Introduction

ince 2008, the USAID Bureau for Global Healths agship Maternal and Child Health Integrated Program (MCHIP) has worked in more than 50 developing countries in Africa, Asia, Latin America and the Caribbean to improve the health of women and their families. MCHIP supports programming in maternal, newborn and child health, immunization, family planning, nutrition, malaria and HIV/ AIDS, and encourages opportunities for integration of programs and services when feasible.
MCHIP addresses the barriers to accessing and using key evidence-based interventions across the life stagesfrom pre-pregnancy to age 5by linking communities, primary health facilities and hospitals. By helping countries identify and focus on those innovations that will save lives, MCHIP supports delivery of evidence-based interventions through strengthening government health systems, nongovernmental organizations and other local partners. MCHIPs overall strategic approach is guided by ve interrelated principles: Taking high-level impact interventions to scale Ensuring country ownership Creating change through global and regional inuence Improving measurement and use of data at the country and global levels Expanding coverage through integrated approaches

MCHIP brings together a partnership of organizations with demonstrated success in reducing maternal and child deaths: Jhpiego ICF International John Snow, Inc. (JSI) Broad Branch Save the Children PSI PATH JHU/IIP

Maternal Health

Epiphanie
Greater availability of misoprostol enables trained community health workers to save the lives of women who give birth in areas that are far from health facilities.
Twenty-ve-year-old Epiphanie felt her labor begin and immediately called Immanaculee, an MCHIP-trained community health worker who supports the families in Bugosa village in the Gakenke district of Rwanda, where she lives. Immanaculee had educated Epiphanie on the importance of making regular prenatal care visits and encouraged her to deliver at the health center, where she would have access to medicine and trained providers. Immanaculee accompanied Epiphanie on the hilly, ve-kilometer trek to the health center, but the baby would not wait. The health worker quickly found a hidden area along the way and covered the spot with the colorful cloths that women traditionally wrap around their waists. There, she helped Epiphanie deliver a healthy baby girl named Patiente. Immediately after the baby was born, Immanaculee gave Epiphanie a lifesaving drug called misoprostol, which she had learned about in her training. When used in the rst two hours after delivery, misoprostol is highly effective at preventing excessive bleeding after childbirth, known as postpartum hemorrhage (PPH). PPH is the leading cause of death among pregnant women globally, and in Rwanda an astounding 45% of women who perish during childbirth die from PPH. Making misoprostol available to mothers is particularly important for women in remote areas, who might have difculty reaching a facility to give birth. Through this Rwandan pilot programand many other USAID/MCHIP activities being carried out globallymore than 700,000 women have received this lifesaving medicine.

ver the last two decades, the global community has witnessed remarkable reductions in the number of maternal deaths worldwide. Yet, too many women still die in pregnancy and childbirth from treatable complicationsnearly 800 women per day.
Postpartum hemorrhage (PPH) and pre-eclampsia/eclampsia (PE/E) together account for more than 40% of maternal deaths. To combat this, MCHIP works in 30 countries to promote access to lifesaving interventions for pregnant women, and address a number of areas integral to improving outcomes for mothers and their babies, such as malaria in pregnancy and care for women affected by HIV. MCHIP provides leadership and technical assistance at the global and country levels for an integrated package of interventions to address PPH, PE/E, preterm birth, maternal anemia and other complications. MCHIP was a key contributor to new World Health Organization (WHO) recommendations on PPH and PE/E. A critical change advocated by MCHIP was the provision by lay workers of misoprostol, a lifesaving drug taken immediately after birth to prevent excessive bleeding. Many women still give birth at home and MCHIP strives to deliver interventions that can reach these women. This means that a woman has access to a skilled birth attendant, as well as the lifesaving drugs she may need. MCHIP recognizes that a skilled birth attendant, such as a midwife, doctor or nurse, is critical to a safe and successful delivery. The program works to increase access to these health workers, and has spearheaded competency-based trainings and development of resources to build provider skills and condence, not only in maternal health but in essential newborn care and family planning as well. Respectful Maternity Care is woven into all aspects of MCHIPs work to strengthen skilled birth attendance. Quality-of-care studies, conducted in seven countries, and a Multi-Country Analysis Survey shed light on critical quality-of-care, health system and policy issues, allowing governments to identify gaps and work toward solutions to prevent and manage the leading causes of maternal death. Survey results have been used for advocacy at national and global levels, including contributions to recommendations of the UN Commission on Life-Saving Commodities.

