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 PHC Primary health care PICT Provider-initiated counselling and testing PMTCT Prevention of mother-to-child transmission PN Professional nurse STI Sexually transmitted infections
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES iv TAT Turnaround time TB Tuberculosis UNICEF United Nations Children’s Fund VCT Voluntary counselling and testing WBC Well-baby clinic WHO World Health Organization
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES v EXECUTIVE SUMMARY
The South African Department of Health, commonly referred to in South Africa as the National Department of Health (NDoH), has prioritised improvements in the health of mothers and children through strategic health programme interventions. To improve the capacity of health districts performing poorly with regard to mother and child health indicators and to meet the Millennium Development Goals (MDGs) NDoH has identified and prioritised 18 health sub-districts across South Africa as districts that need interventions for improvement.
The Health Systems Trust (HST) was commissioned by the NDoH, through the United Nations Children's Fund (UNICEF), to support the implementation of improvements in the quality of care with regard to maternal, neonatal and child health and nutrition (MNCH&N) services in seven districts.
Six of the seven health districts in this project contain one of NDoH’s 18 priority sub-districts (see Annexure A) identified for priority attention and support in delivering maternal and child health services. The six districts are Cacadu, Chris Hani, Amathole and Alfred Nzo in the Eastern Cape Province, Ehlanzeni in Mpumalanga Province and Dr Ruth Segomotsi Mompati (RSM) in North West Province. The seventh district, eThekwini in KwaZulu-Natal (KZN) is not one of the three KZN districts on the NDoH’s priority list. This is because the three priority districts in KZN were already supported by other partners and eThekwini district was then selected as it had poor maternal and child health outcomes. In some cases the eThekwini MNCH outcomes were lower than those of the priority sub-districts selected in the province.
HST and UNICEF developed the MNCH&N project and one of the initial deliverables of the project is to conduct an assessment to determine the factors contributing to poor results pertaining to prevention of mother to child transmission of HIV (PMTCT) in the seven districts. The findings of the assessment are to be used to develop locally relevant integrated MNCH&N district plans which will be incorporated into the official district health plans (DHPs). The results of this baseline study are also to be used to guide HST’s support interventions in these districts.
Methodology
The assessment was conducted in a total of 111 health facilities (12 CHCs, 99 clinics) from the seven priority sub-districts, one from each of the seven selected districts. Patient records (mothers and children) as well as data collection tools were studied and managers and staff were interviewed.
Findings
Status of Service Provision The findings indicate variations in health service provision and in health indicator status between the districts, but these are not vast.
All seven districts lagged behind with regard to percentage of facilities providing highly active antiretroviral therapy (HAART). In addition Alfred Nzo (60%), Chris Hani (43%), eThekwini (17%) and Cacadu (7%) had limited facilities providing delivery services.
Percentage of facilities where antenatal care (ANC) clients were screened for TB as required, ranged from 29% (Ehlanzeni) to 86% (Amathole).
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES vi NDoH has set a target of at least 40% of pregnant women presenting for their first ANC visit before 20 weeks gestation. Averages for districts ranged from 16% (RSM) to 39% (Cacadu).
Mothers who tested positive for HIV who had their CD4 count tested ranged from 31% (RSM) to 93% (Amathole), while the percentage of facilities providing HAART in these districts were Chris Hani 6%, Ehlanzeni 9%, Alfred Nzo 10%, Cacadu 10%, eThekwini 23%, Amathole 54% and RSM 54%.
Record keeping with regard to babies receiving PCR tests at six weeks was poor. On being interviewed, facilities in one of the districts reported that all exposed babies are tested but there were no records to confirm this.
In all districts there was interaction with community groups but very few facilities had meetings with such groups. Of those facilities that did have such meetings, even fewer discussed MNCH&N matters as part of the agenda.
The laboratory turnaround times were poor in all the districts assessed.
The percentage of professional nurses trained on key MNCH&N procedures varied between facilities and districts. A common finding throughout all seven districts was, however, that more professional nurses need to be trained on provider-initiated testing and counselling (PICT), basic antenatal care (BANC), infant feeding, adult HIV and AIDS management, paediatric ART management and the use of information.
Recording, data management and thus reporting is poorly managed at facilities, leading to poor data quality at district level. Services were reported as being provided but some facilities did not have confirmatory data. Differences in understanding and therefore interpretation of data elements and indicators were found, leading to differences in the nature of information being collected, collated and reported on for the same data element. There is no consensus on denominator data used to calculate indicator values.
Factors contributing to service weaknesses Human Resources, Staff Skills and Training Managers and supervisors lack adequate knowledge of PMTCT. This leads to ineffective supervision with concomitant poor clinical and administrative processes, poor service implementation and ultimately to poor outcomes for patients. Examples of this are that there is no platform for PMTCT programme reviews and implementation of quality improvement interventions is lacking.
There are high vacancy rates for both professional nurses and doctors in the districts.
There is a lack of relevant training with regard to specific skills required to ensure service quality in the area of MNCH&N. This leads to, amongst other challenges, poor implementation of maternity guidelines and poor recording of care rendered. Training on PICT, BANC, infant feeding, adult HIV and AIDS management, paediatric art management and the use of information need attention.
MNCH&N and PMTCT Service Processes Perinatal review meetings are not accessible to staff because they are conducted in hospitals. Turnaround times for laboratory results are too long. Limited availability of key IEC material hinders the health education initiatives.
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES vii Inadequate social mobilisation and community education resulting in:
low utilisation of preventative services for children, low numbers of pregnant women beginning ANC services in the first trimester, inadequate understanding of PMTCT, maternal health and child health services amongst community members and too few HIV+ mothers receiving counselling on infant feeding options.
Data management, recording and reporting Poor data management at facilities because of:
Poor data management skills amongst health workers Data collection tools not standardized Facilities do not get feedback on data sent to sub-district and district offices Facilities do not have targets for monitoring programme performance
Conclusion
The assessment, and thus this report, is merely one milestone in the NDoH/UNICEF/HST MNCH&N project. The baseline study was completed in November 2009 and the write up of the first draft reports was completed in January 2010. The final report (this report) was completed in May 2010. HST facilitators in the seven districts had already started using the findings in November 2009 to develop locally relevant, integrated MNCH&N district plans that will be incorporated into the official district health plans. At the time (November 2009), HST facilitators in the districts also started using the study results to guide HST’s support interventions in these districts. A number of other project milestones, guided by these findings, have already been achieved. This project is complementary to efforts of other health service partners and provincial departments of health to bring about sustainable improvements in health outcomes for mothers and children and thus families and communities in South Africa.
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES viii INTRODUCTION
The South African Department of Health commonly referred to in South Africa as the National Department of Health (NDoH) has prioritised improvements in the health of mothers and children through strategic health programme interventions. To improve the capacity of health districts performing poorly with regard to mother and the child health indicators and to meet the Millennium Development Goals (MDGs) the NDoH has identified and prioritised 18 health sub-districts across South Africa as districts that need interventions for improvement.
The Health Systems Trust (HST) has been commissioned by the NDoH, through the United Nations Children's Fund (UNICEF), to support the implementation of improvements in the quality of care with regard to maternal, neonatal and child health and nutrition (MNCH&N) services in seven districts.
HST and UNICEF developed the MNCH&N project and one of the initial deliverables of the project is to conduct an assessment to determine the factors contributing to poor results pertaining to prevention of mother to child transmission (PMTCT) of human immune virus (HIV) in the seven districts. The study was completed in November 2009 and the write up of the first draft reports was completed in January 2010. The final report (this report) was completed in May 2010. HST facilitators in the seven districts already started using the findings in November 2009 to develop locally relevant integrated MNCH&N district plans which will be incorporated into the official district health plans. At this time (November 2009) HST facilitators in the districts also started using the study results to guide HST’s support interventions in these districts.
The report continues to describe the background, project location, methodology, findings and the factors contributing to service weaknesses.
BACKGROUND
Maternal and child morbidity and mortality trends serve as a proxy indicator for the socio-economic status and quality of life in a country. In South Africa, there are ongoing efforts to get scientific data to track maternal and child mortality ratios and measure progress towards achieving the MDGs. While the country is world renowned for having developed progressive legislation, policies and programme strategies, the contradiction is that various data sources indicate a worrying trend of generally declining health outcomes and increasing mortality ratios. The concern exists, therefore, that South Africa may not meet the health-related MDG goals by 2015.
Maternal and child health
In relation to MDG 5, South Africa has a target to have reduced maternal mortality by three-quarters by 2015 using 1990 ratios (230 per 100 000 live births) as the baseline statistic. Currently the country is lagging far behind in progress towards achieving this goal with different sources quoting various maternal mortality rate (MMR) figures. The 1998 South African Demographic and Health Survey (SADHS, 1998)1 reported a MMR of 150 per 100 000 live births. In 2004, the National Committee on Confidential
1 National Department of Health. 1998 South African Demographic and Health Survey. 1998, Pretoria Enquiries into Maternal Deaths calculated MMR of 147 per 100 000 live births, whilst United Nations estimates stand at 400 per 100 000 live births in 2005.
The report on Confidential Enquiries into Maternal Deaths indicates that 43% of maternal deaths are attributable to non-obstetric causes, typically infectious diseases such as HIV and AIDS and tuberculosis (TB).2 Poverty and inequality, which affect women disproportionately, are both causes and consequences of HIV and the acquired immune deficiency syndrome (AIDS). Lack of economic opportunities and high unemployment, limited access to health and social services, rapid urbanization, stigma and gender discrimination all exacerbate the impact of HIV and AIDS.
The stillbirth rate is a reflection of the quality of antenatal and intrapartum care. Over the past decade the still birth rate remained constant while the neonatal death rate declined significantly. With over 90% of women attending antenatal care (ANC) it is clear that the challenge is not in the poor attendance at primary health care (PHC) facilities, but rather in the quality of care provided. To institute improvements in quality of antenatal care at PHC facilities, the NDoH aims to increase the number of facilities implementing the Basic Antenatal Care (BANC) strategy3.
BANC is a quality improvement programme that focuses on the minimum level of antenatal care that every pregnant woman should receive. The important objectives of the BANC approach are to promote early attendance at ANC (during the first trimester), to ensure the provision of high quality ANC and to integrate PMTCT into routine ANC provision.
The national annual antenatal survey indicates that in 2008 the HIV prevalence amongst pregnant women was 29.3%. Approximately one million babies are born in South Africa each year. With an estimated risk of 30% HIV mother to child transmission risk without PMTCT intervention, this translates into 300,000 babies born exposed to HIV and 90 000 babies being infected. However, a good PMTCT programme can save about 75 000 of these babies which are at high risk of infection. A spectrum of evidence shows that provision of high quality prevention of parent-to-child HIV transmission services has resulted in less than 2% transmission rate in formula-fed children and less than 5% in exclusively breastfed children.4 The current PMTCT strategy has not assisted the country in meeting the less than 5% targeted transmission rate due to various factors. PMTCT data reflects missed opportunities in relation to management of pregnant mothers, the cluster of differentiation 4 (CD4) testing of HIV positive patients, dual therapy uptake in both mothers and babies and referral for highly active antiretroviral therapy (HAART). The 2005–2007 Saving Children survey5 identifies that approximately half (47%) of child deaths were classified as having World Health Organization (WHO) stage III or IV HIV- related disease. Currently, testing for HIV in children is varied across the country with pockets of excellence where more than 90% (Western Cape) of HIV exposed babies are tested for polymerase chain reaction (PCR) at 6 weeks to areas of poor performance. The Saving of Children report 2005–2007 indicates that in 53% of the child deaths there was no information on the child’s exposure to PMTCT
2 National Department of Health. 2008. Saving mothers report 2005 – 2007: Fourth Report on Confidential Enquiries into Maternal Deaths in South Africa. 3 The National Department of Health Strategic Plan 2010/11 – 2012/13 has as one of its measurable indicators “To increase the proportion of PHC facilities providing BANC” so as to improve the quality of ANC services provided in PHC facilities. The plan is to have 95% of PHC facilities implementing BANC by 2012/13. 4 World Health Organization.2010. PMTCT Strategic Vision2010 to 2015. Preventing Mother to Child Transmission of HIV to reach the UNGASS and Millennium Development Goals. 5 Saving Children Report 2005-2007. The Child Healthcare Problem Identification Programme (PIP).
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 2 services and 15% did not receive Nevirapine (NVP), even though they were eligible for antiretroviral treatment (ART) prophylaxis.
HIV-infected infants have a higher mortality than infants who are not HIV-exposed. During the first six months, HIV-infected infants are at a high risk of developing serious complications of HIV-related disease (high morbidity). With the immune system of an infant in the developing stages, the superimposed HIV infection results in a rapidly weakening immune system.
The introduction of the PMTCT strategy had been primarily associated with preventing the child from becoming HIV positive (HIV+). The strong focus on protecting the unborn child from infection led pregnant HIV+ women to feel that they were being seen as mere conduits to reduce incidence of HIV in newborns, while they themselves were not receiving the benefits of care required for an HIV+ individual. Recently revised PMTCT guidelines now aim to ensure that prevention of HIV transmission to the child is aligned with provision of high quality care to the HIV positive mother, together with the provision of a comprehensive package of care for the pregnant women’s family who may also require this care.6
In 2009 the NDoH identified that, “In contrast to the antenatal and intrapartum periods, little attention has been paid to ensuring that mothers are supported during the early postnatal period. Not only do many maternal and neonatal deaths occur in this period, but mothers also require support in caring for their babies and implementing the feeding choices which they have made. Postnatal visits are not part of routine service delivery in most parts of South Africa.” The ‘triple six approach’ places emphasis on postnatal care at six hours, six days and six weeks post delivery.7
Community participation
Evidence from various research and intervention programmes indicates that effective engagement with individuals and communities around community health literacy improves health and development outcomes (Alison Dunn, 2006).8
In restructuring the National Health System the White Paper on the Transformation of the Health System in South Africa seeks to mobilise all partners, including community members, to reduce disparities and inequities in health service delivery. The restructuring also seeks to increase access to improved and integrated health services, based on primary health care principles in support of an integrated National Health System, giving priority to maternal, child and women's health.
To achieve this integration, programme planners and implementers in South Africa are increasingly employing social mobilization strategies, including implementing the household component of the community Integrated Management of Childhood Illnesses (HCC-IMCI), to strengthen community participation and thereby improve community-based Maternal, Neonatal and Child Health (MNCH) and Nutrition services.
6 National Department of Health. 2008. Clinical Guideline: Prevention of Mother to Child Transmission. 7 National Department of Health South Africa 2009. Strategic plan for maternal, neonatal, child and women’s health and nutrition in South Africa 2009 – 2014. 8 Dunn, Alison, 2006. Treatment literacy: empowering communities to access AIDS treatment. Findings, No. 6, October 2006. Healthlink Worldwide (www.healthlink.org.uk)
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 3 The NDoH has planned improvements in community outreach as part of community-based health programmes which will provide support and thus serve to improve household management of ill children and minimize deaths in the early neonatal period.
Health information systems (HIS)
Programme planners and implementers are also becoming increasingly aware that in order to be effective they need to know, on a regular and ongoing basis whether their interventions are resulting in improvement or not. The MER system, based on three separate but interrelated concepts: Monitoring, Evaluation and Reporting - is considered to be a strategic system adaptable to assess organizational capacity, judge economic effectiveness or predict future sustainability.
Though there are several legislative requirements, e.g. National Treasury Framework for Programme Performance Information, that mandate planners and implementers in South Africa to ensure that all implementation plans are costed and have a specified monitoring and evaluation framework, these appear to be absent in the district health plans of various districts. The result is that performance is not systematically measured for effectiveness and efficiency. Health managers should utilise the MER system to ensure that they are achieving positive change, to identify the most significant change and to provide information that is critical for evidence-based planning and management decisions.
It is in light of the above that NDoH, UNICEF and HST embarked on a baseline assessment in the seven health districts in four provinces to ascertain their current status in terms of MNCH&N services.
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 4 BRIEF DESCRIPTION OF PROJECT LOCATION The MNCH&N project focuses on seven health districts in four provinces in South Africa. Six of the seven health districts in this project contain one of the NDoH’s 18 priority sub-districts identified for priority attention and support in delivering maternal and child health services. The six districts are Cacadu, Chris Hani, Amathole and Alfred Nzo in the Eastern Cape Province, Ehlanzeni in Mpumalanga Province and Dr Ruth Segomotsi Mompati in North West Province. See annexure A.
The seventh district, eThekwini in KwaZulu-Natal is not one of the province’s three districts on the NDoH’s priority list. This is because the three priority districts in KwaZulu-Natal were already supported by other partners and eThekwini was then selected as it had poor maternal and child health outcomes. In some cases the eThekwini MNCH outcomes were lower than those of the priority sub-districts selected in the province.
The map below indicates of the location of these districts in South Africa.
Figure 1: Map of MNCH&N project sites included in the MNCH&N baseline assessment.
Demographic and socio-economic indicator values for the selected districts are provided in table 1 below. The number of facilities assessed in the baseline study, specifying community health centres and clinics separately, is provided in table 2.
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 5 Table 1: Seven priority sub-districts in which HST conducted MNCH&N base-line assessments
Province District Population % Medical % access Deprivation Socio- (mid 2008) aid to piped Index11 economic coverage9 water10 (High quintile12 value=most (1=poor, deprived) 5=best) Eastern Cape Alfred Nzo District 432 531 3.2% 67% 4.46 1 Municipality Amathole District 279 560 11.7% 76% 3.27 2 Municipality Cacadu District 116 575 14% 96% 1.76 4 Municipality Chris Hani District Municipality 158 497 5% 75% 3.74 1 KwaZulu-Natal eThekwini Metro 3 206 837 18.2% 97% 1.81 4 Municipality Mpumalanga Ehlanzeni District 1 589 953 11% 90% 3.16 2 Municipality North West Dr Ruth Segomotsi Mompati District 96 069 6.9% 90.3% 3.41 2 Municipality
9 HST District Health Barometer 2007/8 10 Statistics South Africa. Community Survey 2007 11 HST District Health Barometer 2007/8 (The deprivation index used in the DHB reports is generated using principal components analysis (PCA). PCA identifies the underlying process that has the most influence in determining the outcome of each variable included in the analysis. Each variable is weighted based on its linear association with the underlying process. The weighted variables are then used to construct the deprivation index.) 12 HST District Health Barometer 2007/8
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 6 METHODOLOGY Study design
Health Systems Research with pre and post intervention elements aimed at assessment for programmatic improvements
Study setting
This assessment was conducted in seven districts (see table 2 below) in four provinces, from a total of 18 NDoH priority sub-districts in the country selected on the basis that their performance was lagging on a number of key maternal and child health care indicators.
Table 2: Seven priority sub-districts in which HST conducted MNCH&N base-line assessments
Province District Sub-District Area Popul- Sites assessed (sq kms) ation CHCs Clinics (2002) (mid2007) Eastern Cape Alfred Nzo District Umzimvubu Health 5 533 432 531 1 14 Municipality sub-District Amathole District Mbashe Health sub- 3 030 279 560 3 11 Municipality District Cacadu District Camdeboo Health 29 238* 116 575 1 13 Municipality sub-District Chris Hani District Ngcobo Health sub- 2 259 158 497 2 11 Municipality District KwaZulu-Natal eThekwini Metro Municipality 2 299 3 183 936 1 29 Mpumalanga Ehlanzeni District Bushbuckridge 2 591# 615 895 1 16 Municipality Local Municipality North West Dr Ruth Segomotsi Kagisano Local Mompati District Municipality 14 857 96 069 3 5 Municipality * not including the Aberdeen Plains District Managed Area comprising 13 283 km2 # area prior to transfer from Limpopo to Mpumalanga Province (population in 2002 was 644 861)
Study population
Assessments were conducted on health records of maternal and child populations presenting at health facilities within the sub-district.
Exclusion criteria
Facilities included in the initial sample, but which had already been assessed by other partners were excluded from the initial sample and replaced with the next ranked facility.
Sampling
A 45% sample of facilities [confidence level = 95%].
The sample took into account well performing, moderately performing and poor performing facilities, ranked by performance, from the District Health Information System (DHIS) for the period January to December 2008, using the following indicators: -
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 7 ANC coverage rate ANC visits before 20 weeks HIV testing rate amongst ANC clients HIV prevalence amongst ANC clients NVP uptake amongst HIV+ mothers, and Dual therapy uptake for April to June 2009 Measurement instrument
A data collection tool was revised to include key components of the programme. The tool assessed services provided, human resources, equipment and drug availability, and output and outcome service performance of the MNCH&N programme.
Data sources
PHC facility registers A list of registers inspected is provided in annexure L.
Service provider interviews Key informant interviews conducted with professionals and nurses directly involved in MNCH services.
District Health Information System Management teams Information not available at the facility, e.g. staff establishments, was requested from sub- district managers.
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 8 FINDINGS Health and Health Service Indicator Status Pertaining to Quality of Care and Services within MNCH&N, with Specific Focus on PMTCT
1. EASTERN CAPE PROVINCE – ALFRED NZO DISTRICT
While the baseline assessment for Umzimvubu and Maluti sub-districts reflects some commendable practice, the results also reflect a number of barriers, gaps and quality of care issues that require attention. MNCH&N findings are summarised first, followed by an overview of the broader issues influencing health service delivery.
