N Rasmeni: Prevention of Mother to Child Transmission (PMTCT) awareness
roadshow

21 September 2007

Programme Director, we are gathered here today as part of an ongoing
campaign to educate one another on the importance of the Prevention of Mother
to Child Transmission (PMTCT) programme. We started this campaign with a road
show in the Southern District where we visited clinics and had an opportunity
to interact with all stakeholders in this programme. This is a provincial
roadshow hence we want to assess the situation in all the districts with a view
to capacitate the PMTCT programme in the entire province.

It will therefore be important to get to know of the challenges faced in
this particular district so that we can together develop plans to eradicate
them so that we may improve on the situation. We all now know that mothers on
the programme experience a number of difficulties among which are stigma
related ones. Like I emphasised during the Budget Speech, we are convinced that
as we intensify this programme we can achieve the goal of having an AIDS free
generation beyond the second decade of freedom.

We are also cautious of the fact that stigmatisation results in mothers
staying away from the service and this cause them to mix feed (breast and
formula feeding) defeating the purpose and effects of Neviripine. This may be a
contributory factor to some children testing HIV positive at the age of 12
months. All these considerations confirm that PMTCT has become such a critical
programme in our health service delivery priorities and it must be treated with
that level of importance.

This awareness road show will therefore unfold to all the districts,
spreading the messages and encourages stakeholders' commitment to the
programme. I am hopeful that, as we engage one other throughout these
roadshows, we will be able to critically evaluate the work we are doing as a
department and as individual districts and institutions in our effort to
improve the PMTCT.

The National Strategic Plan (NSP) for HIV and AIDS and Sexually Transmitted
Infection (STI) for 2007-2011, adopted by Cabinet earlier this year, have made
room for the introduction of dual therapy to reduce
mother-to-child-transmission of HIV. Furthermore, the move from single dose
nevirapine to dual therapy (nevirapine and AZT) has been discussed by the
National Health Council (NHC) which is made up of the Minister and MECs for
Health. The discussions centred on the recommendations of the Medical Research
Council (MRC), National Essential Drugs Committee and the Medicines Control
Council (MCC) to move to dual therapy.

The National Health Council took a decision to evaluate the use of
Nevirapine in reducing mother to child transmission of HIV. The NHC also
deliberated on implications for implementation including training and capacity
of health workers, adherence counselling and support to women. Further work is
being done to improve guidelines and facilitate appropriate training for health
workers, stock management, monitoring of resistance and information management
for the introduction of such a therapy.

As a department, we are on course in as far as improving access to HIV
testing and counselling in antenatal clinics. Obviously more work still needs
to be done. There is a need to also improve family planning services to known
HIV positive women, to improve access to comprehensive reproductive health
services for HIV positive women, to train reproductive health providers on HIV
and AIDS counselling and to implement clinical guidelines to reduce the
transmission of HIV during childbirth and labour.

We must also look at the importance of training all relevant midwives and
medical practitioners as we continue to capacitate this programme. All these
good intentions are captured in the National Strategic Plan for HIV and AIDS
and it remains our responsibility to ensure that the province benefit from
it.

It is important as we move forward that we take note of the challenges of
that district has made us aware of in this programme which includes the
following:

* that there is no HIV co-ordinator in the district
* that there is inadequate use of data analysis and information for action at
facility, sub-district and district level
* not all families are part of the PMTCT programme
* that there is a challenge of mixed feeding by mothers and their
families
* the challenge of migration, farm workers and mine workers
* that not all midwifes are trained on coding system
* that HIV PCR was introduced into the District Health Information System only
in October 2006/07
* PMTCT training is still being conducted.

Our efforts must now be geared towards improving capacity and to strengthen
this programme by addressing the challenges experienced. The appointment of
district programme co-ordinators therefore becomes one of the things we need to
priorities. We must continue to mobilise and educate communities about PMTCT so
that they can begin to get seriously involved and assisting the situation. In
this regard, our antenatal clients (the mothers) become our primary target.
This will also assist the aspect of uptake improvement.

Ongoing counselling and information during the antenatal and postnatal
period to support infant feeding and other decisions such as disclosing HIV
status remains critical. For pregnant women to make informed decisions about
reducing their risks of transmitting HIV to their infants, they must know their
HIV status. Therefore, counselling and HIV testing is the entry point into the
PMTCT programme. Making counselling and testing services available in our
health institutions and clinics is therefore a key PMTCT programme
objective.

Our support groups will also assist a lot. In this regard, the
de-stigmatisation of HIV and AIDS at both the community level and the health
service level may enable individuals with HIV to feel more comfortable
disclosing their status to health workers. It is important that we emphasise
the fact that HIV-infected women need to receive ongoing counselling and
support for whichever infant feeding choice they make. So, in this case the
role of community support or support groups can also go as far as enfant
feeding. We got to learn that community support is especially important for
women's feeding choices in contexts where decisions are not made by the mother
alone and where cultural or family practices are highly influential in
determining ultimate practices.

Other key areas of PMTCT include healthcare infrastructure namely human
resources, training, management, information systems and management of
consumables and supplies. We must really look at ensuring that lay counsellors
training focus not only on counselling skills needed for HIV testing but also
include counselling on infant feeding options. Of course this goes hand in hand
with the supervision, support and mentoring of lay counsellors as well as their
motivation in terms of remuneration. Training here also extend to health
workers in this programme.

It is important that all stakeholders in this programme take seriously the
challenges that still remain so that we may see continuous improvement in the
reduction of mother to child transmission of HIV and AIDS.

I thank you.

Enquiries:
Zakes Molala
Acting Departmental Spokesperson
Tel: 018 387 5830
Fax: 018 387 5830
E-mail: lmolala@nwpg.gov.za

Issued by: Department of Health, North West Provincial Government
21 September 2007
Source: North West Provincial Government (http://www.nwhealth.gov.za)