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Malaria infection in pregnancy is a major cause of maternal death, maternal anaemia, and other adverse pregnancy outcomes. The World Health Organization (WHO) in 2018 estimated that 11 million pregnant women were infected with malaria in areas of moderate and high disease transmission in sub-Saharan Africa. As a result, nearly 900,000 children were born with a low birth weight. It is therefore recommended by the WHO that countries prioritize controlling malaria and its effects during pregnancy.

HFFG with the support of the National Malaria Control Programme, implemented the Malaria Control Project in collaboration with the Twifo Atti-Mokwa District Health Management Team under the National Malaria Control Programmes. The goal of the project was to minimize malaria-related morbidity and mortality burden in the country, especially among pregnant women. The project lasted from July 2021 to December 2021.The implementation took place in 15 communities with high malaria prevalence namely; Kayireku, Mbaabasa, Somnyamekodur, Bepobeng, Moseaso, Nyinase, Abodom, Aboabo, Nyinase Kojokrom, Nuamakrom, Bimpong Egya, Wamaso, Mampoma and Eduabeng.

To achieve the goals of the project, Community Based Agents (CBAs) were selected and empowered to provide community level sensitization on malaria control interventions using the available systems. The CBAs as part of their work identified and linked them to health facilities for to Intermittent Preventive Treatment services.

The agents also sensitized and followed up on the pregnant women to ensure adherence to uptake of Intermittent Preventive Treatment for Pregnant Women.  Emerging issues were discussed with stakeholders to resolve them and documentation of best practices.

Hawa, a 22 year old native of Twifo Atti-Mokwa district in the Central region of Ghana was one of the women identified by a CBA. Hawa was suffering from epilepsy right from her childhood and this condition affected her social life. In her first pregnancy, she could not receive and participate in the prenatal care services due to the fear that receiving any of medication could worsen her condition and may facilitate numerous complications. Unfortunately, she lost the baby. “My first pregnancy was lost due to frequent falling and injuries as a result of seizure episodes and loss of consciousness but when I got pregnant for the second time, I was identified by a community based agent under the Malaria Project by HFFG”, Hawa narrated. “The Community Based Agent came to our house one day to educate us about the malaria control interventions and when she realized that I was pregnant, she advised me to start antenatal clinic as soon as possible to receive medical attention and be guided by a health practitioner.”

With the help of the CBA and the HFFG project team, Hawa started attending clinic at Nyinase Community Health-Based Planning Services compound. She was provided with Intermittent Preventive Treatment therapy and subsequently referred to the Twifo Praso Government hospital to receive special medical attention till she successfully gave birth to a set of healthy twins.

“I never experienced malaria infection nor seizure crises throughout my second pregnancy. I completed all my Intermittent Preventive Treatment dosages and also slept consistently under treated mosquito net without any complications. Now I have given birth to beautiful healthy twins. I am grateful to the malaria project team for checking up on me regularly”.

Within the duration of the project, 191 pregnant women from the beneficiary communities were identified and reached with malarial prevention information by the project team. In total 38,033 individuals were reached through various means including (house-to-house, churches, schools, mosques, mobile van announcement, community information centres, community centres, video shows and durbar sensitizations) and through one-on-one education and group discussions.

Hope for Future Generations (HFFG) a Sub-Recipient (SR) of the HIV component of the Community Systems Strengthening (CSS) intervention under the Global Fund New Funding Model III (NFMIII) grant under Christian Health Association of Ghana (CHAG) as Principal Recipient (PR), has held stakeholders engagement meetings with health professionals from the Volta, Oti, Ashanti, Greater Accra, Bono, Bono East, Western and Western North Regions of Ghana.

