when a set of minimal criteria is met, and inform the central level of the newly established sites. This is a difference to the earlier situation, in which health facilities needed to request authorisation to establish a PMTCT site to the central level, and it will facilitate the scaling up of PMTCT in the country significantly.
By the end of June, just under 10% of the total numbers of people (27,100) receiving anti-retroviral treatment were children under fifteen (2,330). 33 out of 49 treatment sites currently opened are providing ARV syrups. The MOH has instructed all the provincial health authorities to accelerate the establishment of treatment sites in all the districts. The MoH’s paediatric AIDS programme has prepared a draft scale-up plan for paediatric treatment, which is currently undergoing review.
The second round of training for medical teams on Paediatric ARV Management started in July (1st team of Maputo City Hospitals). The training with Maputo Province Hospitals is ongoing. This training will continue until January 2007 and is supported by the Clinton Foundation. At the end of August, 40 doctors from the central region of the country will receive a three-day training course in paediatric ARV treatment in Beira.
In May and June, distribution of the ready-to-use therapeutic food called “PlumpyNut” for malnourished HIV-positive children began in seven day hospitals: three in Tete, one in Beira, one in Xai Xai and two in Maputo. The children’s nutrition status is measured and those malnourished children who are eligible are prescribed PlumpyNut to take home. Those who are severely malnourished with complications are first admitted to the malnutrition or paediatric ward until they recover sufficiently to receive PlumpyNut as outpatients. The target number of children to be enrolled is 2,390. A further 1,430 HIV-exposed children will also receive PlumpyNut when they stop breastfeeding at six months of age as part of the PMTCT programme. This intervention is being implemented in collaboration with MSF-Luxembourg in Tete and Maputo. Data on the outcomes for the two groups of children is being collected and will be analyzed. The PlumpyNut programme has been included in the 2007 MOH plan of action and the Government has initiated the procurement of the product with its own resources.
Protection and support for children affected by HIV/AIDS
The Ministry of Women and Social Action, together with civil society organisations, are working together to ensure that children orphaned and made vulnerable by HIV and AIDS have access to at least three out of six basic services- health, education, nutritional and food support, financial support, legal and psycho-social support. As of June 2006, the Provincial District of Women and Social Action had reached 47,000 children in Nampula, Manica and Sofala with one or more basic services. Interventions by the civil society umbrella organisation RENSIDA have reached 19,500 children with 6 of 6 basic services and delivery arrangements have been finalised to provide the basic package of materials to the 1500 households identified by NGO partners.
Birth registration, a fundamental right and the first legal acknowledgement of a child’s existence, is especially important for orphaned and vulnerable children as facilitates their access to free basic services and social protection and is crucial in guaranteeing their right to inheritance, providing proof of their identity. The birth registration campaign aims to register children who do not have birth certificates and to help government to set up a more effective system for the registration of children at birth. As of 14th of August, a total of 241,296 registrations were reported in the northern provinces of Cabo Delgado, Nampula and Niassa. The campaign is now ongoing in the central and southern provinces of the country, with a total of 1.2 million children expected to be registered by the end of 2006.