RHD Prelude Chapter - Health Systems Trust

availability, access and uptake of reproductive services vary between districts, as described
below.
According to the PHC Service Package (see Chapter 6.4) reproductive health services are
available at all mobile and fixed clinics and all community health centres (CHC), with linkage
to the District Hospital Package of Services. The reproductive services of the PHC package
include:
• Antenatal care – including screening for syphilis infection, PAP smears and counseling
for VCT and inclusion in the PMTCT programme is necessary.
• Post natal care.
• Maternal health – uncomplicated deliveries in clinics and community health centres.
• Counseling and referral (if necessary) for termination of pregnancy.
• Counseling and referral (if necessary) for voluntary testing for HIV infection.
• Screening for cervical cancer.
• Contraceptives.
• Diagnosis and treatment of sexually transmitted infections.
The level of care within each category at mobiles, clinics and CHC is defined in the Package.
All services are expected to be available within each health district on a 24 hour basis; at clinics,
CHC and/or district hospitals. Some of the services allocated to CHC in the Package are likely
to remain with the district hospitals due to the CHCs not being fully operational.
All services are offered in an integrated fashion. Nursing staff have generally adjusted to these
changes. Fast queues are used for patients requiring one service or repeat medication so that
they do not have to wait as long. This was explained by the Central Region Director:
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“Each clinic provides that kind of health service … there has been changes… family planning
clinics are part of mother and child services in the clinic – there are no separate days for
family planning as previously. … we have also created fast lines, so that the person who
is coming for (repeat) family planning does not queue for long time …”
(Regional Health Director)
The integrated service means that a patient is seen by one nurse who attends to all his/her
requirements, as explained by a district MCWH coordinator.
“… when a mother has brought her child for immunisation … we don’t concentrate on only
the child; when the mother comes we also ask if there is anything that she would like us
to attend to concerning her … she goes out having had information … having had her
contraceptives…”
(Health District MCWH Coordinator)
HIV/AIDS programmes are integrated at the service level, although managed vertically from
the national and provincial levels (as described previously).
“… the HIV programme is integrated into the primary health services … like prevention
of mother to child transmission of HIV/AIDS it is provided in all primary health care
facilities. … so a client gets a comprehensive care package. And the other STI services like