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(Mnch&N) Services in Seven Priority

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(Mnch&N) Services in Seven Priority REPORT ON A BASELINE ASSESSMENT OF MATERNAL, NEONATAL AND CHILD HEALTH AND NUTRITION (MNCH&N) SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES September – November 2009 Prepared by: Prepared for: Health Systems Trust UNICEF 34 Essex Terrace 6th Floor, Metro Park Building Westville, 3630 351 Schoeman Street, South Africa Pretoria, 0002 P.O. Box 4884 Enquiries: Ms Jeanette R Hunter Pretoria, 0001, South Africa Chief Executive Officer Health Systems Trust Attention: Dr Ndaye David Kalombo Tel: 011 312 4523 Snr. HIV and AIDS Specialist Email: [email protected] UNICEF South Africa ACKNOWLEDGEMENTS HST thanks the South African Department of Health and the United Nations Children’s Fund for conceptualizing and funding this project. HST staff enjoyed cooperation and support from provincial heads and managers of the four provincial departments of health, as well as from district and sub- district managers and staff. Thank you also to facility managers and staff who allowed us entry to conduct these assessments and provided their record books and responded to numerous questions. We believe that women and children and thus families and communities in South Africa will benefit from quality interventions motivated by the findings of this report. BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES ii TABLE OF CONTENTS ACKNOWLEDGEMENTS ................................................................................................................................................ ii LIST OF ABBREVIATIONS ............................................................................................................................................. iv EXECUTIVE SUMMARY ................................................................................................................................................ vi INTRODUCTION ............................................................................................................................................................ 1 BACKGROUND .............................................................................................................................................................. 1 BRIEF DESCRIPTION OF PROJECT LOCATION ............................................................................................................... 5 METHODOLOGY ........................................................................................................................................................... 7 Study design ............................................................................................................................................................. 7 Study setting ............................................................................................................................................................ 7 Study population ...................................................................................................................................................... 7 Exclusion criteria ...................................................................................................................................................... 7 Sampling................................................................................................................................................................... 7 Measurement instrument ........................................................................................................................................ 8 Data sources ............................................................................................................................................................ 8 FINDINGS ...................................................................................................................................................................... 9 Health and Health Service Indicator Status Pertaining to Quality of Care and Services within MNCH&N, with Specific Focus on PMTCT ......................................................................................................................................... 9 1. EASTERN CAPE PROINCE – ALFRED NZO DISTRICT ......................................................................................... 9 2. EASTERN CAPE PROVINCE – AMATHOLE DISTRICT....................................................................................... 14 3. EASTERN CAPE PROVINCE – CACADU DISTRICT ........................................................................................... 19 4. EASTERN CAPE PROVINCE – CHRIS HANI DISTRICT ...................................................................................... 24 5. KWAZULU-NATAL PROVINCE – ETHEKWINI METRO DISTRICT ..................................................................... 28 6. MPUMALANGA PROVINCE – EHLANZENI DISTRICT ...................................................................................... 34 7. NORTH WEST PROVINCE – DR RUTH S MOMPATI DISTRICT ........................................................................ 38 Factors Contributing to Service Weaknesses ....................................................................................................... 43 1. EASTERN CAPE PROVINCE – ALFRED NZO DISTRICT ..................................................................................... 43 2. EASTERN CAPE PROVINCE – AMATHOLE DISTRICT....................................................................................... 44 3. EASTERN CAPE PROVINCE – CACADU DISTRICT ........................................................................................... 45 4. EASTERN CAPE PROVINCE – CHRIS HANI DISTRICT ...................................................................................... 46 5. KWAZULU-NATAL PROVINCE – ETHEKWINI METRO DISTRICT ..................................................................... 47 6. MPUMALANGA PROVINCE – EHLANZENI DISTRICT ...................................................................................... 48 7. NORTH WEST PROVINCE – DR RUTH S MOMPATI DISTRICT ........................................................................ 49 CONCLUSION .............................................................................................................................................................. 50 ANNEXURES ................................................................................................................................................................ 51 ANNEXURE A: LIST OF THE 18 PRIORITY DISTRICTS AND SUB-DISTRICTS WITH THE HST MNCH&N PROJECT STUDY AREAS HIGHLIGHTED........................................................................................................... 51 ANNEXURE B: AVAILABILITY OF MNCH&N SERVICES ............................................................................................. 52 ANNEXURE C: INTEGRATION OF ANTENATAL CARE WITH HIV AND AIDS CARE .................................................... 56 ANNEXURE D: FACILITIES PROVIDING HAART ........................................................................................................ 61 ANNEXURE E: AVAILABILITY OF ESSENTIAL PMTCT SERVICES DURING LABOUR AND POST-DELIVERY ................. 65 ANNEXURE F: AVAILABILITY OF PHARMACEUTICALS ............................................................................................. 69 ANNEXURE G: PROFESSIONAL NURSES AND LAY COUNSELLORS TRAINED ON KEY MNCH&N COURSES ............. 72 ANNEXURE H: AVAILABILITY OF SKILLED STAFF TO CARRY OUT EMERGENCY ACTIVITIES IN HEALTH FACILITIES . 77 ANNEXURE I: AVAILABILITY OF ANC EQUIPMENT AND SUPPLIES AT HEALTH FACILITIES ..................................... 80 ANNEXURE J: AVAILABILITY OF INFORMAITON EDUCATION AND COMMUNICATION (IEC) MATERIAL ................ 87 ANNEXURE K: PART A: REVIEW OF ANTENATAL, LABOUR AND POSTNATAL SERVICES- ....................................... 91 PART B: RECORD REVIEW TEMPLATE ........................................................................................... 103 ANNEXURE L: FACILITY REGISTERS AND INFORMATION REQUIRED FOR THE MNCH&N AND PMTCT ASSESSMENT ................................................................................................................................. 113 BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES iii LIST OF ABBREVIATIONS AIDS Acquired immune deficiency syndrome ANC Antenatal care ART Antiretroviral treatment ARV Antiretroviral AZT Azidothymidine/Zidovudine treatment BANC Basic antenatal care BBA Born before arrival BP Blood pressure CCG Community Care Giver CCMT Comprehensive care management and treatment CD4 Cluster of differentiation 4 CHC Community Health Centre CHW Community Health Worker CTX Cotrimoxazole DHIS District Health Information System HAART Highly active antiretroviral therapy Hb Haemoglobin HCT HIV counselling and testing HGE Health/group education HHCC-IMCI Household Component of Community Integrated Management of Childhood Illnesses HIS Health information system HIV Human immune virus HIV+ Human immune virus – tested positive HST Health Systems Trust IEC Information, education and communication IMCI Integrated management of childhood illnesses M2M2B Mothers-To-Mothers-To-Be MDG Millennium Development Goal MER Monitoring, evaluation and reporting MMR Maternal mortality rate MNCH Maternal, neonatal and child health MNCH&N Maternal, neonatal and child health and nutrition NDoH National Department of Health NVP Nevirapine PCR Polymerase chain reaction
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