1.1 MNCH&N WITH FOCUS ON PMTCT 1.1.1 Comprehensive MNCH&N service Only one of the 15 health facilities studied rendered a 24 hour service. This one is a CHC. The other facilities all rendered an eight hour service.
The percentage of sampled health facilities providing key MNCH&N services are as indicated below and presented in Figure 2. In this regard the availability of HAART needs to be addressed. Details are provided in annexure B. ANC - 100% of facilities Health group education (HGE) - 100% of facilities Voluntary counselling and testing (VCT) - 100% of facilities PMTCT - 100% of facilities HAART - only two of the sample of 15 facilities (13%) Cervical screening - 87% of facilities Sexually transmitted infections (STI) services - 100% of facilities Delivery services - 60% of facilities Postnatal care provided - 100% of facilities Child health services and well-baby clinic (WBC) services - 100% of facilities Family planning services - 100% of facilities
Most services were available across all facilities. Except for two facilities, HAART services were not available. Nine of the 15 facilities sampled provided delivery services, although only three of them had all the necessary delivery equipment.
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 9 Figure 2: Percentage of sampled facilities offering MNCH and N services
Alfred Nzo District Percentage of sampled facilities offering MNCH and N services
100% 100% 100% 100% 100% 100% 100% 100% 100%
90% 87%
80%
70%
60% 60%
50%
40%
30%
20% 13%
10%
% ANC Health Group VCT PMTCT HAART Cervical STI services Delivery Post Natal Well baby Family Education Screening services Care Clinic planning (HGE)
1.1.2 Integration of antenatal care with HIV and AIDS care The availability of essential antenatal care and PMTCT services in the sampled facilities was found to be as follows: - Obstetric, medical & social history conducted at 1st visit – 87% of facilities Clinical examination at first visit – 87% of facilities Staff able to detect risk factors – 93% of facilities Urine routinely tested – 100% of facilities Blood for haemoglobin (Hb) routinely tested – 93% of facilities Blood routinely tested for syphilis – 100% of facilities Blood compatibility routinely tested – 67% of facilities Provider-initiated counselling and testing (PICT) at first visit – 100% of facilities HIV testing offered at first visit – 100% of facilities HIV counselling and testing done daily – 100% of facilities Infant feeding counselling done – 93% of facilities Down-referral for mother on HAART – 13% of facilities ANC patients screened for TB – 71% of facilities
1.1.3 ANC before 20 weeks One facility reached the NDoH target of at least 40% of mothers attending ANC before 20 weeks of gestation. Four more facilities achieved more than 30%, leaving 10 facilities (66%) below 30%. Two of these 10 facilities had ANC less than 20 weeks attendance of 3% and zero respectively.
1.1.4 HIV care of new pregnant mothers Only 49% of HIV+ first visit mothers were CD4 count tested. The national target is 95%.
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 10 No. of facilities Mothers HIV % mothers tested % HIV+ mothers % HIV+ mothers TB assessed tested HIV+ CD4 count tested screened 15 94% 24% 49% 78% Some of the assessed facilities had not yet started clients on dual therapy as required by the 2008 PMTCT guidelines during the January to June 2009 assessment period. Azidothymidine/Zidovudine treatment (AZT) was issued during the assessment period at nine of the 15 facilities, in three of these facilities to 100% or more of the HIV+ pregnant women.
Ideally, all HIV+ mothers should have their CD4 count tested. This was achieved at just under half (47%) of the facilities, with three more facilities testing more than 70% of the HIV+ clients.
Although facilities were aware of the criteria for initiation of HAART in pregnant women, there was no information at PHC facility level on the numbers of women initiated on HAART.
1.1.5 Facilities providing HAART In this district, as at 30 April 2010, five out of 52 (10%) facilities (clinics, community health centres (CHCs) and district hospitals) provide HAART to patients. See annexure D.
1.1.6 Availability of essential PMTCT services during labour and post-delivery Some pregnant mothers only present at the facility during birth or after the event (born before arrival – BBA). Assessment of the selected facilities’ readiness to conduct PMTCT procedures in these cases revealed that 47% (7/15) of the facilities adhered to the protocol of on-site counselling for HIV testing during labour, 53% had midwives available to conduct routine provider-initiated counselling and testing (PICT) during labour and 80% reported that post-delivery on-site counselling for HIV testing did take place. Details per facility are displayed in annexure E.
1.1.7 Services to babies and children Poor record keeping hindered collecting accurate data from clinic records for children expected to have been PCR tested at six weeks. In addition, very few deliveries are done at PHC facilities. Generally, fewer children were tested than could be expected, based on the district ANC HIV sero-prevalence of 30%.
PCR positivity rates at six weeks recorded at eight of the facilities ranged from 6% to 36%, with a simple mean of 17%. Eight facilities recorded issuing cotrimoxazole (CTX) prophylaxis. The baseline assessment data show that some facilities have a high percentage of babies receiving CTX, although PCR testing was not done for a number of these babies, indicating a shortcoming in implementing the 2008 PMTCT guidelines.
1.1.8 Community outreach and Community Care Givers (CCGs) Thirteen of the 15 facilities (87%) reported using CCGs, although district policy is that each facility will have five CCGs assigned to it. Fourteen facilities reported having clinic committees, but the minutes revealed that only four discussed MNCH issues during their meetings.
1.1.9 Laboratory turnaround time (TAT) for PCR test results Laboratory turnaround times varied considerably between facilities, with times ranging from four days to around 40 days.
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 11 1.2 STAFFING Only one clinic had a full complement of professional nurses (PNs) while eleven (73%) of health facilities had half or fewer of the PN posts filled. Three facilities (20%) did not have a specified staff establishment for this category of staff.
1.3 SKILLS AND TRAINING All facilities had at least one PN trained in each of midwifery, integrated management of childhood illness (IMCI), HCT, PMTCT and BANC. Two facilities had PNs with advanced midwifery. Gaps in other areas of training existed, notably infant feeding, paediatric and adult HIV management and also in HIS. Only two facilities, one being the CHC, had the benefit of regular doctors’ visits.
1.4 EQUIPMENT, SUPPLIES AND MATERIALS In the assessed facilities almost all had most of the equipment necessary for delivering ANC services available and functional. However, basic equipment such as glucose test strips were not available in one third of the clinics even though the clinics had functional glucometers. Details are provided in annexure I.
1.5 AVAILABILITY OF INFORMATION, EDUCATION AND COMMUNICATION (IEC) MATERIAL Raising community members’ knowledge of health issues is an important strategy in improving MNCH&N services and strengthening the delivery of PMTCT. Figure 3 illustrates the availability of materials in the health facilities to assist in this task.
Figure 3: Availability of information, education and communication material
Alfred Nzo - Availability of information,education and communication 100 (IEC)material 90 80 70 60 50 40 30 20 10 0 Nutrition booklet IMCI family % of% facilities with specific IEC material available available Infant Feeding HCT Education ANC InfoPosters ANC HIVreferral consulting room criteria displayed PMTCT Algorithm Algorithm PMTCT dosplayed in each Growth monitoring Details of this are provided in annexure J.
1.6 INFRASTRUCTURE The majority of the facilities share rooms to deliver the different MNCH services. Twelve of the 15 facilities (80%) felt that the infrastructure offered sufficient auditory and visual privacy and was
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 12 adequate to limit cross infection. One facility had simultaneous consultations (more than one patient at the same time) in the consulting rooms. Seven facilities (53%) did not have running water.
1.7 RECORDING AND REPORTING Inaccurate and incomplete data posed major challenges in the baseline assessment. Some facilities reported providing certain services, yet did not have supporting data. Differences in understanding and therefore interpretation of data element and indicator definitions were noted, leading to differences in the nature of information being collected for the same data element.
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 13 2. EASTERN CAPE PROVINCE – AMATHOLE DISTRICT
While the baseline assessment for Mbashe sub-district reflects some commendable practice, the results also reflect a number of barriers, gaps and quality of care issues that require attention. MNCH&N findings are summarised first, followed by an overview of the broader issues influencing health service delivery.
2.1 MNCH&N WITH FOCUS ON PMTCT 2.1.1 Comprehensive MNCH&N service Three of the 14 health facilities studied, rendered a 24 hour service. These three are all CHCs. The other facilities all rendered an eight hour service.
The percentage of sampled health facilities providing key MNCH&N services are as indicated below and presented in Figure 4. In this regard the availability of HAART needs to be addressed. For more detail please see annexure B.
ANC - 100% of facilities Health Group Education (HGE) - 100% of facilities VCT - 100% of facilities PMTCT - 100% of facilities HAART - five of the sample of 15 facilities (36%), although none were accredited to provide the service Cervical screening - 93% of facilities STI services - 100% of facilities Delivery services - 93% of facilities (this could reflect misunderstandings as the ‘no deliveries’ facility had all the delivery room equipment on hand) Postnatal care - 100% of facilities Child health services or well-baby clinic - 100% of facilities Family planning services - 100% of facilities
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 14 Figure 4: Percentage of sampled facilities offering MNCH and N services
Amathole District Percentage of sampled facilities offering MNCH and N services 100% 100% 100% 100% 100% 100% 100% 100% 100% 93% 93%
90%
80%
70%
60%
50%
40% 36%
30%
20%
10%
% ANC Health Group VCT PMTCT HAART Cervical STI services Delivery Post Natal Well baby Family Education Screening services Care Clinic planning (HGE)
2.1.2 Integration of antenatal care with HIV and AIDS care The availability of essential antenatal care and PMTCT services in the sampled facilities was found to be as follows: - ANC patients screened for TB – 86% of facilities
2.1.3 ANC before 20 weeks The percentage of pregnant women making their first ANC visit before 20 weeks was generally low at around 30% against the national target of 40%. Only one facility was above this target and the other 13 facilities ranged from 0 to 31%. This pattern of late presentation is particularly noticeable amongst the teenagers below 18 years of age. Facilities reported an overall drop in numbers of all ANC clients during the winter months which could have adverse consequences for the PMTCT programme, suggesting the need for greater community outreach activities.
2.1.4 HIV care of pregnant mothers A pleasing 93% of HIV+ mothers were CD4 count tested – very close to the national target of 95%.
No. of facilities Mothers HIV % mothers tested % HIV+ mothers % HIV+ mothers assessed tested HIV+ CD4 count tested TB screened 14 96% 25% 93% 56% Only four of the 13 facilities (31%) had started clients on dual therapy at the time of the assessment. Other facilities were issuing both AZT and NVP to HIV+ pregnant women but were not reported as practicing dual therapy.
CD4 testing of HIV+ mothers was generally good with more than two-thirds of the facilities testing over 80% of the eligible clients. Half of these facilities achieved 100% or more. Ideally all facilities would test
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 15 all clients that tested HIV+. Three of the facilities assessed tested less than 60% of the HIV+ ANC first visit clients, indicating the need for an intervention.
The baseline assessment results reflected that in excess of 60% of the HIV+ ANC clients were initiated on HAART. As reported below, this was all through referral as none of the facilities assessed were accredited to deliver the service. Five facilities received back-referrals from comprehensive care management and treatment (CCMT) sites to continue the care of stable patients.
2.1.5 Facilities providing HAART In this district, as at 30 April 2010, 9 out of 234 (4%) facilities (clinics, CHCs and district hospitals) provide HAART to patients. See annexure D.
2.1.6 Availability of essential PMTCT services during labour and post-delivery Some pregnant mothers only present at the facility during birth or after the event (Born before arrival – BBA). Assessment of the selected facilities’ readiness to conduct PMTCT procedures in these cases revealed that 71% (10/14) of the facilities adhered to the protocol of on-site counselling for HIV testing during labour, 71% had midwives available to conduct routine PICT during labour and 79% reported that post delivery on-site counselling for HIV testing did take place. Detail per facility is displayed in Appendix E.
2.1.7 Services to babies and children Of the sampled facilities, 92% tested babies around six weeks. It was noted that the number of babies tested for PCR was more than what was expected, based on 30% of HIV+ pregnant mothers. There were, however, only three facilities which started CTX prophylaxis. The assessment results revealed a gap in the implementation of PMTCT guidelines as all HIV exposed babies should be given CTX as prophylactic treatment irrespective of their status. The assessors noted that TAT on blood results was long - the longest time period was 60 days.
The assessment revealed that only three facilities provided an HIV testing service for babies at 18 months. Poor recording made it difficult to accurately reflect the number of children on paediatric ART.
All assessed facilities carried stocks of Vitamin A supplementation, with no stock-outs recorded. Vitamin A supplementation was reported and recorded by 11 of the 14 (78%) of the facilities.
2.1.8 Community outreach and Community Care Givers (CCGs) All 14 facilities reported having Clinic Committees, but only two sets of minutes reflected discussions on MNCH&N issues. Eight of the 14 facilities assessed (57%) reported the involvement of CCGs in the services, although ten facilities reported referring MNCH cases to CCGs.
2.1.9 Availability of pharmaceuticals Availability of AZT, NVP and CTX were generally good. In one CHC two of the items were found to have expired and two clinics experienced CTX stock-outs during the period being assessed.
2.1.10 Laboratory turnaround time for PCR testing Laboratory turnaround times varied considerably between facilities, with times ranging from seven days to around 100 days.
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 16 2.2 STAFFING Staffing shortages were a major negative factor in delivering PHC, and therefore MNCH&N, services in the sub-district. All except one of the 14 facilities assessed were operating with a third to a tenth of their required professional nurse complement, while the remaining facility had only half of the approved PNs. Only two CHCs had access to sessional doctors’ support.
2.3 SKILLS AND TRAINING The baseline assessment also revealed gaps in the competencies of the available staff. Of the training spheres assessed, eight facilities had less than 50% of their PNs trained in BANC and nine facilities had less than 50% of their PNs trained in infant feeding. Eighty-six percent (12/14) of the facilities did not have staff trained in paediatric ART management. All 14 facilities had PNs with midwifery qualifications but the only two advanced midwives in the sub-district were together in the same CHC. Annexure H shows that facility’s are generally well equipped to handle maternal and neonatal emergencies, but poorly equipped in paediatric care.
2.4 EQUIPMENT, SUPPLIES AND MATERIALS Annexure I illustrates that roughly half of the facilities had all the equipment necessary to render ANC services available and functional. Four clinics did not have a functional glucometer. One third of the clinics did not have basic materials such as glucose strips, even though they had functional glucometers. One clinic did not have a functional weighing scale or a blood pressure (BP) machine.
2.5 AVAILABILITY OF INFORMATION, EDUCATION AND COMMUNICATION (IEC) MATERIAL Facility details on IEC material is presented in figure 5 below and in Annexure J.
Figure 5: Availability of information, education and communication material Amathole: Availability of information, education and communication (IEC) material 100 90 80 70 60 50 93 93 40 72 30 64 64 20 10 22 14 14 0
% of% facilities with specific IEC material available ANC Info IMCI PMTCT ANC HIV Infant HCT Nutrition Growth Posters Family Algorithm Referral feeding education monitoring available booklet displayed criteria in each displayed consulting room
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 17 2.6 INFRASTRUCTURE Of the facilities assessed, 71% did not have clean running water. In 13 of the 14 facilities assessed consulting rooms are shared between the different MNCH services, thereby compromising auditory and visual privacy and increasing the danger of cross-infection of already immuno-compromised clients.
2.7 RECORDING AND REPORTING The baseline assessment of PMTCT and feeding practices in the field revealed non-recording of interventions. Without good records it is difficult to measure the effectiveness of interventions.
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 18 3. EASTERN CAPE PROVINCE – CACADU DISTRICT
While the baseline assessment for Camdeboo sub-district reflects some commendable practice, the results also reflect a number of barriers, gaps and quality of care issues that require attention. MNCH&N findings are summarised first, followed by an overview of the broader issues influencing health service delivery.
3.1 MNCH&N WITH FOCUS ON PMTCT 3.1.1 Comprehensive MNCH&N service All the facilities in this district only rendered an eight hour service
MNCH&N services were reported as available at facilities, although there was no documentation to prove that these services were actually being provided as this information is recorded on cards that mothers carry home.
Despite a gross shortage of both doctors and professional nurses in this sub-district, all facilities were implementing the BANC, VCT and PMTCT. Only one clinic (not the CHC) reported conducting deliveries and postnatal services were available at all the facilities. Only the CHC reported providing HAART.
The percentage of selected health facilities providing key MNCH&N services are as indicated in figure 6 below. In this regard the availability of HAART needs to be addressed. For more detail see annexure B. ANC - 100% of facilities Health group education (HGE) - 93% of facilities VCT - 100% of facilities PMTCT - 100% of facilities HAART - 7% of facilities (1 out of 14) Cervical screening - 86% of facilities STI services - 100% of facilities Delivery services - 7% of facilities Postnatal Care - 100% of facilities Child health services or well-baby clinic - 100% of facilities Family planning services - 100% of facilities
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 19 Figure 6: Percentage of sampled facilities offering MNCH and N services
Cacadu District Percentage of sampled facilities offering MNCH and N services
100% 100% 100% 100% 100% 100% 100% 100% 93%
90% 86%
80%
70%
60%
50%
40%
30%
20%
10% 7% 7%
% ANC Health Group VCT PMTCT HAART Cervical STI services Delivery Post Natal Well baby Family Education Screening services Care Clinic planning (HGE)
3.1.2 Integration of antenatal care with HIV and AIDS care The availability of essential antenatal care and PMTCT services in the sampled facilities was found to be as follows (also see annexure C): Obstetric, medical & social history at 1st visit - 100% of facilities Clinical examination at first visit - 100% of facilities Staff able to detect risk factors - 100% of facilities Urine routinely tested - 100% of facilities Blood for Hb routinely tested - 100% of facilities Blood routinely tested for syphilis - 100% of facilities Blood compatibility routinely tested - 90% of facilities PICT at first visit - 93% of facilities HIV testing offered at first visit - 93% of facilities VCT done daily at - 93% of facilities Infant feeding counselling done- 100% of facilities PMTCTC guidelines available - 22% of facilities CD4 count testing done daily - 93% of facilities Eligible pregnant HIV+ women referred - 100% of facilities HAART accredited facilities - 7% of facilities Down-referral for mother on HAART - 22% of facilities M2M2B programme available - 14% of the facilities Screened for TB - 47% of facilities
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 20 3.1.3 ANC before 20 weeks The average ANC first visit before 20 weeks for the 14 facilities in Camdeboo is 20% which is half the National target of 40% and lower than the sub-district average of 50%. This average is, however, raised by a very high rate of 76% at one clinic (which is also the clinic without PNs) and masks six clinics with zero or negligible values, casting doubt on the quality of the recorded data.
3.1.4 HIV care of pregnant mothers Data represents 14 facilities which were assessed. The percentage of mothers tested for HIV appears to be grossly inflated at 179% unless there is some explanation for the number of HIV tested new exceeding ANC first visit. Sixty-four percent of HIV+ mothers were CD4 count tested. The national target is 95%.
A simple average of the TB screening values per assessed facility indicated that a low 31% of HIV+ mothers were screened for TB as part of the ANC and PMTCT procedure.
No. of facilities % Mothers % Mothers tested % HIV+ Mothers CD4 % HIV+ Mothers TB assessed HIV tested HIV+ count tested screened 14 179% 10% 64% 43% 3.1.5 Facilities providing HAART In this district, as at 30 April 2010, the facilities providing HAART to patients increased from 1 to 7, though this is only 10% (7 out of 70) facilities (clinics, CHCs and district hospital). See annexure D. There is a need to increase the number of facilities providing HAART in this district. 3.1.6 Availability of essential PMTCT services during labour and post-delivery None of the sampled facilities in Cacadu reported providing essential PMTCT services during labour and post-delivery, as indicated in annexure E. Twenty-nine percent of these facilties nevertheless had all the required postnatal care equipment.
There was also a concern that only 22% of the received down-referred mothers on HAART, while only two of the 14 facilities assessed reported a M2M2B programme operating.
A simple average of the CD4 testing rate values per assessed facility showed 67% of HIV+ mothers had CD4 tests conducted as part of the ANC and PMTCT procedure. The records showed a very high (simple average of facility values of 99%) ANC client HIV testing rate in the assessed facilities as well as in the sub-district.
3.1.7 HIV services to babies and children Services for babies and children were available at all the 14 facilities but they were no records kept at most clinics as the information was recorded on cards that mothers keep at their homes. PCR test kits were not available in 43% facilites or were not in stock at the time of the survey. Twenty-six percent of facilities reported to be offering antiretroviral (ARV) prophylaxis at birth and thereafter although there were no confirmatory records, highlighting poor data management at facilities. Most (86%) of facilities were providing counselling and support for breast-fed infants. The same proportion provided CTX prophylaxis to all HIV exposed babies.
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 21 Vitamin A coverage (based on simple averages of facility coverage rates) for infants 6 -11 months (24%) and children 1 to 5 yrs old (17.8%) were both very low in the assessed facilities - far below the national target of 90% and 80% respectively.