The purpose of the engagement meetings held between May and June 2021 was to :

  • Provide updates on the implementation of CSS intervention
  • Discuss the selection criteria for community cadres (Models of Hope, Mentor Mothers, Case Managers and Community Adolescent Treatment Supporters (CATS)
  • Discuss the various cadre numbers, roles, responsibilities and working relationship
  • Solicit for support and partnership in the implementation to achieve overall goal of the Global Fund New Fund Model III project

These meetings were attended by Regional and Deputy Regional Health Directors, Metro, Municipal and District Heath Directors, Medical Superintendents of health facilities, Regional HIV Coordinators, Regional Data Officers, ART in-charges and midwives

In Ho, addressing the participants made up of Regional Health Directors, Municipal/District Directors of Health, Medical Superintendents, Midwives, Nurse in Charges, Data Officers and Regional HIV focal persons, the Executive Director of HFFG, Mrs Cecilia Senoo, said the NFMIII which has CHAG the Principal Recipient seeks to complement Ghana’s efforts to achieving the UNAIDS goal of achieving the 95-95-95 and ultimately ending HIV/AIDS. She said the HIV component of the Community Systems Strengthening intervention aims to Scale up quality HIV care cascade through community engagement and addressing human rights barriers.

She took participants through the various criteria and standards for selecting the volunteers like Models of Hope, Mentor Mother, Case Managers, Community Adolescents Treatment Supporters and Peer Paralegals as well as their roles and responsibilities.

Mrs Senoo urged the health professionals to continue to support HFFG to ensure the goals of the initiative are achieved in the regions.

The Deputy Volta Regional Director of Health, Dr Senanu Kwesi Dzokoto, in his address commended HFFG for organizing such an engagement in the region. He noted that there is a need for participants to work as a team to meet the 95-95- 95 HIV target for Ghana.

In the Ashanti Region, the Regional Director of Health Services, Dr Emmanuel Tinkorang also said for the 95-95-95 target to be achieved, the Ghana Health Service and CSOs need to work together closely to enhance output.

In the same light, Mrs Gifty Ofori-Ansah, the Director of Health Services, Ningo-Prampram also called for the need to intensify community actions to reduce HIV related stigma and discrimination in communities.

In the Bono region, Mr. Obeng Hinneh, the Regional HIV/TB coordinator who represented the Bono Regional Director of Health of health services praised HFFG for working closely with the Regional Health Directorates for effective implementation of projects.   

In general, the regional stakeholders meetings organized by HFFG as a Sub-Recipient under CHAG (Principal Recipient) were successful with all stakeholders pledging to support the intervention in their respective facilities and regions.

Malaria infection during pregnancy can lead to miscarriages and low birth weight babies among pregnant women. In 2003, Ghana adopted the Intermittent Preventive Treatment during Pregnancy (IPTp) strategy using Sulphadoxine and Pyrimethamine (SP), together with the use of insecticides treated nets, for the prevention of malaria in pregnancy.

In the Twifo Atimokwa in the Central Region of Ghana, HFFG in collaboration with the Ghana Health Service, is implementing a National Malaria Control Intervention which focuses on ensuring the correct and consistent use of Long-Lasting Insecticidal Net (LLIN) among pregnant women and also encouraging them to seek Antenatal clinic services and comply with national recommendations for treatment of malaria in pregnancy.

From 2019 to September  2020, about 30,000 community members including pregnant women were also reached with malaria prevention and treatment information through house to house education, community sensitization, durbars and mobile van announcements.

Every year, on 1st December, the world commemorates World AIDS Day. On this day, the world unites to show support for people living with and affected by HIV and to remember those who lost their lives to the pandemic. The celebration also brings focus on the country/world interventions to end HIV. This year is another opportunity to demonstrate solidarity and take stock of what has been achieved so far in ensuring that HIV does not continue to erode gains made by countries at various fronts of their economies and the building of their human capital, realizing that the COVID-19 pandemic has disrupted the provision of HIV services, treatment and care putting more people at risk. The theme for this year is Global solidarity, shared responsibility.

