Master's Project Title:

Process Evaluation of Tiny tim and Friends, Prevention of Mother to Child Transmission of HIV: A Qualitative Analysis From Lusaka, Zambia

MCH Student:

Stephanie Hengst

Date of Defense:

September 18, 2009


Background:  An evaluation of Tiny Tim and Friends (TT&F), a non-governmental organization operating in Lusaka, Zambia was conducted. TT&F provides health services and treatment for pregnant women, co-infected with HIV and tuberculosis, for the prevention of mother-to-child-transmission of HIV (pmtct). The program has also developed a relationship with a Women’s Group, a social support group whose members also engage in income generating activities.

Objectives:  The evaluation objectives are as follows: define planned activities and document services delivered, determine if activities are relevant to program objectives, determine necessary resources to implement planned activities, assess program plan to engage community partners in the prevention of pmtct, and identify opportunities for growth and improvement.

Methods:  Qualitative methodology was used to gather and analyze the data. Stakeholders were engaged through meetings, interviews, and focus groups in Zambia and the US.

Results: Analysis of the data provided feedback on the evaluation objectives. Services described by patients matched the mission set by TT&F. Staff identified key resources necessary to carry out program objectives including; reliable transportation, consistent funding, and ongoing commitment by staff and volunteers. With their unique mission and grassroots approach, TT&F has been sought out by local organizations in the HIV prevention community to identify, enroll and treat this target population.           In addition, several themes emerged throughout the evaluation process apart from the outlined objectives. Medical treatment and additional support, such as nutrition or education, were inseparable expectations by patients. Miscommunication and a lack of transparency about the relationship between the Women’s Group and TT&F led to a sense of frustration and vulnerability among the group members. Counseling services were described as ‘strong’ compared to other clinics and staff was perceived as ‘cohesive’ by patients new to the program. Staff was passionate about their work and reported personal sacrifices to advance the mission of TT&F.

Discussion:  TT&F’s dedication to serving these women for pmtct is commendable not only for addressing the health status of this targeted population, but also for tackling the public health issue of HIV transmission in a high risk region. For future planning, an opportunity for growth and development of the program would be to invest in a vehicle. This would allow for outreach to be conducted more easily and efficiently, reducing the burden on expenditures and staff time. The collaborative relationship between TT&F and the Women’s Group is another area that could benefit from further development and definition of expectations, considering the medical services are reported to be satisfactory.