Côte d’Ivoire
Country Profile
Jhpiego in Côte d’Ivoire
Quick Facts
Estimated total population:1
20.8 million
Maternal mortality ratio:2
400/100,000 live births
Infant mortality rate:2
86/1,000 live births
Under-five mortality rate:2
123/1,000 live births
Total fertility rate:1
4.9
Contraceptive prevalence:1
12% (modern methods)
18% (all methods)
HIV prevalence:3
3.4%
Births with skilled provider:2
56.8%
Sources:
1
Population Reference Bureau 2014
World Population Data Sheet;
2
WHO Global Health Observatory Data
Repository;
3
UNAIDS 2010 Report on the Global
AIDS Epidemic.
Background
One of the most prosperous—and, for years, most peaceful—countries in West
Africa, Côte d’Ivoire has suffered from political instability for more than a
decade. As a result, the health care infrastructure has been weakened, particularly
in the northern regions of the country, which are still undergoing reconstruction.
In 2010, after a contested presidential election, a second civil war broke out, and
basic services, including medical treatment, were extremely limited. In Côte
d’Ivoire, where HIV/AIDS, tuberculosis and malaria are primary health
concerns, access to care is essential.
Jhpiego has been active in Côte d’Ivoire since the late 1980s, initially
strengthening the skills of the faculty of medicine at the University of Abidjan to
teach students about reproductive health and family planning. From
1995 to 2002, Jhpiego implemented the Santé Familiale et Prévention du SIDA
(Family Health and AIDS Prevention) Project, funded by the U.S. Agency for
International Development (USAID). In 2002, with funding from the U.S.
Centers for Disease Control and Prevention (CDC) under the University
Technical Assistance Project (UTAP), the focus of Jhpiego’s work shifted to
HIV/AIDS care and treatment. Under UTAP II, Jhpiego supported more than
35 sites providing services for the prevention of mother-to-child transmission
(PMTCT) of HIV by reinforcing the quality of care using the Jhpiego-developed
Standards-Based Management and Recognition (SBM-R®) approach.
In 2008, Social Sectors Development Strategies, Inc., subcontracted with
Jhpiego with funding from the President’s Emergency Plan for AIDS Relief
(PEPFAR) to provide technical assistance to build capacity and improve and
expand HIV/AIDS prevention and care services. Jhpiego also worked with the
International Center for AIDS Care and Treatment Programs at Columbia
University to expand the role of nurse-midwives in Côte d’Ivoire by shifting
certain HIV-related tasks from doctors to nurse-midwives. In addition, from
2012 to 2013, Jhpiego collaborated with the school of social work, the Institut
de Formation Sociale, to develop curricula that address the needs of orphans and
other vulnerable children, and to ensure that tutors provide high-quality,
competency-based training. In 2013, with funding from the United Nations
Population Fund (UNFPA), Jhpiego assessed and trained personnel at 29 sites to
enable them to provide cervical cancer prevention services, trained 100 providers
from 13 districts and followed up with supportive supervision. Currently,
Jhpiego is implementing two programs in Côte d’Ivoire, as described on the
following page.
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Current Program Highlights
Technical Assistance in Support of HIV Prevention, Care and
Treatment Services, including Cervical Cancer Prevention
With CDC funding, Jhpiego introduced an innovative approach to cervical
cancer screening for HIV-positive women. This approach—referred to as the
“single visit approach”—consists of visual inspection of the cervix with acetic
acid (VIA) and cryotherapy for women who test positive. After successful
implementation at 10 HIV care and treatment sites, Jhpiego expanded the
program to 10 additional sites. Jhpiego also established two referral centers
where women with large pre-cancerous lesions that cannot be treated with
cryotherapy can undergo a loop electrosurgical excision procedure.
In partnership with the Ministry of Health and Fight Against HIV/AIDS (MSLS),
the Ivorian Society of Obstetricians and Gynecologists (SOGOCI) and other
stakeholders, Jhpiego helped form a national technical working group (TWG) to
advocate for a cervical cancer prevention and control policy that incorporates the
single visit approach. The TWG is also responsible for adapting service delivery
guidelines and training materials. With support from the TWG, Jhpiego aims to:
1) train and mentor hospital staff on the single visit approach; 2) develop and
implement a referral system for treatment of women who have lesions that cannot
be removed using cryotherapy, and those with invasive cervical cancer; 3) develop a
monitoring and supervision system for quality assurance; and 4) include cervical
cancer prevention in pre-service education curricula.
Building on the success of this approach, in 2013, Jhpiego began working under
a new, five-year award from CDC to provide technical assistance to the
Government of Côte d’Ivoire to increase its capacity to reduce the morbidity and
mortality of people living with HIV/AIDS and prevent HIV infections among
newborns. This is being achieved by increasing access to high-quality services for
PMTCT and HIV care and treatment services, and increasing access to cervical
cancer prevention. Anticipated results include:
A nurse screens a woman for cervical
cancer at a health clinic in Abidjan while
another health worker positions the light.

