COMMUNITY BASED SITUATIONAL ANALYSIS Maternal and ...

SECTION 4:
FACILITY BASED REVIEW OF PMTCT FOLLOW-UP SERVICES
Methods
Data collection methods consisted of semi-structured interviews with 16 respondents who were
involved in the management and running of the PMTCT programme at either Paarl or Rietvlei.
The respondents included sub-district HIV and AIDS Coordinators, PMTCT Coordinators,
maternity matrons, maternity ward and PHC clinic staff.
Results
Voluntary Counselling and Testing
Human Resources
In Paarl, neither hospital nor clinic professional nurses were routinely trained in VCT. However,
Paarl has lay counsellors who were trained by a private psychologist for a month. The
counsellors were hired on a part-time basis and they usually worked in the mornings. Once a
month, the counsellors receive emotional support from a psychologist in a four hour group
session. In addition, the counsellors were supported, supervised and monitored by a local
NGO.
In Rietvlei all professional nurses were trained in VCT but staff turnover was a problem. For
example, in the hospital, staff in the maternity ward had been trained, but due to staff rotation
there were times when the maternity ward had no VCT trained professional nurses. Therefore,
the demand for training was ongoing. Also Rietvlei had a two-week training for lay counsellors
provided by VCT trainers from the sub-district. They had trained five lay counsellors for each
facility who provided counselling services from 8h00– 6h00 on weekdays. The lay counsellors
were supposed to be supported, supervised and monitored by the clinic sisters; however, the
clinic sisters were neither informed of, nor skilled for, this role. In addition, lay counsellors
remuneration through the District Municipality was problematic and the counsellors were last
paid in 2003 (two years prior to this study).
In order to address the challenges associated with the lay counsellors remuneration,
community based activists (volunteers) who promoted VCT had recently been trained and
started providing VCT services. However, Rietvlei still has a problem with supervision and
monitoring these volunteers because the sub-district HIV and AIDS coordinator who is
mandated to carry out these tasks is too busy to provide this support.
Referral Pathway
Paarl: The referral pathway was complicated because ANC services were not provided at the
PHC clinics. Pregnant women were referred to the hospital Out-patient Department (OPD) for
ANC. After delivery at the maternity facility in the hospital which is located at another venue,
patients were discharged and asked to go back to the OPD for post-natal care. PMTCT clients
were referred from the post-natal ward to another section of the OPD and eventually referred
back to their local clinic.
In spite of the complicated referral pathway described above, communication between the
hospital and clinics was perceived as both effective and efficient by health workers at the
clinics, OPD and the hospital. For example, all patients who had attended ANC had been
informed about the PMTCT programme and received VCT if they agreed to participate in the
Community Based Situation Analysis: Maternal & Neonatal Follow-up Care 34