3.1.8 Community outreach and Community Care Givers (CCGs) Eleven of the 14 facilities (78.5%) reported having functioning Clinic Committees, but only five of these included MNCH issues on the meeting agendas. Nine of 13 facilities (70%) did not have a community- based IMCI programme.
Sixty-four percent of the facilities reported having a cadre of Community Care Givers, of which eight held meetings with their CCGs. Only three facilities report having accompanied the CCGs on their rounds, the low number reportedly as a result of under-staffing at the health facilities.
3.1.9 Availability of Pharmaceuticals Pharmaceutical supplies for HIV and PMTCT services (AZT, NVP, CTX and Vitamin A) were available in 100% of all the facilities during the six months prior to the survey, as can be seen in annexure F. Vitamin A was out of stock at one facility at the time of the survey. One facility also indicated that it provided dual therapy drugs but these were not being issued to deserving clients and in addition these drugs were not entered in the drug book. Seven percent (1 of 14) of facilities was experiencing an intermittent supply of AZT at the time of the survey. 3.1.10 Laboratory turnaround time for PCR test results Laboratory turnaround time is generally too long, ranging between 5 and 28 days. Constraints that were identified in 14% of the facilities providing PCR testing were that babies were not being brought to the clinic and difficulties were experienced in getting the mothers’ consent to have them tested. 3.2 STAFFING Of the 14 facilities for which staffing data was collected, 79% had a recorded staff establishment but only four had a full complement of professional nurses. One clinic had no PNs and in the others’ vacancy rates ranged from 30% to 88%. Sessional doctors were available on specified days to attend to clients. 3.3 SKILLS AND TRAINING Despite the gross shortage of both doctors and professional nurses in this sub-district all facilities were implementing BANC, VCT and the PMTCT package. Although training was conducted (see annexure G), competency gaps were noted in infant feeding (no PNs trained) and in paediatric HIV and AIDs management in which 70% did not have a PN experienced in this field – see figure 7 below. From annexure H it is apparent that 71% of the facilities reported that they have staff experienced in providing emergency paediatric/neonatal care.
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 22 Figure 7: Percentage of professional nurses trained on key courses Percentage of Professional Nurses trained on key courses 90% 80% 80% 83% 80% 73% 70% 70% 63% 67% 60% 53% 50% 50% 47% 40% 33% 30% 20% 10% 0% Percentage of professional nurses (%) nurses professional of Percentage HCT PICT BANC PMTCT ART AIDS Mgt Paediatric Dry blood blood Dry AIDS course Information Management Basic HIV and Use ofHealth management Adult HIV andAdult HIV spot sampling STI syndromic Infant feeding Infant 3.4 EQUIPMENT, SUPPLIES AND MATERIALS Facilities in this sub-district had the necessary equipment required for MNCH services that was also functional – see annexure I. One facility was short of HIV Rapid Test Kits. The one facility that reported offering a delivery service did not, however, have a delivery pack at the time of the assessment. Three other clinics did appear to be equipped to conduct deliveries, possibly only on an emergency basis. Availability of emergency and resuscitation equipment was found to be wanting, although many of the items lacking were those used by doctors and most facilities do not have doctors’ visits. 3.5 AVAILABILITY INFORMATION, EDUCATION AND COMMUNICATION MATERIAL IEC materials observed included ANC posters, posters with referral criteria, VCT posters, PMTCT posters, nutrition posters, infant feeding posters, IMCI family booklets, growth monitoring and promotion posters, as can be seen in annexure J. Information display was poor at facilities thereby depriving clients of access to vital information. In 21% of the facilities, IEC material was not displayed because there were no notice boards, while one facility was in the process of being renovated. 3.6 INFRASTRUCTURE All the facilities had inadequate space for consultations and most of the rooms are shared. Twenty-one percent of the facilities had at least one room allocated for community activities and all those who have no rooms conduct community related activities in outside places such as the school halls, community halls or use the mobile clinic services. Fortunately the delivery room was not shared with any other activity as it this is a specialised room with special equipment.
3.7 RECORDING AND REPORTING No facilities had information officers which created a huge gap in the data management processes. Furthermore, inaccurate and incomplete data posed major challenges in the baseline assessment. Services were reported as being provided but some facilities did not have data to support the reported service. Differences in understanding and therefore interpretation of data element and indicator definitions were noted, leading to differences in the nature of information being collected for the same data element.
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 23 4. EASTERN CAPE PROVINCE – CHRIS HANI DISTRICT
While the baseline assessment for Engcobo sub-district reflects some commendable practice, the results also reflect a number of barriers, gaps and quality of care issues that require attention. MNCH&N findings are summarised first, followed by an overview of the broader issues influencing health service delivery.
4.1 MNCH&N WITH FOCUS ON PMTCT 4.1.1 Comprehensive MNCH&N service Two of the 13 health facilities studied, rendered a 24 hour service. These two are CHCs. The other facilities all rendered an eight hour service
The percentage of sampled health facilities providing key MNCH&N services are as indicated below and reflected in Figure 8. It is clear from the findings that the availability of HAART needs to be addressed. Details are provided in annexure B. ANC - 100% of facilities Health group education (HGE) - 100% of facilities VCT - 100% of facilities PMTCT - 100% of facilities HAART - two of the sample of 13 facilities (15%) Cervical screening - 100% of facilities STI services - 100% of facilities Delivery services - 77% of facilities Postnatal care - 100% of facilities Child health services or well-baby clinic - 100% of facilities Family planning services - 100% of facilities
Figure 8: Percentage of sampled facilities offering MNCH and N services Chris Hani District Percentage of sampled facilities offering MNCH and N services
100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
90%
80%
70%
60%
50% 43%
40%
30%
20% 15%
10%
% ANC Health Group VCT PMTCT HAART Cervical STI services Delivery Post Natal Well baby Family Education Screening services Care Clinic planning (HGE)
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 24 4.1.2 Integration of antenatal care with HIV and AIDS care The availability of essential antenatal care and PMTCT services in the sampled facilities was found to be as follows: - Obstetric, medical & social history conducted at 1st visit – 100% of facilities Clinical examination at first visit – 100% of facilities Staff able to detect risk factors – 100% of facilities Urine routinely tested – 100% of facilities Blood for Hb routinely tested – 100% of facilities Blood routinely tested for syphilis – 100% of facilities Blood compatibility routinely tested – 91% of facilities Provider-initiated Counselling and Testing at first visit – 100% of facilities HIV testing offered at first visit – 100% of facilities HIV counselling and testing done daily – 100% of facilities Infant feeding counselling done – 100% of facilities PMTCT guidelines available – 73% of facilities CD4 count testing done daily – 55% of facilities Eligible pregnant HIV+ women referred – 100% of facilities Down-referral for mothers on HAART – 18% of facilities M2M2B programme available – 0% of facilities ANC patients screened for TB – 69% of facilities
Detailed facility data is presented in Appendix C.
4.1.3 ANC before 20 weeks Two clinics (15%) surpassed the national target of 40% for first ANC visit below 20 weeks, while the remaining seven facilities for which data were available were below target. In four clinics records did not indicate whether a client had come for a first or a repeat visit.
4.1.4 HIV care of pregnant mothers A pleasing 89% of HIV+ mothers were CD4 count tested – very close to the national target of 95%.
No. of facilities Mothers HIV % mothers tested % HIV+ mothers % HIV+ mothers assessed tested HIV+ CD4 count tested TB screened
13 86% 20% 89% 71%
4.1.5 Facilities providing HAART In this district, as at 30 April 2010, 9 out of 155 (6%) facilities (clinics, CHCs and district hospitals) provide HAART to patients. See annexure D.
4.1.6 Availability of essential PMTCT services during labour and post-delivery Annexure E illustrates that facilities were inadequately geared for delivering essential PMTCT services during labour and post-delivery.
4.1.7 Services to babies and children All except one of the assessed facilities reported providing PCR testing to all HIV exposed babies.
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 25 All of the 13 facilities provided cotrimoxazole prophylaxis to all HIV exposed babies. All except one of the facilities were providing Vitamin A supplementation - the information was not gathered for the thirteenth. Vitamin A coverage is far below the national target.
4.1.8 Community outreach and Community Care Givers (CCGs) None of the 13 health facilities implemented a comprehensive list of activities on community outreach, indicating a need to strengthen community outreach activities at all health facilities. Ten of the 13 facilities did not have CCGs supporting maternal and child health issues.
4.1.9 Availability of pharmaceuticals Pharmaceuticals appear to be well-managed in the facilities assessed. Annexure F indicates that none of the facilities experienced stock-outs in the four key PMTCT items during the assessment period.
4.1.10 Laboratory turnaround time for PCR testing Laboratory turnaround time for PCR specimens was one to three weeks in the majority of facilities, although some reported TATs of up to eight weeks. Isolated cases of delays for up to three months were reported. Of concern is that most results came back as invalid. Once-a-week blood specimen transport meant that it was not possible to test and send blood samples on a daily basis.
4.2 STAFFING Of the 11 clinics assessed, only one clinic had a full complement of professional nurse (PN) posts while eight (62%) of health facilities had half or fewer of the PN posts filled. Two facilities (15%) did not know their specified staff establishment for this category of staff.
According to the staff establishment there are doctor’s posts in all the health centres but there are no posts filled and visiting doctors based at the local district hospital only conduct session in the community health centres.
4.3 SKILLS AND TRAINING In all except two clinics all the PNs were trained in HIV counselling and testing. In the majority of clinics all the PNs were trained in PMTCT and PCR, while the remaining clinics had at least one PN trained in these areas. Annexure G also shows that, although all facilities reported being trained in adult HIV and AIDS Management, only one facility had a PN trained in paediatric HIV and AIDS management with ART. In seven facilities (54%) there were no PNs trained on infant feeding. As per annexure H, the assessment revealed that a high percentage of facilities had sufficient competent staff to provide emergency obstetric and maternal care, but fewer staff members were able to handle neonatal care emergencies.
4.4 EQUIPMENT, SUPPLIES AND MATERIALS Except for Hb meters, equipment required for ANC services was available and functional in most facilities. However, of the 10 facilities reported as offering delivery services, only one had a delivery pack. Stocks and equipment for postnatal care was generally good, although none of the facilities assessed had PCR gloves. One clinic had been out-of-stock of PCR kits for about six months. Further details are available in annexure I.
Emergency and resuscitation equipment and supplies were generally inadequate - most facilities assessed did not have a full complement of equipment.
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 26 4.5 AVAILABILITY OF INFORMATION, EDUCATION AND COMMUNICATION (IEC) MATERIAL The assessed facilities varied considerably in what IEC materials they had available in the facility for educating the community on health issues. Infant feeding and IMCI family booklets scored best. Only one facility displayed ANC HIV referral criteria. See annexure J for more details.
4.6 INFRASTRUCTURE All facilities reported adequate visual privacy and 91% reported adequate auditory privacy and space to prevent cross infection. Only 45% (%/11) of the facilities reported having running water.
4.7 RECORDING AND REPORTING Difficulty was experienced in collecting certain data from at least four facilities, especially relating to new ANC clients and PCR testing at six weeks in children, as this could not be found on the day of assessment. Furthermore, inaccurate and incomplete data posed major challenges in the baseline assessment. Services were reported as being provided but some facilities did not have supporting data. Differences in understanding and therefore interpretation of data element and indicator definitions were noted, leading to differences in the nature of information being collected for the same data element.
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 27 5. KWAZULU-NATAL PROVINCE – ETHEKWINI METRO DISTRICT
Although the baseline results for eThekwini show that provision of services in the assessed facilities are largely adequate, a number of barriers, gaps and quality of care issues require highlighting. MNCH&N findings are summarised first, followed by an overview of the broader issues influencing health service delivery.
5.1 MNCH&N WITH FOCUS ON PMTCT 5.1.1 Comprehensive MNCH&N services Three of the 30 health facilities studied, rendered a 24 hour service. One of these three facilities is a CHC. The other two are clinics. The other twenty-seven facilities all rendered an eight hour service.
The percentages of sampled facilities in eThekwini providing key MNCH&N services are reflected in figure 9 below, while the details per facility are provided in See annexure B: ANC - 100% of facilities Health group education (HGE) - 100% of facilities VCT - 100% of facilities PMTCT - 100% of facilities HAART - only four of the sample of 30 facilities (13%) Cervical screening - 100% of facilities STI services - 100% of facilities Delivery services - 17% of facilities Postnatal care provided - 87% of facilities Child health services and well-baby clinic services - 77% of facilities Family planning services - 97% of facilities
Figure 9: Percentage of sampled facilities offering MNCH and N services
eThekwini District Percentage of sampled facilities offering MNCH and N services 100% 100% 100% 100% 100% 100% 100% 97% 97%
90% 87%
80%
70%
60%
50%
40%
30%
20% 17% 13%
10%
% ANC Health Group VCT PMTCT HAART Cervical STI services Delivery Post Natal Well baby Family Education Screening services Care Clinic planning (HGE)
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 28 Not a single facility surveyed in eThekwini offered a comprehensive MNCH&N service and this is cause for concern. Further assessment of the availability of services in eThekwini facilities surveyed, revealed that only 17% offered delivery services although most offered emergency deliveries and referrals. There was inconsistency across the facilities in implementing the new PMTCT guidelines. For example, the referral criteria used by facilities differed widely with respect to clinical stage and CD4 count and it appears that the NDoH protocols and guidelines are not clear enough causing health staff to use their own discretion regarding referrals. Of concern is that 10% of facilities did not have any referral criteria at all.
Although all the facilities assessed stated they offered PMTCT services, only two facilities had all the essential PMTCT services in place. Less than 45% of facilities surveyed offered any essential PMTCT services during labour and post delivery, most probably due to the fact that very few (17%) offered a delivery service. Generally the assessment found that integration of PMTCT and HIV care in MNCH&N services was poor.
5.1.2 Integration of antenatal care with HIV and AIDS care The percentages of the sampled facilities in eThekwini where antenatal care with HIV and AIDS care services are integrated are indicated as below (see also annexure C): Obstetric, medical & social history at 1st visit - 90% of facilities Clinical examination at first visit - 90% of facilities Staff able to detect risk factors - 90% of facilities Urine routinely tested - 90% of facilities Blood for Hb routinely tested - 93% of facilities Blood routinely tested for syphilis - 93% of facilities Blood compatibility routinely tested - 90% of facilities PICT at first visit - 98% of facilities HIV testing offered at first visit - 98% of facilities HIV counselling and testing done daily at - 98% of facilities Infant feeding counselling done - 77% of facilities PMTCTC guidelines available - 60% of facilities CD4 count testing done daily - 63% of facilities Eligible pregnant HIV+ women referred - 90% of facilities Down-referral for mother on HAART - 23% of facilities M2M2B programme available - 20% of facilities Screening for TB - 37% of facilities
With the exception of the third and second last services, namely, down-referral for mothers on HAART and M2M2B programme there was integration of other services in the facilities assessed.
5.1.3 ANC before 20 weeks The record reviews done in the baseline assessment of eThekwini district indicated that most pregnant women presented to ANC only after 20 weeks gestation. Only five facilities had 10% or higher under 18 year old patients who presented in their first gestational trimester, with the highest being Inanda- Newtown A CHC at 25% and Lamontville clinic at 15%. This indicated that educational programmes are
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 29 urgently required to encourage pregnant women to present to ANC early so that, where required, PMTCT can be implemented as early as possible.
5.1.4 HIV care of pregnant mothers From the 30 facilities that were assessed, 61% of HIV+ mothers were CD4 count tested. The national target is 95%.
No. of facilities % Mothers % Mothers tested % HIV+ Mothers CD4 % HIV+ Mothers TB assessed HIV tested HIV+ count tested screened
30 97% 39% 61% 14%
5.1.5 Facilities providing HAART In this district, as at 30 April 2010, 30 out of 132 (23%) facilities (clinics, CHCs and district hospitals) provide HAART to patients. See annexure D. Provision of HAART was highly inadequate in the thirty facilities assessed. Only 13% of facilities provided access to life-saving HAART at the point where women attended antenatal care.
5.1.6 Availability of essential PMTCT services during labour and post-delivery The percentages of the sampled facilities in eThekwini where essential PMTCT services are available during labour and post-delivery are indicated as below (See annexure E): 39% of the facilities offered essential PMTCT services during labour and post-delivery On-site counselling for HIV Testing was offered at 23% of facilities during labour There was 37% availability of midwives to do routine PICT during labour There was also 63% on-site counselling for HIV testing post delivery especially BBAs. 97% of the facilities were offering dual therapy to their clients and only one offered mono therapy. Of particular concern is that 37% of facilities were not offering CD4 testing at ANC clinics and only 7% were accredited, with resulting congestion at these sites. A concerted effort is required to get all facilities accredited.
5.1.7 HIV services to babies and children The percentages of the sampled facilities in eThekwini where essential PMTCT services are available to exposed babies after birth were as follows: 37% of the facilities provided ARV prophylaxis to HIV exposed babies at birth and subsequent days 20% of the facilities provided ARV prophylaxis to HIV exposed babies, as reflected in the delivery register 97% of the facilities provided preventive therapy to HIV exposed babies to prevent MTCT 97% of the facilities offered counselling and support for breast fed infants 37% (11 out of 30) of the facilities gave ARV prophylaxis to HIV exposed babies at birth and subsequent days 97% of the facilities offered provision of CTX prophylaxis to all HIV exposed babies 97% of the facilities offered immunisation services at around six weeks to HIV-exposed infants 83% of the facilities offered PCR testing to all HIV exposed babies 73% of the facilities offered screening for TB 97% of the facilities offered Vitamin A supplementation
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 30 Dual therapy was provided by most of the facilities though a few gave ARV prophylaxis to HIV exposed babies. Only in five facilities that have started with dual therapy to exposed babies actually indicated the start date. The documentation and records were in order in only 20% of the facilities.
5.1.8 Community outreach and community care givers The community outreach programme in eThekwini was poorly implemented and the involvement of CCGs/community health workers (CHWs) was limited. The number of facilities offering an activity ranged between three and 19. Communication links and linkages were non- existent and the number of facilities that provided the “Do not know” as an answer is high and this demonstrate lack of communication at the facility level to explain their outreach programme to the drivers of the programme.
5.1.9 Availability of Pharmaceuticals The availability of drugs (AZT, NVP, CTX and Vitamin A) was as follows (see annexure F): 100% of the facilities had AZT 93% of the facilities had Nevirapine 73% of the facilities had Cotrimoxazole 93% of the facilities had Vitamin A.
5.1.10 Laboratory turnaround time (TAT) for PCR test results Although PCR testing was done in most facilities, major constraints included limited transport and long turnaround times (up to 42 days) resulting in high numbers of patients lost to follow-up. The PCR TAT for eThekwini facilities ranged from less than seven days to more than 28 days, with the highest number of facilities falling between seven to 14 days.
5.2 STAFFING On the human resources side, findings in the baseline study in eThekwini indicate a high vacancy rate of professional nurses (ranging from 25% to 76%) in the primary health care facilities.
Assessment of the staff available to carry out emergency procedures at facilities indicated (as per annexure H) that: 52% of the staff members were able to put up a drip for a patient in shock 14% of the staff members able to intubate an infant 39% of the staff members were able to resuscitate pregnant woman with obstetric emergencies 19% of the staff members had experience in paediatrics/neonatal care 7% of the facilities had an experienced doctor available.
This apparent lack of skills has a direct impact on both the quality of care provided as well as the availability of services. Even more concerning is the skills shortage and lack of experience noted across all facilities in the provision of emergency services, i.e. half of facilities did not have a staff member able to intubate an infant and 20% did not have any staff experienced in paediatric/neonatal care.
Staff categories that were explored in all health facilities did not have a full staff compliment. All professional nurses in positions at all the facilities had training in midwifery. As far as the doctors are
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 31 concerned, 18 out of 30 facilities had resident doctors while those without doctors on their staff establishment rely on sessional doctors who attend clinics on specified days.
5.3 SKILLS AND TRAINING The results are reflected in figure 10 below, as well as in annexure G. As can be seen, almost 80% of the PNs attended the basic HIV and AIDS course and there is a need to increase the numbers trained in other areas.
Figure 10: Percentage of professional nurses trained in key MNCH&N activities eThekwini District Percentage of professional nurses trained on key courses
80% 73% 70%
60% 57%
50%
40% 38%
32% 30% 30% 29% 26% Percentage ofprofessional nurses(%)
20% 19% 20%
13% 12% 10%
0% HCT PICT PMTCT BANC Infant Basic HIV and Adult HIV Paediatric Dry blood Use of Health STI feeding AIDS course and AIDS ART spot Information syndromic Mgt Management sampling management
5.4 EQUIPMENT, SUPPLIES AND MATERIALS Although there were staffing and skills shortages, ANC, delivery room and postnatal equipment, supplies and materials were generally available – as can be seen in annexure I. Emergency and resuscitation equipment was lacking in 77% of the facilities. Of concern was the unavailability of femidoms in facilities which leaves women with fewer choices.
