Government-funded programmes and services for vulnerable - Unicef

Government-funded programmes and services for vulnerable children in SA
Infant testing is complicated, requiring specialised equipment and reliable transport. As a
result, infant testing is often not available at all health facilities, especially those in more
remote rural areas. The polymerase chain reaction (PCR) test for infants, for example, is
effective but complicated. Clinical capacity is a major obstacle inhibiting scaling up of
PCR testing. In 2006, it was only available at six sites. In addition, the results can take up
to two weeks, during which time patients are lost to follow-up.
Children diagnosed too late
Children are being diagnosed too late. They are only being diagnosed and treated when
they are seriously ill. One of the reasons for this is the lack of early HIV screening
at community health facilities providing routine baby and childcare services, such as
immunisations and growth monitoring (Shung-King & Roux 2005). One of the innovations
of the 2010 HIV/AIDS policies is the decentralisation of HIV/AIDS services to primary
healthcare facilities, with the aim of integrating testing, prevention and treatment services
into all primary healthcare programmes for women, infants and children.
Facilities not youth-friendly
Despite the National Adolescent-Friendly Clinic Initiative, many youth are reticent about
being tested because of healthcare workers’ moralistic attitudes to sexually active youth
(Shung-King 2005).
Antiretroviral therapy/treatment
ART started too late
Treatment has been starting too late for infants and children, largely because testing and
diagnosis have been happening too late.
ART does not reach enough children
Cotrimoxazole is not reaching enough children. Cotrimoxazole is not reaching enough
children. In 2008, 9% of HIV-exposed and HIV-infected infants in Southern Africa were
receiving it. (WHO, UNAIDS, UNICEF 2009: 110). In South Africa, the Cotrimoxazole
coverage is not much better at 26 per cent (DoH et al. 2008).
Not enough children are on ART. On average, only 36 per cent of children in need of
ART are receiving it. There are, however, significant provincial variances in coverage rates.
For example, coverage in 2007/08 was 97 per cent in the Western Cape, but only 22 per
cent in the Free State (Scorecard 2009).
The reasons for poor ART coverage have included, to date, an insufficient number of
treatment sites; a lack of qualified and skilled staff to screen and identify children in need of
ART, and then to prescribe and administer ARVs at accredited sites; insufficient staff to cope
with the size of the demand in a community; lack of supplies and medications; and lack of
administrative services in clinics, so preventing the proper patient record keeping necessary
for effective case management and treatment (Shung-King 2005). Treatment sites are too
far from communities needing the service, which is especially problematic in the case of
children who are seriously ill. These barriers have been addressed in the revised 2010 ART
guidelines, which provide for nurse-initiated ART in primary healthcare facilities.
Impediments to maintaining ART
Once on treatment, the distance to clinics, transport costs, and lack of accessible financial
and psychosocial support means that many children do not adhere to their treatment.
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