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Community Focal Mothers Boost Mother-Baby Pair Retention in Care

Mother-baby pair retention in care is critical to the health of both mothers and infants, and in improving the success of prevention of mother-to-child transmission (PMTCT) services. Many mother-baby pairs drop out of care or transfer to another health facility after completing their six-week postpartum visit. Health facilities have no way of knowing if the infant is continuing to receive necessary care, such as regular HIV testing, immunizations, growth monitoring, and vitamin A supplementation. Mothers who fall out of care are also missing important services, including infant feeding counseling, family planning services, and tuberculosis and cervical cancer screening.

A Proactive Approach

In collaboration with the Ministry of Health, USAID, and other key stakeholders, AIDSFree developed a community focal mother (CFM) model to improve retention in care through determination of final PMTCT outcome at 18–24 months. This model uses CFMs to provide community- and household-based follow-up of mother-baby pairs. CFMs are trained and visit mother-baby pairs in their home before they miss a visit to ensure that they continue visiting the health facility for care. CFMs are able to provide referrals to link children and mothers back to care. When a mother-baby pair has missed a child welfare visit, CFMs issue Ministry of Health referral forms to refer them back to care at the health facility.

Three staff members in red shirts relax outside a building.

AIDSFree-trained Community Focal Mothers at their monthly meeting at Silele Red Cross Clinic.
Photo credit: Jennifer Pearson, JSI

Developing a Care Plan

The AIDSFree-trained CFMs visit a mother at home and develop a care plan with her. This plans covers the period until the child is 18 to 24 months, when she and her child receive the most critical services, including immunizations, HIV services, and other standard care. CFMs educate mothers—both HIV-positive and HIV-negative—on the importance of attending all appointments so the health facility can ensure her child is growing well and staying healthy. She can also receive nutrition and family planning counseling, as well as regular HIV testing and other HIV care services.

Improving Health Facility Data Quality

By focusing on enrolling and visiting mothers before they become lost to follow-up, CFMs are filling an important role that health facilities are not able to take on. CFMs are able to visit mothers in their homes and remind them of appointments, as well as follow up with them if they miss a scheduled appointment at their health facility. If a mother took her child in for services at a different health facility, CFMs are able to verify this by looking at the baby’s child health card and inform the clinic so that the facility’s registers are up-to-date. In doing so, CFMs provide quality assurance by ensuring that health facility registers are accurate with what is recorded in the child health card.

CFMs are also able to issue a referral to mothers who are planning to transfer health facilities or move out of the area. Having CFMs who can issue referrals allows clinics to make noticeable improvements in their data quality. Instead of marking mothers-baby pairs as lost to follow-up, they are now confirmed as transfers-out—known to be continuing in care.

Success in Eswatini

Since June 2017, AIDSFree has seen success with this program—in Eswatini, more than 350 mother-baby pairs are retained in care, where they have completed their clinic visits and received all services per the Ministry of Health schedule. There have been many successful transfers-out and linkages back to care from missed visits using the referral forms. None of the mother-baby pairs have been lost to follow-up; 100 percent are currently retained in care. AIDSFree is working with the Eswatini Ministry of Health and other partners to plan for national scale-up of the CFM model.

Retention in Child Welfare Care Visits in Eswatini since September 2018

Expansion to Kenya

Due to the success of the CFM model in Eswatini, AIDSFree is beginning to implement the model in Kenya. AIDSFree will adapt the program to meet local needs, with the goal of improving and mother-baby pair retention in care in Kisumu and Homa Bay, two counties with high mother-to-child transmission rates.