5.5 AVAILABILITY INFORMATION, EDUCATION AND COMMUNICATION MATERIAL IEC materials available in most facilities included ANC posters, posters with referral criteria, VCT posters, PMTCT posters, nutrition posters, infant feeding posters, growth monitoring and promotion posters. There was however a shortage of PMTCTC and IMCI family booklets, as depicted in figure 11 and in annexure J.
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 32 Figure 11: Availability of information, education and communication material Ethekwini: Availability of information, education and communication (IEC) material 90 80 70 60 50 40 83
available 67 30 63 60
20 37 10 17 10 7 0 % of% facilities with specific IEC material Nutrition Infant Growth ANC Info HCT PMTCT ANC HIV IMCI Family Feeding monitoring posters education Algorithm Referral booklet available displayed criteria
5.6 INFRASTRUCTURE The assessment showed that infrastructure at the surveyed PHC facilities was generally lacking as none had sufficient space for MNCH-specific consultations and, in some instances, rooms were shared. More specifically, 57% of the facilities had auditory privacy 80% of the facilities had visual privacy 43% had insufficient space to prevent cross-infection.
5.7 DATA MANAGEMENT AT HEALTH FACILITIES Data management was a challenge at facilities and this ranged from non-functioning computer systems, data collection and collation, lack of understanding of data elements and ambiguity. Records were poorly managed in all the facilities, possibly as a result of poor data management skills, understaffing and time limitations. This needs urgent improvement so that accurate PMTCT data is available for monitoring, to highlight trends and provide evidence for action and resource allocation
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 33 6. MPUMALANGA PROVINCE – EHLANZENI DISTRICT
6.1 MNCH&N WITH FOCUS ON PMTCT 6.1.1 Comprehensive MNCH&N service Only one of the 17 health facilities studied, a CHC, rendered a 24 hour service. The other facilities all rendered an eight hour service.
The percentage of sampled health facilities providing key MNCH&N services are as indicated in figure 12 below. In this regard the availability of HAART needs to be addressed. Details are provided in annexure B. ANC - 100% of facilities Health group education (HGE) - 100% of facilities VCT - 100% of facilities PMTCT - 100% of facilities HAART - only 1 of the sample of 17 facilities (6%) Cervical screening - 94% of facilities STI services - 100% of facilities Delivery services - 88% Postnatal care - 100% Well baby clinic - 100% Family planning services - 100%
Figure 12: Percentage of sampled facilities offering MNCH&N services
Ehlanzeni District Percentage of sampled facilities offering MNCH and N services 100% 100% 100% 100% 100% 100% 100% 100% 100% 94%
90% 88%
80%
70%
60%
50%
40%
30%
20%
10% 6%
% ANC Health Group VCT PMTCT HAART Cervical STI services Delivery Post Natal Well baby Family Education Screening services Care Clinic planning (HGE)
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 34 6.1.2 Integration of antenatal care with HIV and AIDS care The percentage of sampled health facilities that have integrated key HIV and AIDS services into antenatal care are as indicated below. From the details provided below it is evident that down-referral for mothers on HAART needs attention. Details are provided in annexure C. Obstetric, medical and social history at 1st visit - 94% of facilities Clinical examination at first visit - 94% of facilities Staff able to detect risk factors - 94% of facilities Urine routinely tested - 94% of facilities Blood Hb routinely tested - 88% of facilities Blood routinely tested for syphilis - 88% of facilities Blood compatibility routinely tested - 76% of facilities PICT at first visit - 82% of facilities Counselling and testing done daily – 88% of facilities Infant feeding counselling done - 88% of facilities PMTCT guidelines available - 82% of facilities CD4 count testing done daily - 88% of facilities Eligible pregnant HIV+ women referred - 53% of facilities Down-referral received for mother on HAART - 35% of facilities M2M2B programme available - 18% of facilities ANC patients screened for TB – 29% of facilities
Absence of recording during the period reviewed (January to June 2009) was interpreted as a facility not providing the service.
6.1.3 ANC before 20 weeks Thirty-two percent of the ANC clients presented for their first visit during the first trimester (i.e. at less than 20 weeks). The national target is 40%
6.1.4 HIV care of pregnant mothers Dual therapy started in June 2009, when 29% of the HIV+ mothers not on HAART received AZT at 28 weeks. NVP was issued over the six assessment months (January to June 2009) to 38% of the HIV+ mothers. Only 49% of ANC clients who tested positive for HIV received CD4 count testing. The national target is 95%.
Very low numbers of mothers (18 individuals) were referred for HAART – but there was no recording of CD4 count or WHO staging. Thus, there were no eligible records to serve as a denominator. No data was available on mothers actually initiated on HAART.
6.1.5 Facilities providing HAART In this district, as at 30 April 2010, 12 out of 126 (9%) facilities (clinics, CHCs and district hospitals) provide HAART to patients. See annexure D.
6.1.6 Availability of essential PMTCT services during labour and post-delivery The percentage of sampled health facilities providing services contributing to PMTCT during labour and post delivery are as indicated below. Details are provided in annexure E. On site counselling for HIV testing during labour - 29% of facilities Availability of midwives to do routine PICT during labour - 12% of facilities On-site counselling and post delivery test (esp. BBAs) - 41% of facilities
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 35 6.1.7 Services to babies and children Information on infant feeding and support of mothers and babies when they return for review was gathered and this information was checked to see if it was reflected on the records. All 17 facilities reported to offer ongoing counselling and support on breastfeeding for breast fed babies (100%), however this information was reflected only in seven (41%) facility records. Counselling and support for formula feed or mixed fed infants was reported by all (100%) and reflected on records by six (35%) of facilities. Counselling and support on weaning of infants was reported by 17 (100%) and reflected on records by two (12%) of facilities. Growth monitoring and health promotion was reported by 17 (100%) and reflected on records by 11 (65%) of facilities. Vitamin A supplementation was reported by 16 (94%) and reflected on records by 10 (59%) of facilities. Cotrimoxazole given to exposed children was reported by 15 (88%) and reflected on records by seven (41%) of facilities. Seventeen (100%) facilities reported that they provide CTX to exposed children but this was reflected on records of 13 (77%) of facilities. Facility records reflected that 10 out of 17 facilities provided vitamin A supplementation to children 12 to 59 months of age.
6.1.8 Community outreach and Community Care Givers Four (24%) facilities reported that staff conduct community visits. One (6%) reported community IMCI occurring in their relevant communities. Four (24%) reported a cadre of CCGs or CHWs in some form working on maternal and child health issues. Four (24%) reported holding routine meetings with CCGs to review maternal and child health problems. Three facilities (18%) had clinic committees involved in discussions relating to maternal and child health as part of committee meetings.
6.1.9 Availability of pharmaceuticals All of the 17 facilities sampled had stock of AZT, NVP, CTX and Vitamin A. Five facilities were out of NVP intermittently during the period January to June 2009. One facility experienced stock-out of Cotrimoxazole. See annexure F.
6.1.10 Laboratory turnaround time (TAT) for CD4 and PCR test results No records were available for CD4 TAT. For PCR laboratory tests the records reflected a TAT that ranged from two to 12 weeks.
6.2 STAFFING This district did not have an approved staff establishment at the time of the study. No inferences can thus be made about vacancy rates.
6.3 SKILLS AND TRAINING Annexure G and the graph (figure 13) below show that the numbers of professional nurses trained on key MNCH&N activities varies between facilities and also between courses. More professional nurses need to be trained on PICT, BANC, infant feeding, adult HIV and AIDS management, paediatric ART management, dry blood spot sampling, syndromic management of STI and the use of information.
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 36 Figure 13: Percentage of professional nurses trained in key activities Ehlanzeni District Percentage of professional nurses trained on key courses 90%
79% 80%
70% 70%
62% 60%
50% 47% 43%
40% 37% 33%
30% 26%
Percentage of Profesinal nurses Profesinal of (%) Percentage 25%
20% 16%
10%
0% 0% HCT PICT PMTCT BANC Infant feeding Basic HIV and Adult HIV and Paediatric ART Dry blood Use of Health STI syndromic AIDS course AIDS Mgt Management spot sampling Information management
With regard to availability of skilled staff to carry out various emergency activities in health facilities, 59% of staff members were able to put up a drip for patients in shock, 17% of staff members were able to intubate an infant, 42% of staff members were able to resuscitate pregnant woman with obstetric emergencies and 14% of staff members were experienced in paediatric and neonatal care. Details are provided in annexure H. 6.4 EQUIPMENT, SUPPLIES AND MATERIAL Essential equipment was generally available across all facilities. However, staff need to constantly check that equipment utilising batteries have adequate supply of batteries to ensure functionality. Forty-one percent (7/17) of the facilities did not have delivery packs. Apart from this, all delivery rooms had all the necessary equipment available. For postnatal care, PCR test kits were available across facilities. Stocks of Pelargon formula were inadequate in 41% (7/17) of the facilities. Details are provided in annexure I. 6.5 AVAILABILITY OF INFORMATION, EDUCATION AND COMMUNICATION (IEC) MATERIAL ANC information posters were available at 41% of facilities. Only 53% (9/17) of sampled facilities had ANC HIV referral criteria displayed. Seventy-six percent of facilities had information on VCT. Fifty-three percent of facilities had PMTCT algorithms displayed in each consulting room. Seventy-one percent of facilities had information about nutrition and infant feeding available. Forty-one percent of facilities had information on growth monitoring and only four facilities (23%) had the IMCI family booklet available. See annexure J for more detail. 6.6 INFRASTRUCTURE Six of the 17 facilities (35%) felt that they were experiencing inadequate auditory privacy and risk of cross infection because of facility infrastructure weakness. 6.7 DATA MANAGEMENT AT HEALTH FACILITIES Weaknesses in data management resulted from the absence of facility information officers or data capturers, resulting in professional nurses having to do all recording and reporting in addition to their normal duties
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 37 7. NORTH WEST PROVINCE – DR RUTH S MOMPATI DISTRICT
7.1 MNCH&N WITH FOCUS ON PMTCT 7.1.1 Comprehensive MNCH&N service Three of the eight health facilities studied, rendered a 24 hour service. These three are all CHCs. The other five facilities all rendered an eight hour service.
The percentage of sampled health facilities providing key MNCH&N services are as indicated in figure 14 below. In this regard the availability of HAART needs to be addressed. Details are provided in annexure B. ANC - 100% of facilities Health group education (HGE) - 100% of facilities VCT - 100% of facilities PMTCT - 100% of facilities HAART - 12% (one facility) Cervical screening - 94% of facilities STI services - 100% of facilities Delivery services - 87% of facilities Postnatal care - 87% of facilities Well-baby clinic - 100% of facilities Family planning services - 100% of facilities
Figure 14: Percentage of sampled facilities offering MNCH and N services Dr RS Mompati District Percentage of sampled facilities offering MNCH and N services 100% 100% 100% 100% 100% 100% 100% 100%
90% 87% 87% 87%
80%
70%
60%
50%
40%
30%
20% 12% 10%
% ANC Health Group VCT PMTCT HAART Cervical STI services Delivery Post Natal Well baby Family Education Screening services Care Clinic planning (HGE)
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 38 7.1.2 Integration of antenatal care with HIV and AIDS services The availability of essential antenatal care and PMTCT services in the sampled facilities was found to be as reflected below. Details are provided in annexure C. Obstetric, medical & social history conducted at 1st visit – 100% of facilities Clinical examination at first visit – 100% of facilities Staff able to detect risk factors – 100% of facilities Urine routinely tested – 100% of facilities Blood for Hb routinely tested – 100% of facilities Blood routinely tested for syphilis – 100% of facilities Blood compatibility routinely tested – 100% of facilities Provider-initiated counselling and testing at first visit – 100% of facilities HIV counselling and testing done daily – 100% of facilities Infant feeding counselling done – 100% of facilities PMTCT guidelines available – 100% of facilities CD4 count testing done daily – 100% of facilities Eligible pregnant HIV+ women referred – 100% of facilities Down-referral received for mother on HAART – 25% of facilities M2M2B programme available – no facilities ANC patients screened for TB – 75% of facilities Absence of recording during the period reviewed (January to June 2009) was interpreted as a facility not providing the service.
7.1.3 ANC before 20 weeks Only 16% of the ANC clients presented for their first visit during the first trimester (i.e. at less than 20 weeks). The national target is 40%. Of the eight facilities assessed, two were above 30% and the rest were below 20% (with four of these below 10%)
7.1.4 HIV care of pregnant mothers Thirty-one percent of HIV+ new mothers were CD4 count tested. The national target is 95%. No. of facilities mothers HIV % mothers tested % HIV+ mothers % HIV+ mothers TB assessed tested at 1st visit HIV+ CD4 count tested screened 8 66% 18% 31% 25%
The facility records did not reflect any mothers receiving dual therapy during the assessment period – January to June 2009. The DHIS does, however, reflect Nevirapine uptake in the first quarter of 2009/10 in the District in line with the old regimen of prophylaxis before the June 2008 update.
7.1.5 Facilities providing HAART In this district, as at 30 April 2010, 34 out of 63 (54%) facilities (clinics, CHCs and district hospitals) provide HAART to patients. See annexure D 7.1.6 Availability of essential PMTCT services during labour and post-delivery The percentage of sampled health facilities providing services contributing to PMTCT during labour and post delivery are as indicated below. Details are provided in annexure E. On site counselling for HIV testing during labour - 87% of facilities Availability of midwives to do routine PICT during labour - 75% of facilities On-site counselling and post-delivery test (esp. BBAs) - 100% of facilities
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 39 7.1.7 Services to babies and children Seven of the eight facilities assessed conducted PCR testing of HIV exposed infants at around six weeks. The actual data was, however, largely inaccurate and incomplete. All facilities reported giving Cotrimoxazole prophylaxis to HIV exposed infants but this could only be confirmed in the records in three of the six clinics assessed. With the exception of one clinic, it appears that facilities are not conducting HIV antibody tests on babies at 18 months.
All the facilities reported that they provided vitamin A supplementation children 12 - 59 months and this was confirmed by available records.
7.1.8 Community outreach and Community Care Givers None of the eight facilities in the sample study had community-based IMCI programmes in place. All the facilities had facility-associated CCGs covering the entire catchment area, but only half the facilities had CCGs working on MNCH issues. Although cross-referral of MNCH cases between facilities and CCGs was reported in 75% of the cases, only two out of the eight facilities held routine meetings with their CCGs and had staff accompany the CCGs on home visits. Only one of the eight facilities report having a clinic committees in place.
7.1.9 Availability of pharmaceuticals Seven out of eight facilities had stocks of AZT, NVP, CTX and Vitamin A. One facility assessed had no Cotrimoxazole in stock. None of the facilities reported stock-out in the last six months prior to the survey. See annexure F.
7.1.10 Laboratory turnaround time for PCR test results The turnaround time ranged from two to eight weeks.
7.2 STAFFING On average the facilities sampled had a vacancy rate for professional nurses of 60%. The facility with the lowest vacancy rate (Tlapeng) had a rate of 48% while the facility with the highest rate (Morokwaneng) had a rate of 83%.
The average vacancy rate for doctors was 86%, ranging from 60% to 100%. Only the Community Health Centres had the services of visiting doctors available, who attended the facilities on specific days.
7.3 SKILLS AND TRAINING Annexure G and the graph (figure 15) below show that the number of professional nurses trained on key MNCH&N courses varied between facilities and also between courses. More professional nurses need to be trained on PICT, BANC, infant feeding, adult HIV and AIDS management, paediatric art management and the use of information.
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 40 Figure15: Percentage of professional nurses trained in key activities Dr RS Mompati District Percentage of professional nurses trained on key courses 90%
81% 80% 77% 72% 70% 65% 63% 60%
50%
42% 42% 40% 37%
30% 23% Perce ntage of pr ofessi onal nurs es (%) 20%
12% 9% 10%
0% HCT PICT PMTCT BANC Infant feeding Basic HIV and Adult HIV and Paediatric ART Dry blood spot Use of Health STI syndromic AIDS course AIDS Mgt Management sampling Information management
With regard to availability of skilled staff to carry out various emergency activities in health facilities, 94% of staff members were able to put up a drip for patients in shock, 51% of staff members were able to intubate an infant, 90% of staff members were able to resuscitate pregnant woman with obstetric emergencies and 37% of staff members were experienced in paediatric and neonatal care. Details are provided in annexure H.
7.4 EQUIPMENT, SUPPLIES AND MATERIALS The assessed facilities showed up very positively regarding equipment and supplies for providing ANC services. Of the 12 items checked, most facilities had all the items available and functional. The exceptions were one clinic without Rapid HIV test kits and a CHC with an Hb meter that was malfunctioning. A similar scenario applied to delivery room equipment and supplies, suggesting a well run and well supervised situation. A few shortages were noted in postnatal care supplies. Details are provided in annexure I.
7.5 AVAILABILITY OF INFORMATION, EDUCATION AND COMMUNICATION (IEC) MATERIAL ANC information posters were available at all eight facilities. Only 50% (four) of sampled facilities had ANC HIV referral criteria displayed. Seven facilities had information on VCT. Five facilities had PMTCT algorithms displayed in each consulting room. All facilities had information about nutrition and infant feeding available. Seven facilities had information on growth monitoring and four facilities had the IMCI family booklet available. See annexure J for details per facility.
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 41 Figure 16: Availability of information, education and communication material
Dr RSM: Availability of information, education and communication (IEC) material 120
100
80
60 100 100 100 40 88 88 63 50 50 20
0 % of facilitiesof % with specific IEC material available Nutrition Infant Feeding HCT education consulting room displayed ANC HIVReferral criteria displayed displayed in each PMTCT Algorithm Algorithm PMTCT Growth Monitoring IMCI Family booklet ANC InfoPosters
availableReferral criteria
7.6 INFRASTRUCTURE The eight facilities sampled had sufficient physical space for ANC, VCT, PMTCT, health education, well- baby, family planning, cervical screening and STI services. Only one facility (Tlapeng Clinic) had a room for HAART services. One facility (Morokwaneng) had no room for delivery and postnatal services. Facilities reported that visual and auditory privacy was satisfactory.
All facilities had running water available. Two out of the eight facilities did not have sinks with elbow taps.
7.7 DATA MANAGEMENT AT HEALTH FACILITIES Incomplete data complicated the completion of this assessment and, as indicated at the specific areas in this report, have led to questionable findings. Services were reported as being provided but some facilities did not have supporting data. Differences in understanding and therefore interpretation of data elements and indicators were found, leading to differences in the nature of information being collected, collated and reported on for the same data element.
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 42 Factors Contributing To Service Weaknesses
1. EASTERN CAPE PROVINCE – ALFRED NZO DISTRICT
1.1 Human Resources, staff skills and training Poor programme management and supervision at sites
1.2 MNCH&N and PMTCT services processes PMTCT is still not viewed as a priority and some HCWs still have a negative attitude towards the programme Poor integration of programme at implementation level Inadequate utilization of community based and even home based structures in integrating PMTCT care at community level Unclear guidelines and areas of integration for other non-government partners in the PMTCT programme Inadequate counselling services (demand exceeds supply) and poor retesting of negative or unknown patients prior to delivery and/or immediately post-delivery Primary prevention has not been adequately addressed within the PMTCT programme Male or partner involvement remains a challenge in PMTCT Family planning has not been sufficiently integrated in the PMTCT package of care and is not effective as a programme. Less than one third of pregnant women present for their first ANC visit in the first trimester, thereby limiting their access to successful PMTCT Maternal access to HAART remains very limited Many PHC facilities do not have capacity to initiate HAART Patients referred to CCMT sites from PHC facilities are not traced or followed up Long laboratory turnaround times for CD4 blood specimens, made worse by transportation challenges causing further delays - and there is no electronic access system to obtain results Postnatal follow up and care for mother/baby pairs remains weak
1.3 Equipment and Supplies The absence of glucose test strips in a third of the facilities raises questions about provisioning and this aspect of supervision in the MNCH&N activities.
1.4 Infrastructure Seven facilities did not have running water at the time of the assessment.
1.5 Data management, recording and reporting Information management and quality of data is poor. DHIS is slow and unreliable - some of PMTCT information does not appear on DHIS The record keeping system is not standardized and is outdated. Numerous books/registers to be completed by professional nurses whilst there is a shortage of staff
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 43 2. EASTERN CAPE PROVINCE – AMATHOLE DISTRICT
2.1 Human Resources, staff skills and training
Shortage of staff, particularly doctors, data capturers, dieticians, social workers and trained lay counsellors/adherence counsellors Not all staff members trained on PMTCT dual therapy Community health care workers not all trained on HHCC-IMCI
2.2 MNCH&N and PMTCT service processes
Children defaulting on immunizations, especially 12 – 59 months Vitamin A supplementation and Rotavirus vaccinations Inaccessible terrain, especially in Mbashe and Mnquma sub-districts, hinders supervision and the smooth delivery of laboratory services Continuing HIV and AIDS stigmatisation results in community members being unwilling Women not using preventative services adequately, resulting in a low ‘women year protection’ rate Pregnant women booking late for first ANC visit, many after 14 weeks Clients arriving to deliver without having attended ANC Mothers discharged from maternity with unknown HIV status, representing missed opportunities Some home deliveries are not brought to the health facilities as BBA’s for postnatal care Minimal support to mothers’ during post delivery period leads to mixed feeding regimes and therefore greater risk of transmission for HIV-exposed babies Low proportion of HIV-exposed babies initiated on cotrimoxazole prophylaxis Inadequate social mobilisation resulting in low utilisation of preventative services for children, low numbers of pregnant women beginning ANC services in the first trimester, inadequate understanding of PMTCT, maternal health and child health services amongst community members and too few HIV- positive mothers receiving counselling on infant feeding options.