Newborn Health
Shifa
Sixty seconds can mean the difference between life and death for a newborn who isnt breathing. Thats the window of time a health care provider has for resuscitation before a baby suffers injury from lack of oxygen. Jubaida Shirin knows how quickly that golden minute can tick by.
Jubaida Shirin, a community-based skilled birth attendant in Habiganj District in Bangladesh, received a call from one of the women she routinely visited during pregnancy. Minara Khan was in labor. When Shirin arrived at Minaras home, she examined Minara and found that Minaras baby was in the breech position. She quickly applied her training to deliver the child, but as she dried and wrapped the infant, she heard no cries.

The baby girl wasnt breathing. Shirin put the newborn girl on her left side on the mothers abdomen and tried her hardest to stimulate the babys breathing by rubbing the skin over her backbone. The tiny girl did not respond. Shirin next began resuscitating the child using a bag and mask, just as she had been trained to do. It worked! Her training paid off. Baby Shifa survived and is now a healthy toddler. Jubaida received her resuscitation training through a pilot study of the Helping Babies Breathe initiative, sponsored by MCHIP and partners. Due to the success of the program and the strong commitment of the Bangladeshi government to womens and childrens health, training in newborn resuscitation is now available across the country. About 1,700 health facilities have been equipped with resuscitation equipment, and nearly 500 health facilities have received Helping Babies Breathe training materials. Birth attendants throughout Bangladesh now have the knowledge and condence to save the lives of babies like Shifa.

n spite of existing high-impact interventions for newborn health, nearly 3 million babies die each year within the rst month of life, and more than three-quarters of these deaths occur in sub-Saharan Africa and South Asia. Improvements in the prevention of newborn death have lagged behind those for maternal and child health.
MCHIP has assisted 37 countries in addressing the three main causes of newborn death: prematurity, birth asphyxia and infections. There is substantial evidence that the vast majority of these deaths can be prevented if mothers and newborns receive proven low-tech solutions. The program works to expand the use of lifesaving practices and availability of commodities through global advocacy, collaboration with country leadership, health worker trainings and system strengthening. In Liberia and Madagascar, for example, MCHIP collaborated with partners to institute use of chlorhexidine on a babys umbilical cord at birth for prevention of newborn infections. Bangladesh has also recently adopted this intervention. This is a simple technology with the potential to prevent an estimated 500,000 global newborn deaths each year. MCHIP supports health service providers through training and the development of resources covering lifesaving practices in newborn care. In Ethiopia, MCHIP helped standardize newborn health education and supported the training of 24 national trainers and 256 health workers in newborn care including resuscitation. Over the course of one year, these workers saved the lives of more than 578 babies who had stopped breathing at birth. MCHIP recognizes that the sharing of experiences between countries is essential for adoption and expansion of newborn health services, so it seeks to create platforms for countries to have the opportunity to engage in dialogue around maternal and newborn health. In April 2013, MCHIP and partners hosted the Global Newborn Health Conference in Johannesburg, South Africa. As a result of this conference, many countries, including Bangladesh, India, Liberia and Sierra Leone, have pledged to improve the availability of and access to key neglected interventions such as Kangaroo Mother Care and the use of antenatal corticosteroids.

Child Health
Toumani
A health worker in Mali improves the health of an entire village by enlisting the help of the community.
Samata village in Mali is a rural, agricultural community located more than 20 miles from the nearest health center. Lack of accessible and high-quality health services was taking the lives of the children. Villagers would walk for hours to seek care when their children were sick. Toumani Dagno applied for a position as a community health worker through

the Community Essential Care program, implemented by MCHIP in collaboration with UNICEF and other partners. He received training to provide basic health care to the community and was assigned to Samata to provide treatment to children suffering from diarrhea, malaria and pneumonia. Toumani quickly became popular in Samata for his kindness and dedication as well as the quality of the services he provided. In only six months, he treated more than 600 sick children. Toumani recognized that he could have an even greater impact by empowering

