Government-funded programmes and services for vulnerable - Unicef

Department of Health
is found to be HIV positive, she is invited to join the PMTCT programme. Recent evidence
indicates that a significant number of women attending antenatal facilities are not offered
HIV testing and counselling. The reasons for this include inadequate counselling of
patients, as well as shortages of counsellors and testing supplies (Nkonki et al. 2007).
HIV interventions in the post-natal period
The Every Death Counts report (DoH et al. 2008) found that, while antenatal care is
accessible to and accessed by the majority of South African pregnant women, the same
cannot be said for post-natal care and support. Availability of and access to key HIV
interventions drop significantly from the time of childbirth and in the post-natal period,
when they are the most crucial. The post-natal period is crucial for counselling and
support in respect of infant feeding options and maternal nutrition, testing and the
commencement of treatment of the infant. Once the mother and baby leave the clinic or
hospital, there is no system for routine follow-up of mother and baby.
Insufficient trained personnel to prescribe antiretrovirals
Until the ART amended guidelines were introduced in March 2010, only doctors could
initiate and prescribe antiretrovirals (ARVs). Nurses are now authorised to initiate and
administer ART. Once again, the challenge that remains is the inadequacy of existing
human resources to meet current, let alone additional, healthcare obligations.
Lack of coordination between adult and paediatric treatment programmes
There is a lack of coordination and linkages between adult and paediatric care and
treatment programmes. As a consequence, the mother’s HIV status is often not linked to
her HIV-exposed child, resulting in a lack of appropriate and adequate follow-up and
treatment for both the mother and the baby. In addition, the lack of coordination across
prevention and treatment programmes means that there are not quick and effective
referrals between PMTCT and ARV programmes (which are often available at different
physical locations/facilities). This results in delayed commencement of ART for pregnant
mothers with low CD4 counts, which in turn contributes to increased rates of transmission
to their infants (Kak et al. 2006, in Markovitz 2008). There is a similar lack of coordination
between maternal and child health programmes. At the moment, if a baby goes through
the PMTCT programme, they should be, but are not, followed up and tested. If they
test positive, they need to be referred to a clinic where they can access ART. This is not
happening, and as a result, clinics are seeing children when they are desperately ill.
The service needs to be anticipatory and preventative. Children should be coming from
maternity services much earlier. 67
Poor partner participation
There has been a consistent lack of partner participation in the PMTCT programmes.
HIV testing and counselling
Testing of infants
Not enough babies are tested. Of the 800 000 births in 2006, the HIV status of only 3 per
cent of these babies was known (Barron et al. 2006; Ministry of Health 2007). Once again,
the revised 2010 PMTCT guidelines aim to remedy this deficiency by ensuring the early
testing of all infants.
67 Personal communication between Dr David Power and Laura Markovitz, in Markovitz (2008)
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