PREFA over 13 years of its existence is a premiere organization supporting Uganda government in Improving the health of women and children as top priority through high-impact interventions that accrete prevention of maternal and child deaths reduction in Uganda. PREAF brought this to scale by implementing prevention of mother to child transmission (PMTCT) services that significantly contributed to a remarkable reduction of new HIV infections among infants leading to Virtual‟ Elimination of Mother-to-Child Transmission of HIV (eMTCT)”. PREFA implemented innovations to reduce maternal and neonatal deaths by incorporating access to appropriate curative and preventive interventions in homes and communities in the districts of operation.
They included innovative technologies across the continuum of care – including technologies for frontline workers to use in homes, communities, and first-level health facilities that significantly improved pregnancy outcomes. PREFA was at the frontline of supporting its operational 40 districts with 160 health facilities to transition from PMTCT Option A to Option B+ because the latter had superior operational, clinical, and programmatic benefits in light of the stagnating or even increasing HIV prevalence in the country (UAIS 2011). The technologies implemented helped to reduce maternal, fetal and neonatal mortality in rural settings in Uganda.
PREFA’s RMCAH model of improving access and coverage of eMTCT services of program support and delivery is at three levels namely: (1) district health systems (strategic management), (2) health facilities (both government and non-government, (3) community level Implementation of activities. The program mode of implementation is technical assistance through Health Systems Strengthening and through the District and community led Approach.
The target beneficiaries include mothers, their babies, and adolescents of reproductive age, partners and families. Thematic areas of focus include: Capacity building for health workers, Care & treatment for mother-baby pairs, facility-community linkages, gender integration, and family planning, Monitoring & Evaluation as well as National & District level coordination. The program is implemented through its unique community systems model namely; Family Support Groups, and Male Action Groups, among others.
PREFA works with supported districts to implement a real-time reporting mechanism through the Emergency Operations Center (EOC) which is able to capture weekly data on number of women tested for HIV, those tested positive and those initiated on ART and therefore allows for early intervention. Since 2013, PREFA focused its efforts on strengthening retention, integrating RMNCH into HIV care, data improvements; community engagements for retention, and MCH services uptake including;
- Providing support to each RMNCAH site to ensure routine HIV counselling and testing for pregnant women and their partners including ensuring that all pregnant women who test positive for HIV receive lifelong antiretroviral drugs for RMNCAH
- Building capacity of health workers to provide RMNCAH services including early infant testing for HIV through training, coaching, mentorship and support supervision
- Strengthen mechanisms for retention of mothers and their babies in care using the mother-baby care model.
- PREFA also gives transport vouchers to health facilities for vulnerable mothers who need to be referred in case of emergencies to save lives during delivery.
- Supporting health workers to maintain adequate stock of RMNCAH commodities.
- Improving the quality of service provision using CQI and 5S principles and methodologies.
- Initiating Family support groups (FSG) to provide psychosocial support
- RMNCAH Budget advocacy and Human Resources for Health.
- Hosting graduation ceremonies in various Family support groups to reward HIV positive mothers who complete the HIV testing algorithm for their exposed infants and for encouraging those who still have exposed infants to commit to the process as well.
- Implement Gender integration strategy in a bid to increase male partner testing and involvement in Reproductive Health
- Reducing the incidence of postpartum hemorrhage, the number of deaths due to postpartum hemorrhage and the number of stillbirths and perinatal deaths due to birth asphyxia/failure to breathe at birth.
- Helping Mothers Survive-Bleeding after Birth (HMS-BAB) and helping Babies Breathe (HBB) competencies among birth attendants, in health facilities to ensure consistent delivery of life-saving prevention and treatment interventions.