remendous achievements have been made in decreasing the number of deaths of children under the age of 5. The rate of these improvements, however, varies greatly from region to region. In sub-Saharan Africa, for example, 1 in 9 children dies before the fth birthdaymore than 16 times the average for developed regions. For Southern Asia, about 1 in 16 children dies before age 5. The good news is that the primary killers of childrenpneumonia, diarrhea and malariaare preventable and treatable.
MCHIP has been a vital contributor to the global movement to end preventable child deaths, working to improve access to lifesaving treatments at both a global and country levelhaving worked in 17 countries. The program recognizes that efforts to end preventable child deaths will be successful only when treatment is available to the populations most at risk. MCHIP has been at the heart of efforts to expand integrated Community Case Management (iCCM), a strategy to extend the management and care of childhood illness beyond health facilities. The package addresses diarrhea, pneumonia and malaria, and is often extended to include newborn health and malnutrition. Diarrhea and pneumonia have long been the forgotten killers of children under the age of 5. Through global advocacy, MCHIP has worked with USAID, UNICEF, WHO and other key partners to refocus global attention on these illnesses and to increase momentum to address these killers. The development of the Global Action Plan for the Prevention and Control of Pneumonia and Diarrhea (GAPPD) and the Diarrhea and Pneumonia Working Group are two examples of this essential shift. At the country level, MCHIP works to develop child health policies, empower health workers and ensure that clinicians are trained to accurately identify and manage childhood illness. In Kenya, for example, MCHIP worked hand-in-hand with national ministries to reclassify zinc to make it available to treat diarrheal disease without a prescription and to establish a national plan to introduce iCCM.

community members to take care of their own health. He engaged the village authorities and worked with community women and youth groups to organize educational campaigns, including the weekly community Day of Safety. With Toumanis encouragement, the village began promoting proper handwashing and building latrines. More than a year after Toumani began working in the village, Sidibe Bourama, advisor to Samatas chief, remarked on the decrease in deaths. Because of the presence of Toumani, we have not yet registered any child deaths, he said.There is less travel to the health center to treat children, and this has reduced the burden on families for the transport and care.

Prevention of HIV/AIDS

Maternal Health

An Integrated Approach
Immunization
MCHIP ensures an appropriate mix of interventions across the life cycle and along the household-to-hospital continuum of care. As each partner takes the lead in developing programs around a specific technical area, MCHIP is able to respond to the needs for a more integrated approach to services.

Newborn Health

Child Health

Malaria Prevention & Treatment

Family Planning

MCHIP CONTRIBUTIONS YEARS 15

to Global Gains in Maternal, Newborn and Child Health

Globally, maternal and child deaths are significantly decreasing. MCHIP activities contribute to these global reductions in maternal and child deaths, and improve the health of women (from planning a family through pregnancy and delivery) and their children (from infancy through childhood). At the household, community and hospital levels, MCHIP implements and works to scale up high-impact interventions.

MCHIP is working in more than 40 countries worldwide.

FAMILY PLANNING
30% of maternal deaths could be prevented simply by fulfilling the unmet need for family planning.

MATERNAL HEALTH
The major causes of maternal deaths are postpartum hemorrhage (PPH) and pre-eclampsia/eclampsia (PE/E) which together account for more than 40% of maternal mortality.

NEWBORN HEALTH

CHILD HEALTH
Immunization is estimated to prevent the deaths of 2 to 3 million children each year. But another 1.5 million children still die from diseases that could be prevented by vaccination. Child pneumonia remains the leading cause of death among children under 5, accounting for 1 in 5 child deaths globally.

introduced PPIUCDs with MCHIP assistance.

19

improved skilled attendance at birth.

Over women were counseled on family planning as part of integrated essential care services at MCHIP-supported facilities over the last 5 years.

3.6 MILLION

15
Over

introduced PE/E prevention and treatment. Over

30

13

expanded PPH prevention programs.

expanded postnatal care and essential newborn care.

14

MCHIP has provided technical support to strengthen routine immunization programs in

expanded implementation of ORT and zinc for treatment of diarrhea.

couple years of protection to avert pregnancy were supported by MCHIP family planning services.

1.8 MILLION

1.5

expanded Kangaroo Mother Care.

were attended by a skilled attendant in MCHIP programs.

953,000

25

Helping Babies Breathe resuscitation programs in

11

MCHIP has provided technical support to introduce new and underutilized vaccines (Penta, PCV and Rota) in

190,000 740,000
cases of child diarrhea. MCHIP supported the treatment of over

Through MCHIP-supported programs, over

cases of child pneumonia were treated with antibiotics.

women were provided AMTSL.