2.3 Equipment and supplies
Mthatha pharmacy depot experiences ‘stock-outs’ of vaccines
2.4 Infrastructure Ten out of 14 facilities did not have running water. 2.5 Data management, recording and reporting
Poor data management leading to inaccurate and incomplete data Different information collected for the for the same data element as a result of differences in understanding and therefore interpretation of the same data element. Facilities report delivering certain services yet have no supporting records Inadequate use of the available health data in monitoring and evaluating the services at all levels of management
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 44 3. EASTERN CAPE PROVINCE – CACADU DISTRICT
3.1 Human Resources, staff skills, and training Managers and supervisors demonstrate limited knowledge on PMTCT services A number of facilities do not have approved staff establishments Service delivery being hindered by a shortage of professional staff as doctors, pharmacists, nursing staff, dieticians, social workers and pharmacy assistants A high staff vacancy rate, including for critical posts, results in a lack of the essential skills in carrying out various emergency activities (resuscitation, intubation, inserting drips and experience in paediatric/neonatal care) Shortage of clerks, data capturers, facility information officers, general workers and security staff – leading to incomplete records, non-aesthetic environment and lack of security Insufficient skills in facilities in advanced midwifery, BANC and PMTCT 3.2 MNCH&N and PMTCT services process Access to the health services is limited because all the facilities in this district only rendered an eight hour service Limited availability of necessary policy guidelines, e.g. PMTCT Policy Guidelines 2008 Limited facilities conducting deliveries and providing postnatal care Few facilities accredited to provide HAART Very limited down-referral of mothers on HAART from CCMT sites to PHC facilities Limited availability of the mothers-to-mothers-to-be (M2M2B) programme in facilities Limited facilities providing essential PMTCT services during ANC, labour and post-delivery Limited provision of dual therapy regimen to clients with some facilities still providing mono therapy Loss to follow-up of HIV exposed babies Intermittent supply of drugs (ART and Vitamin A) Long PCR TAT as facilities send specimen to distant laboratories (range between 14 and 28 days) Limited availability of Emergency Medical Rescue services Inadequate social mobilization to address the problem of primary prevention Clients often lack health knowledge which is exacerbated by poor IEC practices at facilities
3.3 Equipment and Supplies Lack/shortage of basic equipment in facilities necessary for conducting deliveries, obstetric emergencies and resuscitation
3.4 Infrastructure Lack of adequate space for consultations and patient education as most of the rooms are shared, leading to lack of privacy and cross infection No rooms available/allocated for community outreach activities
3.5 Data management, recording and reporting Poor data management at all facilities Unavailability of PMTCT ANC Register
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 45 4. EASTERN CAPE PROVINCE – CHRIS HANI DISTRICT
4.1 Human Resources, staff skills and training
Shortage of staff, particularly doctors, data capturers, dieticians, social workers and trained lay counsellors/adherence counsellors Not all staff members trained on PMTCT dual therapy, particularly at the maternity ward Community health care workers not all trained on HHCC-IMCI
4.2 MNCH&N and PMTCT service processes
Poor integration of PMTCT into other programmes Low numbers of ANC clients referred for HAART Limited number of babies put onto cotrimoxazole prophylaxis Poor referral systems affecting the referral of HIV+ babies to ART sites Children defaulting on immunizations, especially 12 – 59 months Vitamin A supplementation and Rotavirus vaccinations Women not using preventative services adequately, resulting in a low ‘women year protection’ rate PMTCT delivery being hindered by poor partner involvement and lack of family support Pregnant women booking late for first ANC visit, many after 14 weeks Clients arriving to deliver without having attended ANC Mothers discharged from maternity with their HIV status still unknown, representing missed opportunities Some home-delivered babies are not brought to the health facilities as BBA’s for postnatal care Minimal support to mothers’ during post delivery period leading to mixed feeding regimes and thus greater risk of transmission for HIV-exposed babies Inadequate social mobilisation to address the problem of primary prevention of HIV
4.3 Equipment and supplies
Shortage of basic equipment and resources in facilities, such as Hb meters, BP machines and nutrition supplements Unavailability of stationery/registers, in particular the new ANC registers, maternity registers, PMTCT registers and drug registers Immunisation services challenges because the Central Medicine depot sometimes experiences ‘stock-outs’ of vaccines
4.4 Infrastructure
Inadequate water supplies at some hospitals, such as All Saints hospital
4.5 Data management, recording and reporting
Poor data management, resulting partly from the lack of data capturers at facilities but also from poor data recording in the first instance and then inadequate data verification and validation processes
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 46 5. KWAZULU-NATAL PROVINCE – ETHEKWINI METRO DISTRICT
5.1 Human Resources, staff skills and training Service delivery being hindered by a shortage of professional staff as doctors, pharmacists, nursing staff, dieticians, social workers and pharmacy assistants A high staff vacancy rate, including for critical posts, results in a lack of the essential skills in carrying out various emergency activities (resuscitation, intubation, inserting drips and experience in paediatric/neonatal care) Shortage of clerks, data capturers, facility information officers, general workers and security staff – leading to incomplete records, non-aesthetic environment and lack of security Insufficient skills in facilities in advanced midwifery, BANC and PMTCT 5.2 MNCH&N and PMTCT services processes Three of the 30 health facilities studied rendered a 24 hour service - one of these a CHC and the other two are clinics. The other twenty-seven facilities all rendered an eight hour service. Limited availability of necessary policy guidelines, e.g. PMTCT Policy Guidelines 2008 Limited facilities providing essential PMTCT services during ANC labour and post-delivery Lack of integration between HIV and AIDS and TB Limited facilities conducting deliveries and postnatal care Few facilities accredited to provide HAART Very limited down-referral of mothers on HAART from CCMT sites to PHC facilities Limited availability of the mothers-to-mothers-to-be (M2M2B) programme in all facilities Limited provision of dual therapy regimen to clients with some still providing mono therapy Intermittent supply of drugs (ART and Vitamin A) Lengthy PCR TAT as facilities send specimen to distant facilities (range between 14 and 28 days) Loss to follow-up of HIV exposed babies Inadequate social mobilization to address the problem of primary prevention Clients often lack health knowledge which is exacerbated by poor IEC practices at facilities Social mobilisation limited by the low number of CHWs/CCGs Limited communication between facilities and CHWs/CCGs 5.3 Equipment and Supplies Lack/shortage of basic equipment in facilities necessary for conducting deliveries, emergencies and resuscitation 5.4 Infrastructure Lack of adequate space for consultations and patient education as most of the rooms are shared, leading to lack of privacy and cross infection No rooms allocated for community outreach activities 5.5 Data management, recording and reporting Poor recordkeeping resulting in difficulty in assessing trends Poor data management at all facilities Lack of feedback from Province Ambiguity and lack of understanding of data elements and indictors Lack of services for malfunctioning computers Interrupted supply of data collection tools or instruments
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 47 6. MPUMALANGA PROVINCE – EHLANZENI DISTRICT
6.1 Human Resources, staff skills and training There is a lack of in-service training with regard to specific skills required to ensure service quality in the area of MNCH&N. This leads to, amongst other challenges, poor implementation of maternity guidelines and poor recording of care rendered. Key staff do not know how to use the partogram. As stated in section 6.3 above, training on PICT, BANC, infant feeding, adult HIV and AIDS management, paediatric art management, dry blood spot sampling, syndromic management of STI and the use of information all needs attention.
6.2 MNCH&N and PMTCT service processes
Long patient queues because of shortage of staff Poor referral between and within health facilities Poor adherence to PMTCT policy by health workers Poor attendance of perinatal mortality meetings Poor recording of interventions No full time or session doctors at PHC facilities Shortage of PCR test kits Eight-hour services making the service inaccessible after hours Long laboratory turnaround time Integration of PMTCT is not optimal. For example, nurses will only focus on the fact that the infant was brought to the health facility for immunization without detecting that the infant has been exposed to HIV Key IEC materials are not available in local languages Low level of community education leading to: o Clients commencing ANC attendance late in pregnancy o Clients arriving at health facility in advanced stage of labour o Teenagers hiding their pregnancies until it is very late o Malnourished infants o Children are not brought to the clinic for growth monitoring o Home deaths of infants due to delay in seeking help o No family planning o Myths and misconceptions about the use of condoms leading to STI and HIV
6.3 Data management, recording and reporting
Poor data management at facilities because of: o Poor data management skills amongst health workers o Data collection tools not standardized o Facilities do not get feedback on data sent to sub-district and district offices o Facilities do not have targets for monitoring programme performance
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 48 7. NORTH WEST PROVINCE – DR RUTH S MOMPATI DISTRICT
7.1 Human Resources, staff skills and Training Managers and supervisors lack adequate knowledge of PMTCT. This leads to ineffective supervision with concomitant poor clinical and administrative processes, poor service implementation and ultimately to poor outcomes for patients. Examples of this are that there is no platform for PMTCT programme reviews and a lack of implementation of quality improvement interventions.
There are high vacancy rates for both professional nurses and doctors in this district.
There is a lack of in-service training with regard to specific skills required to ensure service quality in the area of MNCH&N. This leads to, amongst others, poor implementation of maternity guidelines and poor recording of care rendered. As stated in section 7.3 above, training is necessary in PICT, BANC, infant feeding, adult HIV and AIDS management, paediatric art management and the use of information.
7.2 MNCH&N and PMTCT Service Processes
Perinatal review meetings are not accessible to staff because they are conducted in hospitals Turnaround times for laboratory results are too long Limited availability of key IEC material needs attention Low level of community education leading to: o Clients commencing ANC attendance late in pregnancy o Clients arriving at health facility in advanced stage of labour o Home deaths of infants due to delay in seeking help o No family planning Too few existing community structures. Where these exist, they do not have the capacity to contribute meaningfully to improving services. This contributes to poor referral links between CCGs and PHC facilities. Transport for patients to CHC facilities is only available in the mornings and on certain dates
7.3 Data management, recording and reporting
Poor data management at facilities because of: o Poor data management skills amongst health workers o Data collection tools not standardized o Facilities do not get feedback on data sent to sub-district and district offices. o Facilities do not have targets for monitoring programme performance
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 49 CONCLUSION
The assessment, and thus this report, is merely one milestone in the NDoH/UNICEF/HST MNCH&N project. The baseline study was completed in November 2009 and the write up of the first draft reports was completed in January 2010. The final report (this report) was completed in May 2010. HST facilitators in the seven districts had already started using the findings in November 2009 to develop locally relevant, integrated MNCH&N district plans that will be incorporated into the official district health plans. At the time (November 2009), HST facilitators in the districts also started using the study results to guide HST’s support interventions in these districts. A number of other project milestones, guided by these findings, have already been achieved. This project is complementary to efforts of other health service partners and provincial departments of health to bring about sustainable improvements in health outcomes for mothers and children and thus families and communities in South Africa.
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 50 ANNEXURES ANNEXURE A: LIST OF THE 18 PRIORITY DISTRICTS AND SUB-DISTRICTS WITH THE HST MNCH&N PROJECT STUDY AREAS HIGHLIGHTED.
Province District Sub-District Eastern Cape Alfred Nzo District Municipality Umzimvubu Health sub-District
Amathole District Municipality Mbashe Health sub-District
Cacadu District Municipality Camdeboo Health sub-District
Chris Hani District Municipality Ngcobo Health sub-District
Oliver Tambo District Municipality Qaukeni Health sub-District Ukhahlamba District Municipality Senqu Health sub-District Free State Thabo Mofutsanyane District Municipality Maluti a Phofung Local Municipality Gauteng Metsweding District Municipality Kungwini Local Municipality KwaZulu-Natal* Amajuba District Municipality Danhauser Local Municipality
iLembe District Municipality Maphumulo Local Municipality
Umkhanyakude District Municipality Umhlabuyalingana Local Municipality Zululand District Municipality Nongoma Local Municipality Limpopo Mopani District Municipality Greater Giyani Local Municipality Mpumalanga Ehlanzeni District Municipality Bushbuckridge Local Municipality North West Bojanala Platinum District Municipality Moretele Local Municipality
Dr Ruth Segomotsi Mompati District Municipality Kagisano Local Municipality
Northern Cape Kgalagadi District Municipality Moshaweng Local Municipality Western Cape City of Cape Town Metropolitan Municipality Khayelitsha Health sub-District
* KwaZulu-Natal, eThekwini Metropolitan District
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 51 ANNEXURE B: AVAILABILITY OF MNCH&N SERVICES
Alfred Nzo District Services Health Facility Name ANC HGE VCT PMTCT HAART CS STI DS PNC WBC FP Maluti CHC x Chancele Lugageni x x Magadla x x x Mkemane x Mt Hargreaves x x Mtumase x Ntlabeni x x Ntizwa x Nyaniso Paballong x x Qwidlana x x Sheperds Hope x x Silindini x Tela x 𝟏𝟓 𝟏𝟓 𝟏𝟓 𝟏𝟓 𝟐 𝟏𝟑 𝟏𝟓 𝟗 𝟏𝟓 𝟏𝟓 𝟏𝟓 TOTAL 𝟏𝟓 𝟏𝟓 𝟏𝟓 𝟏𝟓 𝟏𝟓 𝟏𝟓 𝟏𝟓 𝟏𝟓 𝟏𝟓 𝟏𝟓 𝟏𝟓 PERCENTAGE 100% 100% 100% 100% 13% 87% 100% 60% 100% 100% 100% KEY: ANC – Antenatal Care; HGE – Health/Group Education; VCT- Voluntary Counselling and Testing; PMTCT – Prevention of Mother-to-Child Transmission; HAART – Highly Active Antiretroviral Therapy; CS - Cervical Screening; STI – Sexually Transmitted Infections; DS – Delivery Services; PNC – Postnatal care; WBC – Well-Baby Clinic; FP – Family Planning
Amathole District Health Facility Services Name ANC HGE VCT PMTCT HAART CS STI DS PNC WBC FP Dutywa CHC Elliotdale CHC Willowvale CHC Bolotwa x Jingqi x Kwamkholoza x Mpozolo x Mqhele x x Nqadu x Nqabara Idutywa x Nqabeni x Soga x Sundwana x Taleni 𝟏𝟒 𝟏𝟒 𝟏𝟒 𝟏𝟒 𝟓 𝟏𝟑 𝟏𝟒 𝟏𝟑 𝟏𝟒 𝟏𝟒 𝟏𝟒 TOTAL 𝟏𝟒 𝟏𝟒 𝟏𝟒 𝟏𝟒 𝟏𝟒 𝟏𝟒 𝟏𝟒 𝟏𝟒 𝟏𝟒 𝟏𝟒 𝟏𝟒 PERCENTAGE 100% 100% 100% 100% 36% 93% 100% 93% 100% 100% 100% KEY: ANC – Antenatal Care; HGE – Health/Group Education; VCT- Voluntary Counselling and Testing; PMTCT – Prevention of Mother-to-Child Transmission; HAART – Highly Active Antiretroviral Therapy; CS - Cervical Screening; STI – Sexually Transmitted Infections; DS – Delivery Services; PNC – Postnatal care; WBC – Well-Baby Clinic; FP – Family Planning
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 52 Cacadu District Health Facility Services Name ANC HGE VCT PMTCT HAART CS STI DS PNC WBC FP Graaf Reinet CHC x Aeroville x x Bongweni x x Brug Straat x x Gracey x Horseshoe x x Kroonvale x x x x Kwazamukucinga x x x Masakhane x x Rietbron x x Steytlerville x x Umasizakhe x x Willowmore x x Wongalethu x x TOTAL 14/14 13/14 14/14 14/14 1/14 12/14 14/14 1/14 14/14 14/14 14/14 PERCENTAGE 100% 93% 100% 100% 7% 86% 100% 7% 100% 100% 100% KEY: ANC – Antenatal Care; HGE – Health/Group Education; VCT- Voluntary Counselling and Testing; PMTCT – Prevention of Mother-to-Child Transmission; HAART – Highly Active Antiretroviral Therapy; CS - Cervical Screening; STI – Sexually Transmitted Infections; DS – Delivery Services; PNC – Postnatal care; WBC – Well-Baby Clinic; FP – Family Planning