According to UNAIDS, as at 2019, adults and children living with HIV in Ghana were estimated to be 342.307. Females living with HIV in 2019 was also estimated to be 219.986, representing 64% of PLHIV. The statistics continue to show a gendered infection in Ghana at the detriment of women and girls.  Numerous efforts: investments of resources, targeted interventions, as well as research and development have led to immense progress in prevention, treatment and care to defeat HIV. The very recent study results showing the effectiveness of long-acting injectable medicines (cabotegravir) for preventing HIV among women; the positive opinion on the effectiveness of the Dapivirine vaginal ring to reduce the risk of HIV infection for women add to the progress made towards defeating the disease. According to UNAIDS, globally, increased access to HIV treatment has averted around 12.1 million AIDS-related deaths since 2010. This victory calls for celebration as it has led to significant reduction of HIV transmission and related deaths.  The progress though remarkable, has been unequal, notably in expanding access to antiretroviral therapy.

Sadly, the COVID-19 pandemic is disrupting HIV prevention, treatment and care services as well as reversing gains made to defeat the disease as governments divert greater health resources into fighting COVID-19. According to UNAIDS, a six-month complete disruption in HIV treatment could cause more than 500,000 additional deaths in sub-Saharan Africa over the next year (2020–2021), bringing the region back to the 2008 HIV mortality levels.

Adolescent girls and young women continue to face unacceptably high risks of HIV infection in high-burden countries as the case is in Ghana.  During the COVID-19 pandemic, this has been exacerbated by lock downs and prolonged periods of being out of school, which has led to early marriage, unplanned pregnancies, gender based violence and reduced enrolment of girls in school, increasing their vulnerability.

More than ever, there is need for urgent and relentless efforts by governments, donors, the private sector, civil society and communities to ensure continued focus on HIV interventions. This will help sustain efforts to defeat HIV and to mitigate the effects of COVID-19 on HIV to avert new infections and deaths.

Agile Leadership and engagement of communities are necessary for a successful HIV response. Community involvement and solidarity have been paramount in providing people affected by HIV with information, services, social protection and hope. There is need for this kind of solidarity by all stakeholders to defeat HIV.

Putting people at the center of the HIV and COVID-19 response and grounding the efforts in human rights and gender-responsive approaches are key to ending the two diseases. Realizing the extreme vulnerability of young women and girls, there is need to scale up prevention programmes for adolescent girls and young women for prevention, care and treatment services. There is the need for greater commitment to health through increased allocation of domestic and international resources for health and the efficient allocation and use of the resources. This will help defeat HIV and COVID-19 and prevent further loss of gains towards the critical fight against HIV. Efforts to defeat the two diseases must guarantee that everyone, everywhere, has access to healthcare they need whenever they need it. No one should be left behind because healthcare is a human right whose access should not at all depend on a person’s financial prowess.

The COVID-19 crisis is a wake-up call, an opportunity to invest better, and together, for desired health outcomes. Largely, the end of HIV as a public health threat and the achievement of sustainable development goal 3 on the health and wellbeing for all is dependent on how well COVID-19 is tackled.

By Cecilia Senoo

Executive Director, Hope for Future Generations and Focal Person-GFAN-Africa, Ghana.

Under the Community Systems intervention of the WAPCAS/Global Fund NFM II intervention, 88 TB champions from 33 districts in 9 regions of Ghana were identified and empowered to undertake contact tracing, intensified case finding, DOT adherence counselling, follow-up on lost cases, drug monitoring at facilities, effective documentation and reporting. TB Champions from January 2019 to July 2020, were able to screen over 17,971 clients out of which 523 people from 6991 presume TB cases tested positive after going through TB testing at the various health facilities. Persons who tested positive were put on treatment.

TB Champions are persons who have been cured of TB and have dedicated their time and resources to serve as advocates in their communities to spread information on TB in order to get persons who might exhibit signs and symptoms of TB to get tested and if positive be enrolled on TB treatment.