MSLS and CDC/PEPFAR implementing partners have the capacity to
improve access to and uptake of high-quality cervical cancer screening
services for HIV-infected women.

The MSLS has been assisted to develop, implement and evaluate an
integrated chronic care model for individuals infected with HIV and other
chronic diseases for each level of the health pyramid.

The MSLS has a demonstrated capacity to plan and scale up effective,
integrated HIV PMTCT, testing and counseling, and care and treatment
services within the existing health care and social services systems, including
the management of chronic diseases such as HIV/AIDS.
Impact Evaluation of an Integrated Chronic Care Model on
Retention Rates among Adults on Antiretroviral Therapy
With funding from 3ie, Jhpiego will implement a pilot intervention related to a
context-specific, integrated chronic care model to show the benefit of a
comprehensive chronic care approach.
Adult retention in HIV treatment, as well as access to other integrated health
services (TB symptom screening, sexually transmitted infection screening, family
planning service provision and hypertension screening) will be assessed after
six months of the intervention to determine the intervention’s effectiveness and
feasibility. This information will provide evidence to decision-makers on how to
optimize HIV/AIDS outcomes and will be hugely important for advancing the
health policy discussion within Côte d’Ivoire.
Resources towards Elimination of Child Vulnerability Project
Jhpiego is supporting Save the Children on the USAID-funded Resources
towards Elimination of Child Vulnerability (REVE Côte d’Ivoire) project to
strengthen the capacity of families and community networks to ensure the
well-being of their most vulnerable members, including persons living with HIV
and AIDS, orphans and vulnerable children (OVC) and adolescent girls. Jhpiego
will serve as the technical lead for clinical linkages and associated training and
capacity-building activities under the project goal of increasing utilization of
HIV and other health services by vulnerable groups. In particular, Jhpiego will
provide long- and short-term technical assistance to:
 Strengthen health sector participation in OVC platforms and establish
routine information-sharing procedures
 Strengthen the referral and counter-referral system to link HIV-affected
households to clinical services through social centers and health facilities in
the target zones, including referrals for a complete package of youth-friendly
reproductive health services
 Train social workers
Key Accomplishments

Under the cervical cancer prevention program, 21 sites are providing cervical
cancer screening and treatment using cryotherapy and two sites are also
providing treatment with loop electrosurgical excision procedure to treat
larger lesions.

To date, Jhpiego has trained 128 providers, who have screened more than
21,875 women. Of the women screened, 1,048 had lesions eligible for
treatment and 917 (88%) eligible women received treatment. More than
80% of women who were eligible for treatment received cryotherapy and the
others were referred for additional treatment.

Five antiretroviral therapy service sites have achieved at least 80% adherence
to HIV care and treatment performance standards.

Ten PMTCT sites have achieved at least 80% adherence to HIV care and
treatment performance standards.
Partners and Donors

Jhpiego collaborates closely with the MSLS, particularly the National
Program for Care and Treatment of People Living with HIV/AIDS, as well
as with SOGOCI and the schools of medicine, midwifery, nursing and
social work.

Jhpiego’s work in Côte d’Ivoire is currently funded by the CDC, 3ie and
USAID.
A health worker at the Treichville Hospital
in Abidjan prepares the simple vinegar
solution for a rapid cervical cancer
detection while two others watch and
learn.
References
Joint United Nations Programme on HIV/AIDS (UNAIDS). 2010 Report on the Global AIDS Epidemic.
At: http://www.unaids.org/globalreport/Global_report.htm
Population Reference Bureau. 2014 World Population Data Sheet. Washington, D.C.
World Health Organization (WHO) Global Health Observatory Data Repository. Accessed at:
http://apps.who.int/ghodata/?theme=country
Castellsagué X, et al. HPV and Cervical Cancer in the World. 2007 Report. WHO/ICO Information Centre on HPV and
Cervical Cancer (HPV Information Centre). At: www.who.int/hpvcentre