Chris Hani District Services Health Facility Name ANC HGE VCT PMTCT HAART CS STI DS PNC WBC FP
Ngcobo CHC x Zwelakhe-Dalasile CHC All Saints Gateway Clinic x x Boklein x Clarkbury Clinic x Lahlangubo x Lucwecwe x Manzana x Mhlophekazi x x Nkwenkwana x Ntsimba Clinic x Tora x Zadungeni x 𝟏𝟑 𝟏𝟑 𝟏𝟑 𝟏𝟑 𝟐 𝟏𝟑 𝟏𝟑 𝟏𝟎 𝟏𝟑 𝟏𝟑 𝟏𝟑 TOTAL 𝟏𝟑 𝟏𝟑 𝟏𝟑 𝟏𝟑 𝟏𝟑 𝟏𝟑 𝟏𝟑 𝟏𝟑 𝟏𝟑 𝟏𝟑 𝟏𝟑 PERCENTAGE 100% 100% 100% 100% 15% 100% 100% 77% 100% 100% 100% KEY: ANC – Antenatal Care; HGE – Health/Group Education; VCT- Voluntary Counselling and Testing; PMTCT – Prevention of Mother-to-Child Transmission; HAART – Highly Active Antiretroviral Therapy; CS - Cervical Screening; STI – Sexually Transmitted Infections; DS – Delivery Services; PNC – Postnatal care; WBC – Well-Baby Clinic; FP – Family Planning
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 53 eThekwini District Services Health Facility Name ANC HGE VCT PMTCT HAART CS STI DS PNC WBC FP Inanda –Newtown A CHC Amaoti x Bester x x Cane Side x x Clare Estate x x Craigburn x x Danganya x x Glen Earl x x x Goodwins x x Hambanathi x x Inanda Seminary x x Klaar Wager x x Kloof x x - - Lamontville x Lindelani PHC Maphephetheni x x Mpola x x Nagina x x Newlands East Clinic x x x Oakford Clinic x x x Qadi x Queensburn x Reservoir Hills x x Sea Cowlake x x Township Centre x x Umkomaas x x Umlazi G x x Umlazi N Clinic x x Umlazi U21 x Water Loo x x 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟒 𝟑𝟎 𝟑𝟎 𝟓 𝟐𝟔 𝟐𝟗 𝟐𝟗 TOTAL 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 PERCENTAGE 100% 100% 100% 100% 13% 100% 100% 17% 87% 77% 97% KEY: ANC – Antenatal Care; HGE – Health/Group Education; VCT- Voluntary Counselling and Testing; PMTCT – Prevention of Mother-to-Child Transmission; HAART – Highly Active Antiretroviral Therapy; CS - Cervical Screening; STI – Sexually Transmitted Infections; DS – Delivery Services; PNC – Postnatal care; WBC – Well-Baby Clinic; FP – Family Planning
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 54 Ehlanzeni District Services Health Facility Name ANC HGE VCT PMTCT HAART CS STI DS PNC WBC FP Thulamahashe CHC Arthurstone x Brooklyn x x Calcutta x Casteel x Dingledale x Gottenburg x Hluvukani x Jim Brown x Justicia x Kildare x Lillydale x x Ludlow x Maviljan x Shatale x Xanthia x Zoeknog x 𝟏𝟕 𝟏𝟕 𝟏𝟕 𝟏𝟕 𝟏 𝟏𝟕 𝟏𝟕 𝟏𝟓 𝟏𝟕 𝟏𝟕 𝟏𝟕 TOTAL 𝟏𝟕 𝟏𝟕 𝟏𝟕 𝟏𝟕 𝟏𝟕 𝟏𝟕 𝟏𝟕 𝟏𝟕 𝟏𝟕 𝟏𝟕 𝟏𝟕 PERCENTAGE 100% 100% 100% 100% 6% 100% 100% 88% 100% 100% 100% KEY: ANC – Antenatal Care; HGE – Health/Group Education; VCT- Voluntary Counselling and Testing; PMTCT – Prevention of Mother-to-Child Transmission; HAART – Highly Active Antiretroviral Therapy; CS - Cervical Screening; STI – Sexually Transmitted Infections; DS – Delivery Services; PNC – Postnatal care; WBC – Well-Baby Clinic; FP – Family Planning
Dr RSM District Services Health Facility Name ANC HE VCT PMTCT HAART CS STI DS PNC WBC FP Ganyesa CHC x x Morokweng CHC x Tlakgameng CHC Austrey Clinic x Kgokgole Clinic x Kudunkgwane Clinic x Morokwaneng x x x Tlapeng Clinic x TOTAL 8/8 8/8 8/8 8/8 1/8 8/ 8 8/8 7/8 7/8 8/8 8/8 PERCENTAGE 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% KEY: ANC – Antenatal Care; HGE – Health/Group Education; VCT- Voluntary Counselling and Testing; PMTCT – Prevention of Mother-to-Child Transmission; HAART – Highly Active Antiretroviral Therapy; CS - Cervical Screening; STI – Sexually Transmitted Infections; DS – Delivery Services; PNC – Postnatal care; WBC – Well-Baby Clinic; FP – Family Planning
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 55 ANNEXURE C: INTEGRATION OF ANTENATAL CARE WITH HIV AND AIDS CARE
Cacadu District ANC Services
Health Facility
Name visit st Urine routinely tested Blood for haemoglobin routinely tested Blood routinely tested for syphilis Blood compatibility routinely tested visit first TAT & PI C at offered HIV testing visitfirst C & T done daily feeding Infant counselling done 2008 PMTCT guidelines available CD4 count testing done daily Eligible Pregnant HIV+ women referred HAART accredited facilities Down-referral for HAART on mothers M2M2B programme available Obstets, med & socio history at 1 exam at first Clinical visit Staff able to detect risk factors Graaff Reinet CHC x x x x Aeroville x x x x Bongweni x x x x Brug Straat x x x x Gracey x x x x Horseshoe x x x x x Kroonvale x x x Kwazamukucinga x x x Masakhane x x x x x Rietbron x x x x x x Steytlerville x x x x x Umasizakhe x Willowmore x x x x Wongalethu x x x TOTAL 14/14 14/14 14/14 14/14 14/14 14/14 13/14 13/14 13/14 13/14 14/14 3/14 13/14 14/14 1/14 3/14 2/14 PERCENTAGE 100% 100% 100% 100% 100% 100% 93% 93% 93% 93% 100% 22% 93% 100% 7% 22% 14%
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 56
Chris Hani District
ANC Services
Health Facility Name Obstets, med & socio history at first visit exam at first Clinical visit Staff able to detect risk factors Urine routinely tested for Blood haemoglobin routinely tested routinely Blood tested for syphilis Blood compatibility routinely tested visit first TAT & PI C offered HIV testing visitat first C & T done daily feeding Infant counselling done 2008 PMTCT guidelines available CD4 count testing done daily Eligible Pregnant women HIV+ referred HAART accredited facilities Down-referral for HAART on mothers M2M2B programme available
Ngcobo CHC X X X Zwelakhe-Dalasile CHC X X X X X All Saints Gateway Clinic X X X X Boklein X X X X Clarkbury Clinic --- X X X X Lahlangubo X X X X Lucwecwe X X X X Manzana X X X Nkwenkwana X X Ntsimba Clinic X X X Tora X X X X Mhlophekazi * Zadungeni TOTAL 11/11 11/11 11/11 11/11 11/11 11/11 10/11 11/11 11/11 11/11 11/11 8/10 6/11 11/11 1/11 2/11 0/11 PERCENTAGE 100% 100% 100% 100% 100% 100% 91% 100% 100% 100% 100% 73% 55% 100% 9% 18% 0% * Data was only available for 11 facilities
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 57 eThekwini District ANC Services
Health Facility Name - RT visit visit st taff able to at first visitat first detect risk factors routinely tested haemoglobin routinely tested routinely tested for syphilis compatibility routinely tested visit at offered visitfirst daily feeding counselling done guidelines available testing done daily Pregnant women HIV+ referred referral for on mothers HAA programme available Obstets, & med socio history at 1 M2M2B S Urine for Blood Blood Blood PI C T at first HIV testing C & T done Infant PMTCT CD4 count Eligible Down Clinical exam Inanda –Newtown A CHC x Sea Cowlake x x Glen Earl x x x x x Queensburn x x x Cane Side x x Maphephetheni - - - - - - x x Danganya x x x Qadi Umlazi U21 - x Amaoti x Inanda Seminary x x Bester x x x Mpola Umkomaas x x x x x Umlazi G x x x Clare Estate - x x x x x Craigburn x x x x x Klaar Water x x x Water Loo ------ - - x - x x Kloof x x x Reservoir Hills x x x Nagina ------ x x x Goodwins x x Hambanathi x x x x Lindelani PHC x Newlands East Clinic x Umlazi N Clinic x x Lamontville x x x Township Centre x x Oakford Clinic x x x 𝟐𝟕 𝟐𝟕 𝟐𝟕 𝟐𝟕 𝟐𝟖 𝟐𝟖 𝟐𝟕 𝟐𝟗 𝟐𝟗 𝟐𝟗 𝟐𝟑 𝟏𝟖 𝟏𝟗 𝟐𝟕 𝟕 𝟔 TOTAL 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 PERCENTAGE 90% 90% 90% 90% 93% 93% 90% 98% 98% 98% 77% 60% 63% 90% 23% 20%
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 58 Ehlanzeni District ANC Services
Health Facility Name visit visit st HIV+ women women HIV+ referred Down-referral for HAART on mothers M2M2B programme available Obstetric, medical medical Obstetric, & social history at 1 Clinical examination visitat first Staff able to detect risk factors Urine routinely tested HB for Blood routinely tested routinely Blood tested for syphilis Blood compatibility routinely tested PI C T at first visit offered HIV testing visitat first VCT done daily feeding Infant counselling done PMTCT guidelines available CD4 count testing done daily Eligible Pregnant Thulamahashe CHC x x x x x x x x x Arthurstone x x x x x x x x √ x x x x x Brooklyn x x x x Calcutta x x x Casteel x x x x Dingledale x x Gottenburg x x Hluvukani x Jim Brown x x Justicia x x x x Kildare x x Lillydale x Ludlow x x x x x Maviljan x x x Shatale Xanthia x x Zoeknog √ x TOTAL 16/17 16/17 16/17 16/17 15/17 15/17 13/17 14/17 16/17 15/17 15/17 14/17 15/17 9/17 6/17 3/17 PERCENTAGE 94% 94% 94% 94% 88% 88% 76% 82% 94% 88% 88% 82% 88% 53% 35% 18%
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 59 Dr RSM District Service
Health Facility Name visit visit st M2M2B programme available TB Screening Obstetric, medi& medi& Obstetric, social history at 1 Clinical exam first visit to able Staff detect risk factors Urine routinely tested HB for Blood routinely tested routinely Blood tested for syphilis Blood compatibility routinely tested PI CT at first visit HIV testing at first offered visit C & T done daily feeding Infant counselling done PMTCT guidelines available CD4 count testing done daily Eligible Pregnant women HIV+ referred Down-referral for on mothers HAART
Ganyesa CHC x x x Morokweng CHC x Tlakgameng CHC x x Austrey Clinic x x Kgokgole Clinic x x Kundunkgwane Clinic x x Morokwaneng x Tlapeng Clinic x x 8 8 8 8 8 8 8 8 8 8 8 8 8 8 2 0 6 TOTAL 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 PERCENTAGE 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 25% 0% 75%
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 60 ANNEXURE D: FACILITIES PROVIDING HAART
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 61
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 62
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 63
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 64 ANNEXURE E: AVAILABILITY OF ESSENTIAL PMTCT SERVICES DURING LABOUR AND POST-DELIVERY
Alfred Nzo District
Services On site counselling for HIV Availability of Midwives to Post delivery on-site Health Facility Name testing during labour do routine PICT during counselling and testing for labour HIV Maluti CHC Cancele x x - Lugageni x x x Magadla x x Mkemane Mt Hargreaves x x Mtumase x Ntlabeni Ntsizwa Nyaniso Paballong x x Qwidlana x x Sheperds Hope Silindini x x x Tela 𝟕 𝟖 𝟏𝟐 TOTAL 𝟏𝟓 𝟏𝟓 𝟏𝟓 PERCENTAGE 47% 53% 80%
Amathole District Municipality Services Health Facility On site counselling for HIV Availability of midwives to do Postnatal on-site counselling Name testing during labour routine PICT during labour and testing for HIV Dutywa CHC Elliotdale CHC x Willowvale CHC Bolotwa x x x Jingqi x x Kwamkholoza x Mpozolo Mqhele x x Nqadu Nqabara Dutywa Nqabeni Soga Sundwana x x Taleni 𝟏𝟎 𝟏𝟎 𝟏𝟏 TOTAL 𝟏𝟒 𝟏𝟒 𝟏𝟒 PERCENTAGE 71% 71% 79%
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 65 Cacadu District Services Health Facility Name On site counselling for HIV Availability of Midwives to do On-site counselling and post Testing during labour routine PICT during labour delivery test, esp. BBAs Graaff Reinet CHC x x x Aeroville x x x Bongweni x x x Brug Straat x x x Gracey x x x Horseshoe x x x Kroonvale x x x Kwazamukucinga x x x Masakhane x x x Rietbron x x x Steytlerville x x x Umasizakhe x x x Willowmore x x x Wongalethu x x x TOTAL 0/15 0/15 0/15 PERCENTAGE 0% 0% 0%
Chris Hani District
Services On site counselling for HIV Availability of Midwives to Post delivery on-site Health Facility Name testing during labour do routine PICT during counselling and testing for labour HIV Ngcobo CHC x x x
Zwelakhe-Dalasile CHC
All Saints Gateway Clinic x x x
Boklein
Clarkbury Clinic x
Lahlangubo x x
Lucwecwe --- x
Manzana x x x
Nkwenkwana x x
Ntsimba Clinic
Tora Mhlophekazi * Zadungeni TOTAL 5/11 6/11 6/11
PERCENTAGE 45% 55% 55%
* Data was only available for 11 facilities
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 66 eThekwini District Services Health Facility Name On site counselling for HIV Availability of Midwives to do On-site counselling and post Testing during labour routine PICT during labour delivery test, esp. BBAs Inanda - Newtown A CHC Sea Cowlake x x Glen Earl x x x Queensburn x x x Cane Side x x x Maphephetheni x x Danganya x x Qadi Umlazi U21 Amaoti Inanda Seminary x x Bester x x Mpola Umkomaas n/a n/a n/a Umlazi G x Clare Estate x x Craigburn x Klaar Water x x x Water Loo x x Kloof x Reservoir Hills x x x Nagina x x Goodwins x x x Hambanathi x Lindelani PHC Newlands East Clinic x x x Umlazi N Clinic x x Lamontville x x Township Centre Oakford Clinic n/a n/a n/a 𝟕 𝟏𝟏 𝟏𝟗 TOTAL 𝟑𝟎 𝟑𝟎 𝟑𝟎 PERCENTAGE 23% 37% 63%
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 67 Ehlanzeni District Services
Health Facility Name On site counselling for HIV Availability of Midwives On-site counselling and Testing during labour to do routine PICT during post- delivery test ( esp. labour BBAs) Thulamahashe CHC x x x Arthurstone x x x Brooklyn x x x Calcutta x x x Casteel x x x Dingledale x x Gottenburg x x Hluvukani x Jim Brown x x x Justicia Kildare x x Lillydale x x Ludlow x x x Maviljan x x x Shatale x Xanthia x x x Zoeknog 𝟓 𝟐 𝟕 TOTAL 𝟏𝟕 𝟏𝟕 𝟏𝟕 PERCENTAGE 29% 12% 41%
Dr RSM District
Services On site counselling for HIV Availability of Midwives to On-site counselling and post Health Facility Name Testing during labour do routine PICT during delivery test (esp. BBAs) labour Ganyesa Health Centre Morokweng Health Centre Tlakgameng Health Centre Austrey Clinic Kgokgole Clinic Kudunkgwane Clinic x Morokwaneng x x Tlapeng Clinic TOTAL 7/8 6/8 8/8 PERCENTAGE 87% 75% 100%
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 68 ANNEXURE F: AVAILABILITY OF PHARMACEUTICALS
Cacadu District Pharmaceuticals Health Facility Name AZT NVP Cotrimoxazole Vitamin A Graaff Reinet CHC Aeroville Bongweni Brug Straat Gracey Horseshoe Kroonvale Kwazamukucinga Masakhane Rietbron Steytlerville Umasizakhe Willowmore Wongalethu TOTAL 14/14 14/14 14/14 14/14 PERCENTAGE 100% 100% 100% 100%
Chris Hani District
Pharmaceuticals Health Facility Name AZT NVP Cotrimoxazole Vitamin A Ngcobo CHC Zwelakhe-Dalasile CHC All Saints Gateway Clinic Boklein Clarkbury Clinic Lahlangubo Lucwecwe Manzana Nkwenkwana Ntsimba Clinic Tora Mhlophekazi * Zadungeni TOTAL 11/11 11/11 11/11 11/11 PERCENTAGE 100% 100% 100% 100% * Data was only available for 11 facilities
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 69 eThekwini District Pharmaceuticals Health Facility Name AZT NVP Cotrimoxazole Vitamin A Inanda –Newtown A CHC Amaoti Bester x x Cane Side Clare Estate x Craigburn Danganya Glen Earl Goodwins x Hambanathi Inanda Seminary Klaar Water Kloof Lamontville Lindelani PHC Maphephetheni Mpola x Nagina x Newlands East Clinic Oakford Clinic Qadi x Queensburn Reservoir Hills x Sea Cowlake Township Centre x Umkomaas x Umlazi G x Umlazi N Clinic Umlazi U21 x Water Loo 𝟑𝟎 𝟐𝟖 𝟐𝟐 𝟐𝟖 TOTAL 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 PERCENTAGE 100% 93% 73% 93% Ehlanzeni District Pharmaceuticals Health Facility Name AZT NVP CTX Vitamin A Thulamahashe CHC Arthurstone SO Brooklyn SO Calcutta Casteel X Dingledale S0 Gottenburg Hluvukani Jim Brown Justicia Kildare Lillydale SO Ludlow Maviljan SO Shatale Xanthia SO Zoeknog 𝟏𝟔 𝟏𝟐 𝟏𝟔 𝟏𝟕 TOTAL 𝟏𝟕 𝟏𝟕 𝟏𝟕 𝟏𝟕 PERCENTAGE 94% 71% 94% 100% SO = Item was there at the time of visiting the facility but there was a stock-out during the previous six months
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 70 Dr RSM District Pharmaceuticals Health Facility Name AZT NVP Cotrimoxizole Vitamin A Morokwaneng Ganyesa Health Centre Austrey Clinic Kundunkgwane Clinic Tlakgameng Health Centre Tlapeng Clinic x Morokweng Health Centre Kgokgole Clinic TOTAL 8/8 8/8 7/8 8/8 PERCENTAGE 100% 100% 88% 100%
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 71 ANNEXURE G: PROFESSIONAL NURSES AND LAY COUNSELLORS TRAINED ON KEY MNCH&N COURSES
Cacadu District
Key MNCH&N activity
Health Facility VCT PICT PMTCT BANC Infant Basic HIV Adult HIV and Paediatric ART Dry blood Name feeding and AIDS AIDS Mgt Management spot Use of Health STI syndromic course sampling Information management PNs LCs PNs LCs PNs LCs PNs LCs PNs LCs PNs LCs PNs LCs PNs LCs PNs LCs PNs LCs PNs LCs Graaff Reinet CHC 5 2 5 2 5 2 4 n/a 3 2 5 2 3 0 3 0 3 n/a 8 0 4 n/a Aeroville 2 2 1 2 2 0 1 n/a 1 2 1 2 1 0 0 0 2 n/a 2 2 2 n/a Bongweni 2 2 2 2 2 2 2 n/a 2 2 3 2 2 0 2 0 3 n/a 3 2 2 n/a Brug Straat 1 2 1 2 1 2 1 n/a 1 2 1 2 1 0 1 0 1 n/a 1 0 1 n/a Gracey 2 2 0 0 2 2 1 n/a 1 0 2 0 0 0 0 0 1 n/a 0 0 1 n/a Horseshoe 1 2 1 2 1 2 1 n/a 1 2 1 2 1 0 0 0 1 n/a 0 0 0 n/a Kroonvale 1 2 0 0 1 2 1 n/a 0 0 1 2 1 0 0 0 1 n/a 1 0 1 n/a Kwazamukucinga 1 2 0 0 1 0 0 n/a 1 0 1 2 1 2 1 0 1 n/a 1 2 1 n/a Masakhane 2 2 2 2 2 2 2 n/a 0 2 2 2 0 0 0 0 2 n/a 2 0 2 n/a Rietbron 1 0 1 0 1 0 1 n/a 1 0 1 0 1 0 1 0 1 n/a 1 0 1 n/a Steytlerville 1 2 1 2 1 2 1 n/a 1 2 1 2 1 0 0 0 1 n/a 0 0 1 n/a Umasizakhe 1 0 1 1 n/a 1 1 0 0 1 n/a 1 1 n/a Willowmore 3 0 0 0 3 0 3 n/a 2 0 4 0 3 0 2 0 3 n/a 0 0 3 n/a Wongalethu 1 2 0 0 1 2 0 n/a 0 0 1 0 1 0 0 0 1 n/a 0 0 1 n/a 𝟐𝟒 𝟏𝟒 𝟐𝟒 𝟏𝟗 𝟏𝟓 𝟐𝟓 𝟏𝟔 𝟏𝟎 𝟐𝟐 𝟐𝟎 𝟐𝟏 TOTAL 22 14 18 0 14 18 2 0 0 6 0 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 PERCENTAGE 80% 47% 80% 63% 50% 83% 53% 33% 73% 67% 70%
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 72
Chris Hani District