309,000

Antibiotic treatment for over

Over the life of MCHIP, more than...

Sustaining these achievements requires improved national policies, training and contributions to global learning Across MCHIP countries, USG-supported training programs graduated nearly 282,000* participants. Over the life of the project, 155 national policies were drafted with USG support. *Actual total for life of project is 281,834 total participants (Program Year 1 through Program Year 2 did not count unique individuals).

88

children received DTP3 (from MCHIP supported immunization programs).

Malaria Prevention and Treatment

Adissa
By training providers of routine care for pregnant women in Burkina Faso, the National Malaria Control Program keeps more women malaria-free during their pregnancy.
Adissa Silga had traveled to the local health clinic for prenatal care and to protect herself and her unborn child against malaria, a disease endemic to this rural area about a two-hour drive from Burkina Fasos capital. But the side effects of the chloroquine pills made her ill and she stopped taking them, which left her at risk of contracting malaria. Indeed, she later became sick from the disease. This type of treatment was very hard for me because I often forgot to take my tablets, Adissa said. Sometimes I avoided taking them because of side effects such as dizziness and itchiness and, therefore, I contracted malaria and had to stay in the health center

n estimated 85% of all deaths from malaria occur in children under 5. In malaria-endemic areas, 50 million women will become pregnant each year. These women are highly susceptible to the consequences of malaria, which lead to increased maternal death and severe maternal anemia, low birth weight and infant death.
MCHIP works to control malaria, focusing on the prevention and treatment of the disease among the most vulnerable groupswomen and children in low- and middleincome countries. The program contributes to global programs and partnerships, most notably by working with the Roll Back Malaria partnership and the Presidents Malaria Initiative (PMI). Through these high-level, global partnerships, MCHIP has helped focus attention on the importance of addressing MIP, including assisting with the rollout of WHO global policies regarding MIP prevention and treatment to countries across sub-Saharan Africa. At the country level, MCHIP has supported Ministries of Health in 20 African countries to increase malaria prevention and treatment, integrated with maternal and child health and HIV programming. Through PMIs Malaria Communities Program, MCHIP supports efforts of communities and nongovernmental organizations to combat malaria at the local level. Because malaria is one of the leading killers of children under the age of 5, MCHIP strengthens malaria prevention and treatment services for children by working with countries to introduce and scale up integrated Community Case Management (iCCM). The iCCM strategy extends lifesaving treatment to children without access to health facilities by training community health workers in remote villages in the case management of childhood illness.

for care. Pregnancies were very hard for me. Through the MCHIP-supported National Malaria Control Program, Adissa beneted from an improved prevention regime to help keep her malaria-free during her next pregnancy. The program works at the national, regional and district levels to build capacity and strengthen health systems for malaria control and prevention services. The program pays particular attention to pregnant women and children under the age of 5, who bear the heaviest burden of malaria. Each year, approximately 750,000 women in Burkina Faso become pregnant and are at risk of malaria, which leads to higher rates of maternal anemia and low birth weight babies. In order to reach more women with interventions to reduce the dangers of malaria in pregnancy, MCHIP focuses on training the health care providers who see women during regular antenatal care visits. Since the program began in 2009, MCHIP has trained health care providers from 17 districts. Adissa has become a new champion for the program: I can tell you that I feel better. I would like to encourage each pregnant woman to attend health facilities and that their pregnancy will be safe and they will have healthy babies.

Family Planning
Seema
An auxiliary nurse-midwife in India educates her community about options for family planning after birth.
Seema Verma is on a mission. An auxiliary nurse-midwife in Uttarakhand, India, the mother of two wants to help other women make an informed choice about family planning services, just as she was able to do. I want to pass on the same hope and possibilities to other women in my community, she said. When Seema was pregnant for the second

