THE ROLE OF PSYCHOSOCIAL SUPPORT IN PMTCT

EGPAF Satellite – 6th IAS Conference: Rome, 17-20 July 2011

By Dr. Tapfuma MuroveWith support from Noreen Huni

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WHO ARE WE?

The REPSSI (Regional Psychosocial Support Initiative) is:

a non profit regional organization supporting implementing partners in 13 countries of East & Southern Africa to mainstream PSS

provides expert assistance on emotional and social support for children and youth living with traumatic effects of poverty, conflict, HIV and AIDS

We believe all children need love, care, protection and support

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PSS is support for emotional and social aspects of children’s lives

Girls and boys exposed to devastating effects of HIV & AIDS are especially in need of care for their emotional and social well being

Pregnancy and child bearing is a family and not an individual issue

Expecting parents, especially mothers living with HIV & AIDS also face emotional and social challenges related to issues of disclosure, stigma, cultural practices, social exclusion & violence

These challenges affect PSS well-being and highlight the need for PSS in promoting PMTC T in communities

Family and community support is critical for PSS well-being

WHAT IS PSYCHOSOCIAL SUPPORT? (PSS)

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REPSSI tool: Are We Making a Difference helps monitor PSS mainstreaming among implementing partners; 3 broad outcomes are:

Skills and knowledge: competencies & capacities to cope with life’s demands, stressful situations and managing relationships (problem solving, decision making, negotiation)

Emotional well-being: ability to know and manage oneself, self awareness, self worth, feeling safe & happy, purpose & hope (intrapersonal)

Social well-being: ability to interact with others, quality of social interaction, having relationships & social support networks, social connectedness, sense of belonging & ability to communicate (interpersonal)

Key lesson in applying this tool across programmes is that social and emotional well being is difficult to monitor and measure. This is an area for further research

WHAT ARE PSS OUTCOMES?

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In all programmes (Health, Nutrition, Education, etc), include psychosocial support – Review HOW we programme!

This approach:• Acknowledges that PSS has a role across sectors• PSS is an integral part of PMTCT • Community prevention, care and support programmes should

include PSS

A SUCCESSFUL APPROACH: MAINSTREAMING PSS

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Information and knowledge on PSS issues in PMTCT (Mainstreaming PSS within Paediatric HIV & AIDS Treatment)

Community mobilization for PSS in prevention, care and treatment (Journey of Life Tool in Kenya & Botswana)

Peer education & support to pregnant and new mothers; mentor training on HIV & AIDS basics, disclosure safer infant feeding and positive living (Talking Book, Safe Disclosure to Children with HIV & AIDS – South Africa)

Counselling services linked to VCT & male involvement (KORDP Kenya)

Promoting sexual and reproductive health services (Training on adolescent Sexual Reproductive Health and Rights)

WHAT COMMUNITY PROGRAMMES ARE DOING

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Pregnancy results in emotional changes, depression, anxiety and at times suicidal tendencies - based on physiological, social & economic pregnancy related circumstances.

Deciding to fall pregnant and being pregnant while HIV positive creates emotional and social challenges – uncertain of pregnancy outcome.

Discovering HIV+ve status – fear, blame, shame, stigma & discrimination.

Limited male involvement during pregnancy and at delivery• Health infrastructure and facilities may limit male involvement during delivery• Culture, men & women socialisation towards pregnancy & delivery, health worker

attitudes, etc

Culture, family and involvement of men influence feeding practices

PSS ISSUES IN PMTCT

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Enhances one’s ability and assertiveness to access prevention, treatment, care & support services (before, during and after pregnancy).

Emotional and social wellbeing reduces stress and depression; improved mother-baby interactions.

Family and community social support increases adherence to treatment, facilitates disclosure

Skills and knowledge + options = informed feeding choices & adherence to decision despite associated social and emotional challenges

Emotional wellbeing enables mothers to provide better care

Social + emotional support = happy, safe & thriving children

Therefore PSS contributes to positive PMTCT outcomes

INTERPLAY BETWEEN PSS AND PMTCT OUTCOMES:

© UNICEF South Africa/2010

Whichever method, it’s a pubic act!

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Limited role of families & communities in providing PSS

Role of the traditional birth attendants

Health workers inadequate training & resources in PSS

Linking PMTCT to child & HIV sensitive social protection

Mainstreaming PSS into Sexual Reproductive Health & Rights

Community programmes that promote male involvement

Balancing impact and reach in delivery of PMTCT programmes

Social workforce capacity strengthening - family, community & referral to formal services (early referral for testing, treatment, etc)

Evidence and improved data use

GAPS IN PROGRAMMES: FIELD EXPERIENCE

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Policy harmonization (PMTCT, prevention, treatment, care & support)

Aligning policy to programmes

Mainstreaming PSS into national health and HIV and AIDS plans and frameworks

Clear and consistent advocacy messages

Mainstreaming PSS into prevention, treatment, care & support

Access to treatment and support services

Structural barriers to male involvement

Community awareness and mobilisation

POLICY AND ADVOCACY ISSUES IN PMTCT

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Strengthen social service workforce to deliver PSS

Develop culturally appropriate PSS tools & interventions

Create enabling policies and environment for holistic PMTCT

Strengthen PSS within sexual reproductive health and rights

Increase information and capacities of communities to care

Promote male involvement

Counselling and support services at community level

RECOMMENDATIONS

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Personal & Professional Development

Human Rights Based Approaches & Child Protection

Child and Youth Development

Care and Support of Children at Risk

Integrated Development in Communities

Service Learning Project

What are capacity gaps in pediatric care and PMTCT that require innovative skills building?

Accredited learning programme. The University of Kwa-Zulu Natal & the African Centre for Childhood support delivery of programme. 6 Modules:

DISCUSSION: A CAPACITY BUIDLING MODEL FOR ENHANCING SKILLS IN PMTCT AND PAEDIATRIC CARE?

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THANK YOU