Key MNCH&N activity Basic HIV Adult HIV Dry blood Use of STI Infant Paediatric Health Facility Name VCT PICT PMTCT BANC and AIDS and AIDS spot Health syndromic feeding ART mgt course mgt sampling Information mgt PNs LCs PNs LCs PNs LCs PNs LCs PNs LCs PNs LCs PNs LCs PNs LCs PNs LCs PNs LCs PNs LCs Ngcobo CHC 7 3 0 0 3 1 2 n/a 9 0 7 3 2 n/a 0 n/a 9 n/a 9 n/a 4 n/a Zwelakhe-Dalasile CHC 7 2 7 2 7 0 3 n/a 0 0 7 2 2 n/a 0 n/a 7 n/a 1 n/a 2 n/a Manzana 3 2 2 0 2 0 1 n/a 2 0 3 0 1 n/a 0 n/a 3 n/a 1 n/a 3 n/a All Saints Gateway Clinic 5 3 0 0 3 1 2 n/a 0 0 5 3 0 n/a 0 n/a 2 n/a 1 n/a 1 n/a Boklein 3 2 3 2 2 1 1 n/a 0 0 3 2 3 n/a 0 n/a 2 n/a 2 n/a 2 n/a Tora 3 2 3 0 3 0 0 n/a 0 0 2 0 2 n/a 0 n/a 3 n/a 3 n/a 1 n/a Lahlangubo 2 1 2 0 2 0 1 n/a 0 0 2 1 2 n/a 0 n/a 2 n/a 2 n/a 2 n/a Clarkbury Clinic 1 1 1 1 1 1 1 n/a 0 0 1 0 1 n/a 0 n/a 1 n/a 0 n/a 1 n/a Nkwenkwana 2 2 0 0 3 1 3 n/a 3 1 3 2 1 n/a 1 n/a 3 n/a 3 n/a 3 n/a Lucwecwe 3 1 3 1 3 1 3 n/a 0 0 3 0 3 n/a 0 n/a 3 n/a 3 n/a 3 n/a Ntsimba Clinic 1 2 1 2 1 2 1 n/a 1 0 1 2 1 n/a 0 n/a 1 n/a 1 n/a 1 n/a Zadungeni * Mhlophekazi 𝟑𝟕 𝟐𝟏 𝟐𝟐 𝟖 𝟑𝟎 𝟖 𝟏𝟖 𝟏𝟓 𝟏 𝟑𝟕 𝟏𝟓 𝟏𝟖 𝟏 𝟑𝟔 𝟐𝟔 𝟐𝟑 TOTAL n/a n/a n/a n/a n/a n/a 𝟒𝟑 𝟐𝟎 𝟒𝟑 𝟐𝟎 𝟒𝟑 𝟐𝟎 𝟒𝟑 𝟒𝟑 𝟐𝟎 𝟒𝟑 𝟐𝟎 𝟒𝟑 𝟒𝟑 𝟒𝟑 𝟒𝟑 𝟒𝟑 PERCENTAGE 86% 105% 51% 40% 70% 40% 42% 35% 5% 86% 75% 42% 2% 84% 61% 53% * Data was only available for 11 facilities
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 73 eThekwini District Key MNCH&N activity Basic HIV Paediatric Dry blood Use of Infant Adult HIV and STI syndromic Health Facility Name VCT PICT PMTCT BANC and AIDS ART spot Health feeding AIDS Mgt management course Management sampling Information PNs LCs PNs LCs PNs LCs PNs LCs PNs LCs PNs LCs PNs LCs PNs LCs PNs LCs PNs LCs PNs LCs Inanda -Newtown A CHC n/a n/a n/a Amaoti 3 3 3 3 2 1 1 n/a 4 n/a 3 3 3 n/a 3 n/a 10 n/a 10 n/a 10 n/a Bester 2 2 n/a n/a 1 2 2 n/a n/a n/a 1 n/a n/a n/a n/a n/a 3 n/a n/a n/a 3 n/a Cane Side 2 1 0 0 0 0 2 0 0 0 5 1 0 0 0 0 0 0 0 0 5 0 Clare Estate 3 2 0 0 0 0 1 n/a 0 1 6 2 2 0 2 0 2 n/a 0 0 1 n/a Craigburn 0 1 0 0 2 0 2 n/a 0 0 2 1 0 0 0 0 2 n/a 0 0 2 n/a Danganya 3 2 3 0 1 2 3 2 1 0 3 1 3 0 1 0 1 0 0 0 3 0 Glen Earl 2 2 0 0 1 0 1 0 0 0 2 2 2 2 0 0 0 0 0 0 2 0 Goodwins 4 2 1 0 3 0 1 n/a 0 0 7 2 0 0 1 1 0 n/a 1 0 4 n/a Hambanathi 2 2 0 0 2 1 0 n/a 0 1 2 2 0 0 0 0 0 n/a 0 0 2 n/a Inanda Seminary 1 2 4 2 4 0 3 n/a 4 4 2 1 0 0 0 4 n/a 4 2 4 n/a Klaar Water 0 0 0 0 1 0 3 n/a 0 0 3 1 3 0 3 0 0 (1) n/a 2 0 3 n/a Kloof Borough 2 1 0 0 0 1 1 n/a 1 0 2 1 0 0 0 0 0 n/a 0 0 2 n/a Lamontville 0 2 3 2 0 1 2 n/a 1 1 4 2 0 0 0 0 0 n/a 0 0 2 n/a Lindelani PHC 4 3 4 2 5 2 3 n/a 0 11 2 4 0 4 0 4 n/a 5 0 4 n/a Maphephetheni 2 1 0 0 2 1 1 0 0 0 2 1 0 0 0 0 0 0 0 0 0 0 Mpola 2 2 2 1 1 1 1 0 0 0 2 2 1 0 0 0 1 0 0 0 2 0 Nagina 2 1 1 0 1 0 1 n/a 0 1 4 1 4 0 0 0 4 n/a 0 0 1 n/a Newlands East Clinic 5 1 0 0 1 1 1 n/a 0 1 5 1 0 0 0 0 0 n/a 0 0 5 n/a Oakford Clinic 0 0 0 0 0 0 0 n/a 0 3 2 3 0 0 0 3 n/a 3 0 3 n/a Qadi 4 2 0 0 2 0 3 0 2 4 2 2 0 1 0 2 0 2 0 7 0 Queensburn 1 1 1 0 1 0 1 0 0 0 4 1 1 0 1 0 1 0 0 0 4 0 Reservoir Hills 1 1 3 0 4 0 4 n/a 0 0 3 1 2 0 2 0 2 n/a 0 0 4 n/a Sea Cowlake 1 0 1 0 1 0 1 0 1 0 1 0 1 0 0 0 1 0 1 0 1 0 Township Centre 1 3 1 0 1 0 1 n/a 0 3 6 2 6 0 0 0 6 n/a 0 0 6 n/a Umkomaas 2 1 2 0 2 0 2 n/a 2 1 2 1 2 0 0 0 0 n/a 0 0 2 n/a Umlazi G 2 1 0 0 1 1 2 n/a 1 0 5 1 1 0 0 0 0 n/a 0 0 1 n/a Umlazi N Clinic 2 2 0 0 0 0 1 n/a 1 1 3 2 2 0 1 0 3 n/a 0 0 1 n/a Umlazi U21 6 3 2 3 1 3 3 0 1 3 13 3 2 0 0 0 1 0 2 0 3 0 Water Loo 1 2 0 0 1 0 0 n/a 2 0 2 2 0 0 0 0 0 n/a 0 0 2 n/a 𝟔𝟎 𝟒𝟔 𝟑𝟏 𝟏𝟑 𝟒𝟏 𝟏𝟕 𝟒𝟕 𝟐 𝟐𝟏 𝟏𝟑 𝟏𝟏𝟒 𝟒𝟒 𝟒𝟓 𝟐 𝟏𝟗 𝟏 𝟓𝟎 𝟎 𝟑𝟎 𝟐 𝟖𝟗 𝟎 TOTAL 𝟐𝟖𝟓 𝟓𝟐 𝟐𝟖𝟓 𝟓𝟐 𝟐𝟖𝟓 𝟓𝟐 𝟐𝟖𝟓 𝟓𝟐 𝟐𝟖𝟓 𝟓𝟐 𝟐𝟖𝟓 𝟓𝟐 𝟐𝟖𝟓 𝟓𝟐 𝟐𝟖𝟓 𝟓𝟐 𝟐𝟖𝟓 𝟓𝟐 𝟐𝟖𝟓 𝟓𝟐 𝟐𝟖𝟓 𝟓𝟐 PERCENTAGE 21% 88% 11% 25% 14% 33% 16% 4% 7% 25% 40% 85% 16% 4% 7% 2% 18% 0% 11% 4% 31% 0%
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 74 Ehlanzeni District
Key MNCH&N activity
Health Facility Paediatric Basic HIV and Adult HIV and Dry blood Use of Health STI syndromic Name VCT PICT PMTCT BANC Infant feeding ART AIDS course AIDS Mgt spot sampling Information management Management PNs LCs PNs LCs PNs LCs PNs LCs PNs LCs PNs LCs PNs LCs PNs LCs PNs LCs PNs LCs PNs LCs Thulamahashe 13 5 0 0 7 4 1 0 3 0 13 5 14 0 0 0 2 0 3 0 3 0 CHC Arthurstone 4 2 0 0 4 1 2 0 1 0 4 2 3 0 0 0 1 2 2 0 4 0 Brooklyn 1 2 0 0 1 2 1 0 1 2 1 2 1 0 0 0 1 0 1 0 1 0 Calcutta 3 2 0 0 2 0 0 0 0 0 3 2 0 0 0 0 1 0 0 0 0 0 Casteel 1 2 0 0 0 2 0 0 0 0 1 2 0 0 0 0 1 0 0 0 0 0 Dingledale 2 0 0 0 2 0 1 0 2 0 1 0 1 0 0 0 1 0 1 0 2 0 Gottenburg 3 2 3 0 2 2 2 0 1 2 3 2 1 0 0 0 1 0 2 0 0 0 Hluvukani 3 2 0 0 3 0 2 0 0 0 0 0 0 0 0 0 1 0 0 0 3 0 Jim Brown 3 0 4 0 4 0 1 0 3 0 5 0 5 0 0 0 1 0 3 0 2 0 Justicia 3 0 1 0 3 0 1 0 1 0 1 0 0 0 0 0 1 0 1 0 2 0 Kildare 4 2 0 0 4 2 3 0 4 2 1 2 1 0 0 0 0 0 0 0 2 0 Lillydale 3 2 0 0 3 0 1 0 3 0 0 0 3 0 0 0 1 0 1 0 1 0 Ludlow 3 2 0 0 3 0 2 0 0 0 0 2 0 0 0 0 1 0 1 0 2 0 Maviljan 3 2 0 0 3 0 1 0 3 0 2 0 2 - 0 0 2 0 - 0 2 0 Shatale 4 3 4 0 5 0 5 0 0 0 5 3 1 0 0 0 3 0 2 0 5 0 Xanthia 3 1 0 0 3 0 0 0 2 0 3 1 1 0 0 0 1 0 2 0 3 0 Zoeknog 4 2 0 0 4 0 2 0 4 0 4 0 0 2 0 0 1 0 0 0 4 0 60 31 12 0 53 13 25 0 28 6 47 23 33 2 0 0 20 2 19 0 36 0 TOTAL 142 37 142 37 142 37 142 37 142 37 142 37 142 37 142 37 142 37 142 37 142 37 PERCENTAGE 42% 84% 8% 0% 37% 35% 18% 0% 20% 16% 33% 62% 23% 5% 0% 0% 14% 5% 13% 0% 25% 0%
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 75 Dr RSM District Key MNCH&N activity VCT PICT PMTCT BANC Infant Basic HIV Adult HIV Paediatric Dry blood Use of Health STI syndromic Health Facility Name feeding and AIDS and AIDS ART spot Information management course Mgt Management sampling PNs LCs PNs LCs PNs LCs PNs LCs PNs LCs PNs LCs PNs LCs PNs LCs PNs LCs PNs LCs PNs LCs Ganyesa CHC 7 4 0 0 7 2 0 0 0 0 0 0 0 0 0 0 7 0 2 0 2 0 Morokweng CHC 7 5 0 0 7 5 0 0 0 4 7 4 0 0 0 0 7 0 0 0 7 0 Tlakgameng CHC 13 4 0 0 13 0 0 0 13 0 13 0 13 0 8 0 13 0 13 0 13 0 Austrey Clinic 2 2 2 2 0 0 1 0 0 0 2 2 0 0 0 0 1 0 1 0 0 0 Kundunkgwane 2 2 0 0 2 0 0 0 0 0 2 2 2 2 0 0 0 0 0 0 2 0 Kgokgole 2 3 2 3 2 2 2 0 2 2 2 2 2 0 2 0 1 0 2 0 2 0 Morokwaneng 1 1 1 1 1 1 1 1 0 2 0 2 Tlapeng Clinic 1 1 0 0 1 1 0 0 - - 0 0 0 0 0 0 0 0 0 0 0 0 35/4 33/4 16/4 27/4 18/4 10/4 31/4 28/4 TOTAL 21 5/49 5 11 4/49 0 6 10 2 0 0 18/49 0 0 9 9 9 9 9 9 9 9 PERCENTAGES 59% 10% 67% 8% 33% 55% 37% 20% 63% 37% 57%
Please Note: There are no lay counsellor posts on this district’s establishments. The lay counsellors trained are volunteers. There is thus no denominator for lay counsellors to calculate a percentage.
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 76 ANNEXURE H: AVAILABILITY OF SKILLED STAFF TO CARRY OUT EMERGENCY ACTIVITIES IN HEALTH FACILITIES
Amathole District Emergency Services Health Facility Name Staff members able Staff member able Staff members able Staff members to put a drip for to incubate an to resuscitate experienced with patient in shock infant pregnant woman paediatrics/neonat with obstetric al care emergencies Dutywa CHC 20/20 20/20 20/20 2/20 Elliotdale CHC 14/20 14/20 14/20 2/20 Willowvale CHC 22/22 22/22 22/22 2/22 Bolotwa 3/3 3/3 3/3 3/3 Jingqi 1/1 1/1 1/1 1/1 Kwamkhloza 3/3 3/3 3/3 3/3 Mpozolo 3/3 3/3 3/3 3/3 Mqhele 2/2 2/2 2/2 2/2 Nqabara Idutywa 3/3 3/3 3/3 3/3 Nqabeni 1/2 1/2 1/2 1/2 Nqadu 3/3 3/3 3/3 3/3 Soga 5/5 5/5 5/5 5/5 Sundwana 3/3 3/3 3/3 3/3 Taleni 3/3 3/3 3/3 3/3 TOTAL 65/71 65/71 65/71 35/71 PERCENTAGE 92% 92% 92% 49% Cacadu District Emergency Services Staff members able Staff member able Staff members able Staff members Health Facility Name to put a drip for to intubate an to resuscitate experienced with patient in shock infant pregnant woman paediatrics/neonat with obstetric al care emergencies Graaff Reinet CC 8 0 8 8 Aeroville 2 2 2 0 Bongweni 0 0 0 3 Brug Straat 1 1 1 1 Gracey 3 0 0 3 Horseshoe 1 1 1 1 Kroonvale 1 1 1 1 Kwazamukucinga 1 1 0 1 Masakhane 2 2 2 0 Rietbron 0 0 0 0 Steytlerville 1 1 1 1 Umasizakhe 0 0 2 0 Willowmore 4 4 4 4 Wongalethu 1 1 0 1 TOTAL 25/30 14/30 22/30 24/30 PERCENTAGE 83% 47% 73% 80%
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 77
Chris Hani District Emergency Services No. of staff able to Staff able to Staff able to Staff experienced Health Facility Name put a drip for intubate an infant resuscitate with paediatrics/ patient in shock pregnant woman neonatal care with obstetric emergencies Engcobo CHC 9/9 0/9 9/9 9/9 Zwelakhe-Dalasile CHC 7/7 1/7 7/7 1/7 All Saints Gateway Clinic 6/6 1/6 0/6 1/6 Boklein 3/3 3/3 3/3 0/3 Clarkbury Clinic 2/2 2/2 1/2 1/2 Lahlangubo 2/2 2/2 2/2 0/2 Lucwecwe 3/3 2/3 3/3 1/3 Manzana 3/3 - 3/3 0/3 Mhlophekazi 2/2 2/2 2/2 2/2 Nkwenkwana 3/3 3/3 3/3 0/3 Ntsimba Clinic 2/2 2/2 2/2 1/2 Tora 3/3 3/3 3/3 1/3 Zadungeni 2/2 2/2 2/2 2/2 TOTAL 47/47 23/47 40/47 19/47 PERCENTAGE 100% 49% 85% 40% eThekwini District Emergency services Staff members Staff member Staff members able Availability of Staff members Health Facility able to put a drip able to intubate to resuscitate experienced experienced with Name for patient in an infant pregnant woman doctor paediatrics/neona shock with obstetric tal care emergencies Inanda - Newtown A 7/62 2/62 3/62 x 3/62 CHC Amaoti 7/19 7/19 7/19 x 1/19 Bester 4/6 2/6 4/6 x 1/6 Cane Side 5/3 0/3 5/3 1/3 Clare Estate 7/8 0/8 5/8 x 5/8 Craigburn 2/4 0/4 2/4 x 0/4 Danganya 3/6 0/6 3/6 x 3/6 Glen Earl 4/5 4/5 4/5 x 0/5 Goodwins 6/13 4/13 4/13 x 2/13 Hambanathi 2/4 0/4 2/4 x ¼ Inanda Seminary 5/8 1/8 3/8 x 1/8 Klaar Wager 3/5 0/5 1/5 x 1/5 Kloof 3/4 0/4 2/4 2/4 Lamontville 6/7 0/7 4/7 x 1/7 Lindelani PHC 18/24 - 5/24 x 6/24 Maphephetheni 5/5 0/5 2/5 x 0/5 Mpola 2/3 2/3 2/3 x 0/3 Nagina 4/6 0/6 4/6 x 1/6 Newlands East Clinic 6/9 0/9 5/9 x 4/9 Oakford Clinic 3/4 3/4 3/4 x 3/4 Qadi 7/13 2/13 1/13 x 1/13 Queensburn 4/5 4/5 4/5 x 4/5 Reservoir Hills 4/6 0/6 4/6 x 0/6 Sea Cowlake 1/3 1/3 1/3 x 1/3 Township Centre 5/8 0/8 5/8 x 5/8 Umkomaas 3/3 0/3 2/3 x 1/3
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 78 Emergency services Staff members Staff member Staff members able Availability of Staff members Health Facility able to put a drip able to intubate to resuscitate experienced experienced with Name for patient in an infant pregnant woman doctor paediatrics/neona shock with obstetric tal care emergencies Umlazi G 5/7 5/7 5/7 x 0/7 Umlazi N Clinic 3/5 0/5 3/5 x 3/5 Umlazi U21 13/27 1/27 13/27 x 1/27 Water Loo 2/3 1/3 2/3 x 2/3 TOTAL 149/285 39/285 110/285 2/30 54/285 PERCENTAGE 52% 14% 39% 7% 19% Ehlanzeni District Emergency Services Staff member able to Staff member Staff members able resuscitate pregnant Health Facility Name Staff member able to experienced with to put a drip for woman with intubate an infant paediatrics/neonatal patient in shock obstetric care emergencies Thulamahashe CHC 20/26 4/26 14/26 1/26 Arthurstone 6/10 - 6/10 1/10 Brooklyn 3/4 1/4 1/4 1/4 Calcutta 6/7 0/7 0/7 0/7 Casteel 4/7 1/7 2/7 0/7 Dingledale 4/6 0/6 4/6 0/6 Gottenburg 3/7 3/7 3/7 0/7 Hluvukani 4/9 0/9 3/9 0/9 Jim Brown 5/8 - 5/8 5/8 Justicia 3/7 0/7 3/7 0/7 Kildare 4/9 4/9 4/9 4/9 Lillydale 4/6 2/6 4/6 1/6 Ludlow 3/8 1/8 3/8 3/8 Maviljan 3/6 - 3/6 0/6 Shatale 5/8 4/8 4/8 4/8 Xanthia 3/6 0/6 0/6 0/6 Zoeknog 4/8 4/8 1/8 0/8 TOTAL 84/142 24/142 60/142 20/142 PERCENTAGE 59% 17% 42% 14%
Dr RSM District
Emergency services Number of staff Staff member able to Staff members able Staff members members able to put intubate an infant to resuscitate experienced with Health Facility Name a drip for patient in pregnant woman paediatrics/neonatal shock with obstetric care emergencies Ganyesa CHC 12/13 5/13 12/13 0/13 Morokweng CHC 10/13 10/13 10/13 10/13 Tlakgameng CHC 13/13 2/13 13/13 2/13 Austrey Clinic 3/2 2/2 2/2 2/2 Kgokgole Clinic 2/2 1/2 2/2 0/2 Kudunkgwane Clinic 2/2 1/2 1/2 1/2 Morokwaneng 2/2 2/2 2/2 1/2 Tlapeng Clinic 2/2 2/2 2/2 2/2 TOTAL 46/49 25/49 44/49 18/49
PERCENTAGE 94% 51% 90% 37%
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 79 ANNEXURE I: AVAILABILITY OF ANC EQUIPMENT AND SUPPLIES AT HEALTH FACILITIES
Alfred Nzo District Equipment and supplies
Health Facility Name (CHC and Clinics) Formula Infant Feed Road-to- Card Health BP machine BP machine Glucometer Glucometer sticks HB meter scale Weight Uristix Blood collection test tubes Rapid HIV test kits Tape measure Foetoscopes Condoms Femidoms kit PCR test PCR gloves
Maluti CHC x Chancele x X x Lugangeni E x Magadla x - Mkemane x x Mt Hargreaves x Mtumase - x - Ntlabeni x - E x Ntsizwa Nyaniso - x Paballong x x - Qwidlana E x Sheperds - - x x - Silindini x - Tela x 15 14 10 15 15 15 14 14 15 15 14 11 12 5 13 10 TOTAL 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 PERCENTAGE 100% 93% 67% 100% 100% 100% 93% 93% 100% 100% 93% 73% 80% 33% 87% 67%
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 80
Amathole District Equipment and supplies
Health Facility Name (CHC and Clinics) Glucometer Glucometer sticks HB meter scale Weight Uristix Blood collection test tubes Rapid HIV test kits Tape measure Foetoscopes Condoms Femidoms kit PCR test PCR gloves Formula Feed Infant Road-to- Card Health BP machine BP machine
Dutywa CHC Expired x
Elliotdale CHC x x
Willowvale CHC
Bolotwa x X x
Jingqi Expired
Kwamkholoza x x x x
Mpozolo x x x
Mqhele x
Nqadu x Expired
Nqabara Idutywa x x x x
Nqabeni x
Soga x x
Sundwana x x
Taleni Expired x TOTAL 13/14 10/14 9/14 13/14 13/14 14/14 14/14 14/14 13/14 14/14 14/14 13/14 8/14 6/14 13/14 14/14 PERCENTAGE 93% 71% 64% 93% 93% 100% 100% 100% 93% 100% 100% 93% 57% 43% 93% 100%
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 81 Cacadu District Equipment and supplies
Health Facility Name Gluco- sticksmeter meter Hb Weight scale Uristix Blood collection test tubes Rapid HIV test kits Tape measure Foeto- scope Condoms Femidoms BP machine BP machine Glucometer
Graaff Reinet CHC x x Aeroville Bongweni x Brug Straat Gracey x Horseshoe Kroonvale Kwazamukucinga x Masakhane Rietbron Steytlerville Umasizakhe Willowmore Wongalethu TOTAL 14/14 14/14 14/14 14/14 14/14 13/14 14/14 13/14 14/14 14/14 14/14 11/14 PERCENTAGE 100% 100% 100% 93% 100% 93% 100% 93% 100% 100% 100% 79%
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 82 Chris Hani District Equipment and supplies
Health Facility Name (CHC and Clinics) Formula Feed Infant Road-to- Card Health BP machine BP machine Glucometer Glucometer sticks HB meter scale Weight Uristix Blood collection test tubes Rapid HIV test kits Tape measure Foetoscopes Condoms Femidoms kit PCR test PCR gloves
Engcobo CHC x x x Zwelakhe- x Dalasile CHC All Saints x x x Gateway Clinic Boklein x x x x x
Clarkbury Clinic x x x
Lahlangubo x
Lucwecwe x x x x
Manzana x
Mhlophekazi x x
Nkwenkwana x x x
Ntsimba Clinic x x x
Tora x x x
Zadungeni x
12 13 12 7 13 12 13 12 13 13 12 9 12 0 12 10 TOTAL 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13 PERCENTAGE 92% 100% 92% 54% 100% 92% 100% 92% 100% 100% 92% 69% 92% 0% 92% 77%
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 83 eThekwini District Equipment and supplies
Health Facility Name d oo Glucome ter Gluco- meter sticks Hb meter Weight scale Uristix Bl collectio n test tubes Rapid HIV test kits Tape measure Foeto- scope Condoms Femido ms test PCR kit PCR gloves Pelargon supplem entary feeding Road-to- Health Card BP machine Inanda -Newtown A CHC x x Amaoti x Bester x x Cane Side bex x x Clare Estate x x Craigburn x x Danganya x - Glen Earl n/a x Goodwins x x x Hambanathi x x x x - Inanda Seminary x x Klaar Water x x Kloof x x x - Lamontville x x - Lindelani PHC nf x x x Maphephetheni bex x x Mpola x x Nagina x x Newlands East Clinic x x x Oakford Clinic Qadi x - Queensburn x x Reservoir Hills x Sea Cowlake x x Township Centre x x Umkomaas x x Umlazi G x Umlazi N Clinic x x x Umlazi U21 D/NA x Water Loo x x x 𝟑𝟎 𝟐𝟗 𝟐𝟗 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟐𝟗 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟐 𝟐𝟖 𝟑𝟎 𝟐𝟏 𝟐𝟓 TOTAL 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 𝟑𝟎 PERCENTAGE 100% 97% 97% 100% 100% 100% 100% 97% 100% 100% 100% 7% 93% 100%% 70% 83%
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 84 Ehlanzeni District Equipment and supplies
Health Facility Name BP machine BP machine Glucometer Glucometer sticks HB meter scale Weight Uristix Blood collection test tubes Rapid HIV test kits Tape measure Foetoscopes Condoms Femidoms kit PCR test PCR gloves Pelargon supplementary feeding? Infant feeding Road-to-Health Card Thulamahashe CHC v ES X x Arthurstone M √ ES x x x Brooklyn √ x Calcutta √ x Casteel √ x x Dingledale √ x Gottenburg √ x X x x Hluvukani √ ES x x X x x Jim Brown M √ x Justicia √ x Kildare M √ x x Lillydale √ X x Ludlow √ x x Maviljan M M M √ ES x x Shatale M √ Xanthia M x √ ES X x Zoeknog x √ x x TOTAL 17/17 14/17 14/17 12/17 17/17 17/17 17/17 10/17 17/17 17/17 17/17 6/17 17/17 8/17 9/17 14/17 PERCENTAGE 100% 82% 82% 71% 100% 100% 100% 59% 100% 100% 100% 35% 100% 47% 53% 82% M = malfunctioning, ES = Expired stock
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 85 Dr RSM District Equipment and supplies
Health Facility Name Pelargon Pelargon supplement ary feeding Road-to- Card Health BP machine BP machine Glucometer Glucometer sticks meter Hb Weight scale Uristix Blood collection test tubes Rapid HIV test kits Tape measure Foetoscope Condoms Femidoms kit PCR test PCR gloves
Ganyesa CHC Morokweng CHC Tlakgameng CHC √M Austrey Clinic x Kgokgo Clinic x Kudunkgwane x Clinic Expired Morokwaneng x x Tlapeng Clinic 8 8 8 𝟕 8 8 8 𝟕 8 8 8 8 8 5 7 8 TOTAL 8 8 8 𝟖 8 8 8 𝟖 8 8 8 8 8 8 8 8 PERCENTAGE 100% 100% 100% 88% 100% 100% 100% 88% 100% 100% 100% 100% 100% 63% 88% 100%