orldwide, 222 million women currently wish to delay or prevent pregnancy, yet do not use contraceptives to plan their family. The reasons for non-use are complex, involving social, cultural and economic barriers, fears about side effects and lack of access to a trusted provider. There is signicant evidence, however, that greater access to family planning can be vital to achieving global goals in maternal health and child survival.
MCHIP has helped 21 countries integrate postpartum family planning (PPFP) into maternal, newborn and child health programming, averting unintended pregnancies and promoting healthy spacing between pregnancies. MCHIP takes advantage of the frequent contact women have with health care providers during a pregnancy, birth, and child health and immunization services to integrate PPFP counseling and services whenever possible. The program has also developed materials to educate and advocate for expanded access to the postpartum intrauterine contraceptive device as a reliable and convenient method of family planning, as well as screening and referral processes to offer PPFP linked with child health visits. MCHIP generates and disseminates information on the benets of integrating PPFP with maternal, newborn and child health services. In Bangladesh, for example, MCHIP worked with Johns Hopkins University to conduct the Healthy Fertility Study to examine the effect of an integrated package of services delivered by a female community health worker on key newborn and infant health practices and use of PPFP to achieve healthy pregnancy spacing. The studys positive results inuenced other programs in Bangladesh to adopt the practices, leading to successful scale-up of these practices. At the global level, MCHIP is a leader in the effort to gather evidence, build consensus, advocate and innovate around PPFP. An MCHIP-facilitated PPFP Community of Practice draws attention to the barriers that restrict postpartum womens access to family planning and tests solutions to address them. MCHIP was an integral partner with USAID and WHO on the development of the Statement for Collective Action for Postpartum Family Planning and the forthcoming WHO document on Programming Strategies for Postpartum Family Planning, garnering global support for PPFP.

time and looking for a viable, long-term family planning method, she received counseling from a visiting team from MCHIP. They explained the importance of using contraceptives after delivery to delay or prevent the next pregnancy. They also gave her information about the intrauterine contraceptive device (IUCD), which can be inserted within 48 hours of delivery. Seema chose to deliver her baby at Womens Hospital in Dehradunan MCHIP intervention siteso that she could get an IUCD immediately after the birth of her daughter, Ritika. For Seema, an IUCD was the best family planning choice for many reasons: It lasts for 10 years, could be inserted while she was still in the hospital and was free under government policy. Moreover, she appreciates that she does not need to remember to take a pill every day. Seema was so enthusiastic about her family planning decision that, while resting in the postpartum ward, she counseled two other women who were sharing the room with her. They too chose to have an IUCD inserted. Seema is optimistic that her decision offers a promising future for her own two daughters. As one of four children in a poor family, Seema struggled to nish her schooling and became the most educated member of her family. I want my daughters to study more than me, she said. My husband and I want to work hard to make this possible.

Support for Nongovernmental Organizations, Innovation and Collaboration

Catholic Medical Missions Board (PVO/NGO)

Catholic Medical Missions Board (CMMB) implemented a Presidents Malaria Initiative-funded Malaria Communities Program project in three districts of Luapula Province, Zambia, from 2009 to 2012. Kawambwa, Mwense and Samfya districts are among those with the highest burden of malaria in the country. Through community mobilization by community volunteers and traditional leaders, CMMB increased uptake of malaria prevention and care-seeking and addressed gaps in knowledge and misconceptions about the use of long-lasting insecticide-treated bed nets (ITNs) and prevention of malaria in pregnancy. Just after receiving their award from the Presidents Malaria Initiative (PMI), CMMB staff joined staff from the 19 other PMI grantees in Nairobi, Kenya, for an MCHIPdesigned and -led training on Program Design, Monitoring, and Evaluation. During the

training, CMMB dened specic project objectives, developed indicators to measure progress and outcomes, and drafted a monitoring and evaluation plan. To measure coverage of key interventions and behaviors and assess project success, CMMB conducted baseline and endline populationbased coverage surveys. This was the rst time CMMB had implemented such an exercise in Zambia. MCHIP worked closely with CMMB to prepare survey methodology and tools, and provided on-the-ground training for CMMB survey enumerators and supervisors. With the experience gained through the baseline exercise and ongoing technical assistance from MCHIP, CMMB was able to conduct the endline survey independently. CMMB measured increases in household ITN ownership, ITN use by children under the age of 5 and treatment-seeking for children with fever. Throughout CMMBs three-year project, MCHIP reviewed drafts of CMMBs project work plans, M&E plan and reports to PMI, providing support and recommendations to strengthen project implementation and monitoring progress. MCHIP provided technical assistance to 20 NGOs in PMIs Malaria Communities Program.

