Children and AIDS campaign update: September – December 2007
The Unite for Children Unite against AIDS initiative is bringing together various partners in Mozambique including Government, civil society organisations, associations of people living with HIV and AIDS, national and international NGOs and the UN, to scale up the national response to children and HIV and AIDS.
Prevention among adolescents and young people
As of December 2007, social mobilisation activities carried out by Social Communication Institute (ICS) and Social Education Group of Manica (GESOM) multimedia mobile unit teams reached over 550,000 people in eight provinces, ensuring the most remote communities have access to information and participate in debates on HIV prevention.
The multimedia mobile units use video projections and participatory approaches such as dance, drama and community debates to raise awareness on HIV prevention, in addition to other important development issues. Community theatre sessions carried out by the Community Theatre Network (GTO) reached 400,000 people in eight provinces, using interactive techniques to promote community dialogue on key development issues including HIV prevention.
In 2007, the School Awareness Programme was expanded to 10 provinces (plus Maputo City), reaching 725 primary schools. The programme, which is implemented by associations of People Living with HIV and AIDS (PLWHA) in collaboration with MEC, involved the participation of 469,367 children (of which 55 per cent are girls) in debates, theatre groups and sports activities related to life skills.
The knowledge and attitudes of children participating in the School Awareness Programme were assessed during routine monitoring and out of a total of 186,953 participants, 48 per cent passed the pre-test and 72 per cent passed the post-test.
Prevention of mother-to-child transmission
The number of PMTCT sites established in the country has risen to 384. Approximately 800 health centres have an antenatal care facility, which means that almost half of the antenatal care sites are now offering PMTCT services. In September, the MoH authorised maternal and child health nurses and health technicians to prescribe antiretroviral treatment (ART) for pregnant women.
This is significant progress because in health facilities where there are no doctors available to prescribe treatment, pregnant women will be now able to receive ART prescriptions. As a result, an increased number of women are likely to take ART to improve their own health and reduce the risk of mother to child transmission. Women who are in need of ART are the ones who are most likely to transmit HIV to their children, so it is crucial that they access this treatment.
The Minister of Health, along with the Director of the Reproductive Health programme, a provincial and a district representative of the MoH, as well as the PMTCT focal points of WHO and UNICEF, participated in the second Global Partners Forum on PMTCT on 26-27 November in Johannesburg.
In this meeting, attended by representatives from 20 “high burden” countries, delegates reconfirmed their commitment to achieving universal access to comprehensive PMTCT services and endorsed the 2007 Inter Agency Task Team Global Guidance document.
In Mozambique, most of the recommended policies are already in place. The constraints are similar to those faced by other countries, such as high drop out rates of women and children along with low levels of male involvement and community engagement.
At the end of September 78,236 people including 6,068 children under the age of 15 - approximately 7.8 per cent of the total - were receiving ART. The proportion of eligible children receiving treatment is currently 18 per cent, based on calculations using the 2004 epidemiological data on HIV. The original targets for the coverage of paediatric ART in Mozambique were based on MoH estimates that 75 per cent of HIV positive children are eligible for treatment.
The UNAIDS "Spectrum" software was used to recalculate the proportion of children eligible for treatment, and found the number eligible to be 32,500 children or 31 per cent of the total children estimated to be living with HIV. The new HIV epidemiological data will be input into the Spectrum programme in early 2008 and the MoH will revise its paediatric treatment targets on this basis.
UNICEF and partners are currently supporting 124 sites with paediatric ART plus an integrated package of care and nutrition services. The number of health facilities offering ART has increased to 209 from 150 in 2006 and 38 in 2005. Of these 209 sites, 148 (71 per cent of total sites) are providing paediatric treatment.
Good progress, including a reduction in abandonment rates, is being made in the central province of Sofala. In the Beira Central Hospital, the NGO partner CUAMM is training and supervising health staff working at the day hospital, malnutrition ward and at-risk child consultation. It is also supporting a system whereby health workers or volunteers accompany children to the ART consultation. These close linkages help to facilitate better uptake of ART and as a result, the number of children receiving ART is 11 per cent of the total number of people on treatment.
From January to September a quarter of all malnourished children treated in the country were treated in Sofala. In Manica province the number of children on ART has almost tripled compared to the same time in 2006, and in the northern province of Cabo Delgado there has been a six fold increase in the numbers of children on ART.
The MoH, with support from UNICEF, is compiling data on the management of acute malnutrition in children, around 40 to 50 per cent of whom are HIV positive. By the end of October, a total of 12,863 severely malnourished children had been enrolled in the programme and treated with therapeutic products, of this number 8,845 were admitted to health centres and 4,018 were treated as out-patients.
UNICEF and partners are supporting the capacity building of 878 health workers in 115 sites where children are receiving ready to use therapeutic food. Health workers also provide counselling and testing in the paediatric wards, where uptake of testing is high.
From 3-5 December the first paediatric conference, organised by the Ministry of Health, was being held in Maputo. The conference brought together the First Lady of Mozambique, Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), the United States Embassy and UNICEF, as well as two hundred national and international health specialists to exchange ideas on improving child health, and discuss strategies on the integration of health services, with a focus on interventions that are already yielding results in child survival and development.
Protection and support for children affected by HIV/AIDS
In 2007 the target was for 120,000 orphaned and vulnerable children to have access to basic services - health, education, legal support, financial support, nutritional support and psycho-social care. This figure had been exceeded by early December, with 160,000 orphaned and vulnerable children reached with basic services by Civil Society partners.
Government collects data from a broader range of partners and reports higher numbers. Current monitoring systems do not allow the tracking of individual children to ensure that each child has access to the full range of basic services. However, an appropriate system is under development and will be used by partners in 2008, allowing a more accurate measurement of this key indicator.
The development of provincial plans for co-coordinating the Plan of Action for Orphaned and Vulnerable Children at provincial level in 2008 is underway after a successful meeting held in early November bringing together the key players at provincial level from the Ministry of Women and Social Action and the Umbrella Civil Society Partners. Provincial level Technical Working Groups for Orphaned and Vulnerable Children are operational in seven of the eleven provinces in the country and a mapping of civil society interventions for orphaned and vulnerable children is now underway.
With just a few weeks to go until the end of accelerated registration activities in all 14 districts targeted by this initiative in 2007, over 800,000 children (with focus on orphaned and vulnerable children) have been registered. Approximately 500 new registration agents and 150 social mobilisation activists were trained to work with mobile registration teams in order to reach more remote areas.
In addition, the roll-out of the community based registration system that follows accelerated registration is expected to be completed by the end of 2007 with fixed registration agents continuing routine activities as the significant backlog of unregistered births has been cleared in targets districts. Routine registration activities are complemented by a comprehensive social mobilisation strategy aiming to raise awareness among families and caregivers about the importance of birth registration and provide accurate information about the schedule of the permanent registration agents in each of the localities.