Research on the Integration of HIV, Maternal and Child Health Services in KwaZulu-Natal

UKZN’s Centre for Rural Health (CRH) has developed an intervention model that is designed to assist public health clinics in KwaZulu-Natal to integrate maternal, child, women’s health (MCWH) and HIV services into the well child setting.

This was announced when the Centre recently held a feedback session on one of its research projects funded by the United Nations Children’s Fund (UNICEF) and supported by KwaZulu-Natal’s Department of Health.

Dr Christiane Horwood, a member of the Centre’s research team said, ‘Although uptake of services for prevention of mother-to-child transmission of HIV (PMTCT) is high in the antenatal period in KwaZulu-Natal, there is considerable loss to follow up once the baby is born.’

‘Many HIV infected mothers and their babies do not receive key interventions that have been shown to improve outcomes. Uptake of postnatal care for mothers, including family planning, is also poor. However, immunisation services are well attended. So, providing key PMTCT and maternal health interventions during well-child visits provides an opportunity to increase uptake of these interventions within existing services.’

The study found that mother-baby pairs do attend the clinics timeously but they do not receive a comprehensive range of services at this visit.  This was due to a number of factors including lack of role clarification in terms of who should be responsible for providing key services to mothers and their babies, and a lack of coordination of services leading to missed opportunities for care and fragmentation of services and equipment.

Lack of privacy and long waiting times were also identified as barriers to providing quality of care to mother-baby pairs. The study found that many of the components necessary for an integrated service were available, but they needed to be strengthened and streamlined.

Based on the findings of this research CRH together with the provincial Department of Health identified a range of activities that could be included in an integrated well mother and baby service, the roles and responsibilities of each cadre of health worker in providing this service, and the resources required for its successful implementation.

Recommendations included shifting key tasks to lower cadres of health workers to maximise efficient use of health workers, to train health workers these new roles where necessary, to better coordinate mother and baby services, and to streamline the clinic to prevent fragmentation of services.

The researchers reported that integration is complex and one model of integration may not be suitable in all clinics. ‘Implementation may be dependent on specific circumstances in the individual clinics and clinics may need to adapt the model to suit their own unique circumstances.’

‘The suggestions made in this report on providing an integrated service need to be viewed as flexible and open to change. The piloting of an integrated MCWH and HIV service will shed further light on the way forward.’