he collaboration of civil society is pivotal to achieving global aims to end preventable maternal, newborn and child deaths worldwide. Many international nongovernmental organizations (iNGOs) and their in-country partners reach underserved and vulnerable populations with low-cost, high-impact interventions. They are also often at the forefront of developing practical solutions to the barriers they encounter on the ground related to implementation and scale-up of integrated intervention packages to inform national policies and strategies.
MCHIP supports iNGOs through USAIDs Child Survival and Health Grants Program (CSHGP)currently 32 projects in 24 countriesthe majority of which involve partnerships with academia, Ministries of Health and other local entities to implement and test approaches that bridge gaps in the household-to-health-facility continuum of the health system. The MCHIP team provides technical assistance to the grantees in program design, monitoring, implementation and evaluation, including operations research. This capacity building promotes a standard level of quality and rigor across projects. MCHIP also works closely with the CORE Group to foster communities of practice and contribute to global learning for community health. Operations research supported through the CSHGP contributes to national and global evidence. Topics included smart integration of services, civic participation, privatepublic partnerships, promoting and advancing equity, community health system capacity building, and the introduction of low-cost technologies to improve access and efciency of health interventions. Grantee work has also been included in recent peer-reviewed publications including:

Health Policy and Planning (February 2013), demonstrating plausible evidence for child
mortality impact, and Global Health: Science and Practice (March 2013), documenting improvements in under-nutrition at scale in Mozambique, using the Care Group Model.

Immunization
Senegal Ministry of Health
With meticulous planning and a dedicated staff, the Senegal Ministry of Health protects the population from meningitis through a successful vaccine rollout.
In November of 2012, Senegal became the ninth country in the meningitis belta band of 26 countries stretching from Senegal to Ethiopiato introduce the effective, low-cost MenAfriVac vaccine through the Meningitis Vaccine Project (MVP), a partnership between WHO and MCHIP partner PATH. In countries where the vaccine has been introduced, there has been a dramatic reduction in reported meningitis cases. The Senegalese Ministry of Health

launched a two-week immunization campaign in one of the areas of the country most severely affected by meningitis outbreaks. Vaccination campaigns typically target infants under the age of one, so this project produced a particular challenge in that it targeted the regions 1- to 29-year-oldsnearly 4 million people. Organizers needed to take a creative approach to reach this population by sending campaign volunteers to the many places where they would nd young peopleat work, markets, universities, military camps, prisons, taxi stands, workshops and in the elds. They traveled by automobiles, bikes, motorcycles and even carts pulled by donkeys and horses. MCHIP was a key technical partner in supporting the preparation and implementation of the campaign. There are many elements that must be planned and considered before an immunization campaign can even begin, such as public information, staff training, transportation and distribution logistics, community partnerships, crowd control, surveillance and planned active monitoring following the campaign to measure the coverage, quality and impact of the effort. The launch and distribution of the MenAfriVac vaccine were successful due to the meticulous organization and careful management of the processes.

lobally, immunization prevents 3 million child deaths each year, and WHO estimates that 17% of the remaining under-5 deaths approximately 1.5 million deaths annuallycould be prevented with existing vaccines. Success in reducing vaccine-preventable mortality has been dramatic, but it cannot be taken for granted.
Achievements in immunization must be maintained and built upon every year. While infant vaccination coverage in some countries now exceeds 80%, coverage is not the only measure of success. Before they are exposed to disease, women and newborns must be reached by both potent vaccines and high-quality services in a timely, safe, effective and affordable manner so that they return to complete all of their doses. Coverage disparities also continue within countries, with few countries reaching 80% or higher coverage in all districts. MCHIP is dedicated to ensuring that every infant and woman of childbearing age in the developing world is fully immunized. A great deal of work and planning must take place behind the scenes before a country can introduce a new lifesaving vaccine. The MCHIP team applies its technical expertise to support 15 countries through every step of the introduction process and strengthen routine immunization. When possible, MCHIP explores opportunities to integrate immunization services with the delivery of other interventions. MCHIP programs aim to reach the hard-to-reach and marginalized groups to improve access, use and equity. The program works with Ministries of Health, civil society and other partners to identify and prioritize under-immunized populations and operationalize the Reaching Every District approach. MCHIP also recognizes that it is important not only to achieve high, countrywide coverage of each vaccine, but also to ensure that success is sustained even after coverage goals have been achieved. To prevent outbreaks, uniform and consistently high coverage is needed everywhere, year after year. MCHIP works closely with international organizations, such as the GAVI Alliance, WHO and UNICEF, on important global and regional initiatives. For example, the program provided technical support to WHO to assist with the response to the pandemic H1N1 inuenza. MCHIP also serves on many global advisory bodies to use its in-country experience to inuence immunization policy and strategies.

