Development of A Package for Integration of PMTCT Into Routine MCH Services in South Africa

Background: South Africa has had a national program to prevent mother-to-child transmission (PMTCT) of HIV since 2002. In 2010 the National Department of Health is revising the PMTCT guidelines and has placed renewed emphasis on scale-up. Like many other countries the burden of HIV disease in South Africa resulted in the PMTCT program being implemented vertically, which has been identified as a common reason for the sub-optimal performance of PMTCT. This project has developed practical guidelines and tools for implementation and evaluation of integrated PMTCT services. Methods: A review of case studies of well performing PMTCT sites was conducted in 2009. Best practices for integrated care were identified. A conceptual framework for integration is based on five care areas: Primary prevention, Antenatal care, Labour and delivery, Immediate postnatal care, Ongoing postnatal care (EPI/MNCH). Across these care areas there are 14 identified priority integration activities. A review of existing evaluation tools was conducted to guide the process of assessing integration. Results: A handbook has been developed which presents creative strategies to enhance effective service delivery and PMTCT integration based on the Best Practices case studies. Checklists guide integration of PMTCT into services at clinic level, focusing on critical inputs and required elements and processes to deliver essential PMTCT services for effective integration. The checklists measure program performance, ensure it is on track and guide actions to keep the program at optimal functioning. The evaluation process focuses on developing capacity of district level supervisors to conduct rapid assessments and monitor program data.