Government-funded programmes and services for vulnerable - Unicef

Government-funded programmes and services for vulnerable children in SA
The recent changes to the PMTCT guidelines and the guidelines on the management of
HIV in children have the potential to make a positive difference to the level and quality
of support on infant feeding choices for HIV-positive mothers. It is, however, still early
days and these guidelines only commenced at the beginning of 2010. As such, it remains
to be seen how well systemic challenges within the health system can be overcome to
realise the potential of these guidelines.
It is cause for concern that these new guidelines, being split into as many guiding
documents as they are, are difficult to piece together and in fact do introduce confusion
through inconsistent provisions appearing on the same issue in different documents.
One such contradiction appears in the PMTCT guidelines and the guidelines for the
management of HIV in children. The latter guidelines provide that exclusive breastfeeding
for six months is the preferred option and that mothers who choose to formula feed will
be required to purchase their own formula (section 4.1). The PMTCT guidelines contradict
this in the provision that mothers who choose to formula feed will be provided with at
least six months of free age- and weight-appropriate formula.
Inconsistencies such as these add to the already troubling confusion and poor quality of
feeding option counselling that has been provided up until now.
Insufficient provision of nutritional support
The infant and young child feeding policy makes provision for nutritional support to HIVinfected
pregnant women and those who choose to breastfeed. However, Hendricks et al.
(2003) found in their study that HIV-positive pregnant and lactating women were not put
on the nutritional support programme, primarily because clinic staff were not aware that
they were entitled to this benefit.
PMTCT programme
Insufficient HIV testing and provision of prophylaxis
Approximately 168 000 of the 800 000 public sector births in 2006 were to HIV-positive
women. Only 50 per cent (74 052) of these HIV-positive pregnant women received
nevirapine prophylaxis. Furthermore, the testing rate of babies in public sector births is
very low. Of the 800 000 births in 2006, the HIV status of only 3 per cent of the babies
was known and, of these 3 per cent, the transmission rate was 18 per cent, which is
much higher than the targeted 5 per cent transmission rate (Barron et al. 2006; Ministry of
Health 2007). These statistics are the product of the previously limited PMTCT policies and
programmes. The 2010 amendments to these policies have been designed to remedy the
shortcomings, but whether the desired impact will be achieved depends on the proper and
timeous application of the various progressive guidelines and the ability to overcome the
more systemic health challenges which impact on all healthcare programmes and services.
Poor coverage of antenatal visits
The coverage of antenatal visits in South Africa is high for one visit, standing at 94
per cent, but it drops to 73 per cent for four visits or more and to below 30 per cent
for antenatal visits before 20 weeks. This means that there are significant missed
opportunities for counselling, testing and introducing the PMTCT programme to the
pregnant mothers and infants that are not accessing antenatal clinics and maternity health
facilities (DoH et al. 2008). In addition, the care that is provided at the visits that do take
place does not include sufficient access to counselling and HIV testing. Access to the
PMTCT programme is via HIV testing by a pregnant woman at her antenatal facility. If she
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