Prevention of HIV/AIDS
IV is a leading cause of death among women of reproductive age and a major contributor to maternal mortality in high-prevalence settings. According to recent estimates, HIV-infected pregnant or postpartum women have about eight times higher mortality than their counterparts who are not infected with HIV. Moreover, despite a 24% drop in new pediatric infections, 900 children are still newly infected every day.
For the rst time, the global community has the tools needed to virtually eliminate pediatric HIV and keep HIV-infected women alive and healthy. MCHIP continues to focus on a strategic approach that has helped 16 countries scale up high-impact interventions to prevent new infections and ensure that HIVinfected persons are linked to the care and treatment they need. To eliminate mother-to-child transmission of HIV, MCHIP engages communities to increase access to services and ensure that women are utilizing the services. When and where appropriate, MCHIP integrates HIV services with other maternal and newborn health programs to ensure that women and their families receive the appropriate care they need for all aspects of their health. MCHIP is committed to reaching the unreached and underserved populations with comprehensive HIV services. By adapting the Reaching Every District approach for prevention of mother-to-child transmission in Kenya, MCHIP and the district health ofce increased coverage of community health workers in Kenyas Bondo district from 38% to 100% in two years. This led to an improvement in earlier rst antenatal care visits (from 45% to 76%) as well as labor and delivery coverage in the new facilities (5% to 15%). MCHIP has made great strides in the implementation of voluntary medical male circumcision (VMMC) services, ensuring that the programs are truly country-owned and integrated within existing health systems. In addition to serving as global advocates for the intervention, MCHIP has implemented VMMC programs in three countries: Malawi, Lesotho and Tanzania. As of June 2013, nearly 200,000 MCHIP-supported VMMCs had been performed. HIV testing and counseling (HTC) remains a critical gateway to treatment, care and prevention interventions. MCHIP works with countries to improve HTC systems and conduct HTC research. In South Sudan, MCHIPs work with 56 health facility staff from 15 facilities meant that staff were trained in testing and counseling; this enabled the staff to test 4,500 people by January 2013. And both women are grateful for Janes support. After I delivered my baby, Jane advised me on how to take care of my child by exclusive breastfeeding for six months and to continue taking my medication, Grace said. I request Jane to continue doing what she is doing so that she can help other mothers. Jane is among more than 300 community health workers whose outreach has resulted in impressive gains. Since 2010, the number of community units under the program more than doubled, expanding coverage to women living in the most hard-to-reach areas of Bondo district. As a result, more women are taking advantage of these servicesthe percentage of expectant mothers going to all four antenatal care visits increased from 25% to 41% in two years, and the percentage of HIV-exposed infants who were tested for HIV increased from 27% to 78%. I like working with these two. They are very good at following advice, said Jane. Both attended all four of their antenatal clinics and also adhere to their medication.

Beatrice and Grace

Community health workers in Kenya are creating an AIDS-free generation one pregnancy at a time.
Beatrice and Grace are proof that an AIDS-free generation is within our power. The two mothers live in the Bondo district in Kenya, where 20% of the community is infected with HIV, including Beatrice and Grace. Both women, however, gave birth to healthy, HIV-negative babies thanks to help from community health worker Jane Akoth of the Barkowino Community Unit. During their pregnancies, Jane saw Beatrice and Grace regularly, either through home visits or appointments at the clinic, to ensure that the women were well and their pregnancies remained healthy.

MCHIP
Recognizes that more women and children
will have improved health outcomes if they have high-quality health services

Values equitable care in all phases of the

work it does to reach the unreached

Increases the impact of tested health care

innovations by taking them to scale

Integrates services, where feasible, to

ensure there are no missed opportunities to provide care

Provides services within the community

while also maintaining and improving services at facilities

1300 Pennsylvania Avenue Washington, DC 20523 tel202.712.4564

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