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 86 ANNEXURE J: AVAILABILITY OF INFORMAITON EDUCATION AND COMMUNICATION (IEC) MATERIAL
Alfred Nzo District IEC material
Health Facility
Name ANC Info posters available ANC HIV referral criteria displayed education VCT algorithm PMTCT displayed in each consulting room Nutrition feeding Infant Growth monitoring IMCI family booklet Chancele x x x x x Lugageni x x Magadla x Maluti Mkemane x x Mt Hargreaves x Mtumase x Ntlabeni x x Ntizwa x Nyaniso x x Paballong x Qwidlana x x Sheperds Hope x x Silindini x x Tela x x 𝟏𝟒 𝟗 𝟏𝟒 𝟒 𝟏𝟒 𝟏𝟒 𝟏𝟐 𝟏𝟐 TOTAL 𝟏𝟓 𝟏𝟓 𝟏𝟓 𝟏𝟓 𝟏𝟓 𝟏𝟓 𝟏𝟓 𝟏𝟓 PERCENTAGE 93% 60% 93% 27% 93% 93% 80% 80% Amathole District IEC materials
Health Facility g
Name ANC Info posters available ANC HIV referral criteria displayed education VCT algorithm displayed in each consultin Nutrition feeding Infant Growth monitoring IMCI family booklet Dutywa CHC x x x x x Elliotdale CHC x Willowvale CHC x x x Bolotwa x Jingqi Kwamkholoza x Mpozolo x x Mqhele Nqadu x x Nqabara Idutywa x x Nqabeni x Soga x x x x Sundwana x Taleni x 𝟏𝟑 𝟗 𝟏𝟏 𝟗 𝟏𝟐 𝟗 𝟏𝟐 𝟏𝟑 TOTAL 𝟏𝟒 𝟏𝟒 𝟏𝟒 𝟏𝟒 𝟏𝟒 𝟏𝟒 𝟏𝟒 𝟏𝟒 PERCENTAGE 93% 64% 79% 64% 86% 64% 86% 93%
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 87
Cacadu District IEC materials
Health Facility
Name ANC Info posters available ANC HIV referral criteria displayed education VCT algorithm PMTCT displayed in each consulting room Nutrition feeding Infant Growth monitoring IMCI family booklet Brug Straat x x x x x x x x Steytlerville x x x x x x x x Gracey Aeroville x Bongweni x Kroonvale Umasizakhe Kwazamukucinga x x x x Horseshoe x x Rietbron x x x x x x x x Willowmore x x Wongalethu x x x x x x x Graaff Reinet x Masakhane 𝟖 𝟗 𝟏𝟎 𝟓 𝟗 𝟗 𝟗 𝟖 TOTAL 𝟏𝟒 𝟏𝟒 𝟏𝟒 𝟏𝟒 𝟏𝟒 𝟏𝟒 𝟏𝟒 𝟏𝟒 PERCENTAGE 57% 62% 71% 36% 62% 62% 62% 57%
Chris Hani District IEC material
Health Facility Name
ANC Info posters available ANC HIV referral criteria displayed education VCT algorithm PMTCT displayed in each consulting room Nutrition feeding Infant Growth monitoring IMCI family booklet Ngcobo CHC x x x x x x Zwelakhe-Dalasile CHC x x x x x All Saints Gateway Clinic x x x x x x Boklein x x x x x x Clarkbury Clinic x x x x Lahlangubo x x x x Lucwecwe x x Manzana x x x x x Nkwenkwana x x x x Ntsimba Clinic x x Tora - x Mhlophekazi * Zadungeni TOTAL 3/11 1/11 6/11 5/11 7/11 8/11 5/11 7/11 PERCENTAGE 27% 9% 55% 45% 64% 73% 45% 64% * Data was only available for 11 facilities
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 88 eThekwini District IEC materials
Health Facility
Name ANC Info posters available ANC HIV referral criteria displayed education VCT algorithm PMTCT displayed in each consulting room Nutrition feeding Infant Growth monitoring IMCI family booklet Inanda - x x x x x Newtown A CHC Sea Cowlake - x x x Glen Earl x x x x x Queensburn x x x x Cane Side x x x x x x Maphephetheni x x x Danganya x x x x x x Qadi x x x Umlazi U21 x x x x x Amaoti Inanda Seminary x x Bester x x x Mpola x x x x Umkomaas x x x x x Umlazi G x x x x x Clare Estate x x x x x Craigburn x x x x x x x Klaar Water x x x x x x Water Loo x x x x x Kloof x x x x Reservoir Hills x x x x Nagina x x x x x x Goodwins x x x x Hambanathi x x x Lindelani PHC x x x x Newlands East x x x x x Clinic Umlazi N Clinic x x x x Lamontville x x x Township Centre x x x x Oakford Clinic x x x x x TOTAL 18/30 3/30 11/30 5/30 25/30 20/30 19/30 2/30 PERCENTAGE 60% 10% 37% 17% 83% 67% 63% 7%
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 89 Ehlanzeni IEC Material
Health Facility Name
ANC Info Posters available ANC HIV Referral criteria displayed education VCT Algorithm PMTCT displayed in each consulting room Nutrition Feeding Infant Growth Monitoring IMCI Family booklet Thulamahashe CHC x x Arthurstone x x x x Brooklyn x x x Calcutta x x x x Casteel x x x x Dingledale v x x x x Gottenburg x Hluvukani x x x x x x Jim Brown x x x Justicia x x Kildare x x x x x x x x Lillydale x x x x x Ludlow x x Maviljan x x x x Shatale x x x x x Xanthia x x x x x x Zoeknog x x x TOTAL 7/17 9/17 13/17 9/17 12/17 9/17 7/17 4/17 PERCENTAGE 41% 53% 76% 53% 71% 53% 41% 23%
Dr RSM District
IEC MATERIALS
Health Facility Name
ANC Info posters available ANC HIV referral criteria displayed education VCT algorithm PMTCT displayed in each consulting room Nutrition feeding Infant Growth monitoring IMCI family booklet Ganyesa CHC x x x Morokweng CHC Tlakgameng CHC x x x x Austrey Clinic x Kgokgole Clinic x Kudunkgwane Clinic x x x x Morokwaneng Tlapeng Clinic TOTAL 8/8 4/8 7/8 5/8 8/8 8/8 7/8 4/8
PERCENTAGE 100% 50% 87% 62% 100% 100% 87% 50%
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 90 ANNEXURE K: PART A: Review of antenatal, labour and postnatal services- In Clinics, Health Centres Level 1 Hospital and Level 2 Hospitals
INSTRUCTIONS
This form is intended to assist with the review of the prenatal, labour and postnatal services in facilities and how these impact on PMTCT in order to assess the extent to which services are available and effective The data is collected from Clinics, Health Centres, Level 1 and Level 2 Hospitals Please note: The period under review is from 1st January 2009 to 30th June 2009. Collect sample sheets of all PMTCT data collection tools including those for NGO data collection
Section 1: Background information
1. Province
2. Sub-district or Municipality
3. Name of Facility
4. Contact information: Tel: Fax: Contact person: Interviewee
5. Type of Facility Clinic Health Centre Level 1 Hospital Level 2 Hospital
6. Location of facility Urban Rural Peri - urban
7. Operational Hours 8 hours 12 hours 24 hours
8. Catchment population of area served by facility Population Number:
9. Date of assessment Dd: Mm: Yy: Interviewer’s Name ______
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 91 Section 2: Human Resource and Training Indicate your responses by a means of a number. Staff Category # of Approved Staff # of Filled Posts # of Vacant Establishment Posts
Professional Nurses (PN)
- PNs above trained in midwifery
- PNs above with Advanced Midwifery
Staff Nurses (Enrolled Nurse)
Midwives (Enrolled Nurse)
Enrolled Staff Nurses (ENA) Lay Counsellors
Doctors
Facility Information Officer
Data Capturer
Other e.g. HP, EHPs, Cleaners, etc
How many staff members are able to put up a drip for an infant or adult in shock? How many staff members are able to intubate an infant? How many staff members are able to resuscitate a pregnant woman with obstetric emergencies? Is there a doctor with experience in obstetrics and gynaecology providing a service within this facility? YES /NO How many staff members have experience with paediatrics/neonatal care?
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 92 Indicate your responses by a means of a number. If the category of the staff is not available, write N/A response How many staff at this Doctors Professional Enrolled Enrolled Lay Facility facility have been trained in Nurses Nurses/ Nursing Counsellors information the following areas: Staff Nurse Assistants officer /Data capturer HIV counselling and testing (10 days) Provider initiated HIV counselling and testing (1-3 days) PMTCT (3-5 days) BANC (3 days )
Infant feeding (2 – 5 days) ? Basic HIV and AIDS course/knowledge (formal/informal/self trained) Adult HIV and AIDS clinical Management
Paediatric ART management
Dry Blood Spot sampling (PCR) (1 – 3 days) Use of Health Information (2 -3 days) Syndromic management of STI (3 -5 days)
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 93 Section 3: Services
Are the following services provided by the facility? Circle the appropriate response
ANC Y N
HEALTH/GROUP EDUCATION Y N
VCT Y N
PMTCT Y N
HAART Y N
CERVICAL SCREENING Y N
STI Y N
DELIVERY SERVICES Y N
PNC Y N
WELL BABY CLINIC Y N
FAMILY PLANNING Y N
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 94 Section 4: Infrastructure
If answer is yes in the questions below please write Y, if answer is no please write N and where a number is requested please indicate the number.
Number of rooms Are the rooms for this service shared with any other service ANC HEALTH/GROUP EDUCATION HIV COUNSELLING AND TESTING PMTCT HAART CERVICAL SCREENING STI DELIVERY SERVICES PNC WELL BABY CLINIC FAMILY PLANNING COMMUNITY OUTREACH
1. Which of the above services are provided as a select service in a specific consulting room?
2. Is more than one consultation conducted in the same consulting room at the same time? Y N
3. If your response is yes in question 2, which services are delivered in one consulting room at the same time? Consulting room one: Consulting room two: Consulting room three: Community room four:
4. Do you feel there is adequate space to ensure: a) Auditory privacy YN b) Visual Privacy YN
c) To avoid cross infection YN
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 95 SECTION 5: EQUIPMENT AND SUPPLIES Please response by yes or no and add narratives if necessary 1. Is the equipment needed for antenatal care available and Available Functional Comment functional? a) BP machine, b) glucometer c) glucometer sticks (check expiry date) d) Hb meter e) weight scale f) uristix (check expiry date)
g) blood collection test tubes
h) rapid HIV test kits (check expiry date) i) Tape measure j) Foetoscope k) Condoms: Check expiry date l) Femidoms: Check expiry date
2. Are the following items and supplies available where Available Functional Comments blood drawing/testing takes place? a) Working counter b) Desk and Chair c) Refrigerator (working – between 3o and 8o) d) Gloves e) Sharps box f) Disposable needles and syringes g) Running water h) Sink with elbow taps i) Lockable storage for HIV test kits j) Adequate light source and ventilation k) Hand washing items (e.g. hand soap and towel) l) Disinfectant m) Lancets for finger pricking
3. Is the equipment needed for delivery available and Available Functional Comments functional? a) Delivery pack b) Cord ligature c) Disposable needles and syringes d) Sharps disposal box e) Gloves f) Protective clothing/apron g) Antiseptic
4. Is the equipment needed for postnatal care available Available Functional and functional? a) PCR test kit: Check expiry date b) PCR gloves: Check expiry date
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 96 c) Pelargon supplementary feeding ? Infant feeding d) Road-to-Health Card
5. Materials necessary for Information, Education and Available Functional Comment Communication a) ANC - general information posters b) Are there clear referral criteria displayed in the facility for ANC cases who are HIV+? c) HIV/Aids Counselling and Testing d) PMTCT algorithm displayed in each consulting room e) Nutrition d) Infant feeding e) Growth monitoring and promotion f) IMCI family booklet
6. Emergency and resuscitation equipment Available Functional Comment a) Infant laryngoscope b) Adult laryngoscope c) Infant ambubag d) Adult ambubag e) Endotracheal tube f) IV fluid (Ringer’s Lactate) (Check expiry date) g) IV fluid (Dextrose 5%) (Check expiry date) h) IV cannula i) Adrenaline: Check expiry dates j) Hydrocortisone: Check expiry dates k) Phenergan: Check expiry dates l) Ergometrine: Check expiry dates m) Vitamin K (Konakion): Check expiry dates
7. Pharmaceutical supplies Available Stock-out /s in Duration (longest last 6 months period) a) AZT Y/N Y/N b) NVP c) Co-trimoxizole d) Vitamin A
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 97 Section 6: Availability of essential antenatal care and PMTCT services
1. What is the average number of ANC visits that a pregnant woman makes during each pregnancy?
2. From which trimester are pregnant women encouraged to attend ANC for the 1st 2nd 3rd first time? 3. Is obstetric, medical & social history routinely obtained during the first ANC Y N visit and important issues recorded on the patient’s record? Check 5 patient records 4. Are women clinically examined during the first antenatal visit to detect Y N underlying clinical problems such as pelvic abnormalities, heart disease, hypertension and diabetes? Select 5 patient records 5. Are all the staff providing ANC able to detect risk factors such as twins, Y N malposition of the foetus, pregnancy induced hypertension (PIH) (= pre- eclampsia, toxaemia), hydramnios etc? Check 5 records 6. Is urine routinely checked for protein, glucose and other abnormalities? Check Y N patient records 7. Is blood for haemoglobin routinely taken during the first visit? Check patient Y N records 8. Is blood for syphilis routinely taken during the first visit? Check records (where Y N it is normally recorded as “RPR test”) 9. Is blood for compatibility routinely taken during the first visit? Check records Y N 10. Do providers routinely initiate C&T for HIV during the first visit? Check records Y N 11. Is HIV testing done (or offered) routinely during the first visit? Check records Y N (ANC card) 12. Is counselling and testing available daily? Check records Y N 13. Is infant feeding counselling provided during the antenatal period? Check Y N record (ANC card) 14. Are the 2008 PMTCT Policies and Guidelines available? Please check Y N availability 15. Is CD4 count testing undertaken daily? Check records Y N 16. What is the CD 4 cell turnaround time in this facility? 17. Are HIV+ve eligible (CD4<200 and clinical staging) women presenting in Y N pregnancy referred to an ARV site? Check 5 records 18. Is this facility accredited to provide HAART? Y N 19. Which pregnant HIV+ mothers do you refer for HAART? Explain Explain: 20. If the facility is not providing HAART, are there any down-referral mechanisms Y N for mothers on HAART to this facility? 21. If your response in question 20 was yes, what types of HAART patients are Explain down referred to your facility? Explain: 22. Does this facility have a mothers-to-mothers-to-be (M2M2B) programme? Y N
Comments in relation to Section:
______
______
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 98 Section 7: Availability of essential PMTCT services during labour and post-delivery
1. Is there on-site counselling for HIV testing during labour? Check record Y N (PMTCT or VCT Register) PMTCT Protocol requires that pregnant women with unknown HIV status and those that previously tested negative should be retested during labour.
2. Are midwives available to do routine provider initiated counselling and Y N testing (PICT) during labour? Check records 3. Is there on-site counselling for HIV testing post-delivery (especially Y N BBAs)? 4. How are you addressing the problem of maternal mortality? Explain Explain: …………………………………………………………………………………….
Comments in relation to Section 7:
______
______
Section 8: Availability of essential PMTCT services during postnatal period
1. Is ARV prophylaxis given to HIV exposed babies at birth and Yes No subsequent days? Check records 2. Is ARV prophylaxis given to HIV exposed babies reflected in the Yes No delivery register? Check records. 3. What type of preventive therapy is being offered to HIV exposed Nil Mono Dual babies to prevent MTCT? 4. If dual therapy is offered, when did this facility begin providing this? Dd Mm Yy
5. Is PCR Testing available and done for HIV exposed infants? Yes No DK
6. What are the constraints in providing PCR testing for infants? Explain DK Explain: ……………………………………… 7. What is the Turn around time (TAT) for PCR results during the past 3 No. DK months? 8. From facility register, list 5 top causes of neonatal mortality. Please list …………………………………………………………………………………… …………………………………………………………………………………… Comments in relation to Section 8:
______
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 99 Section 9: Feeding and PMTCT services
What services do you provide to mothers of breast / formula fed children when they return for review? Item Service Available Check Records, Is this recorded? 1. Ongoing counselling and support on breast feeding for breast fed Yes No Yes No children 2. Ongoing counselling and support on formula feeding for formula Yes No Yes No or mixed fed infants 3. Nutritional counselling and support on weaning and introduction Yes No Yes No of solids 4. Growth monitoring and promotion. Check 5 RTHC. Yes No Yes No 5. Screening for TB (asking the six questions). Check 5 child patient Yes No Yes No records 6. Provision of co-trimoxazole prophylaxis to all HIV exposed babies Yes No Yes No 7. Immunization services as should be done to date. Check records Yes No Yes No 8. PCR Testing to all HIV exposed babies Yes No Yes No 9. Vitamin A supplementation Yes No Yes No 10. Assessing infants’ general health and development. Check 5 RTH Yes No Yes No Cards. 11. Assessing mothers’ general health. Check 5 records. Yes No Yes No
Comments in relation to Section 9:
______
______
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 100 Section 10: Data management
In Clinics, Health Centres, Level 1 Hospital Review the monthly summaries compiled from the general register in this facility for the period 1st January 2009 to 30th June 2009
Record the following data:
1. Who is responsible for summarising the daily tally sheet?
2. Who is responsible to verify the correctness of the facility data?
3. Is there a process of analysing, interpreting and discussing the facility data/information (Check meeting records)?
……………………………………………………………………………………………………………………………….
4. Are there any challenges with data collection and flow to the sub-district/ district? Unavailability of data collection tools (e.g. tally sheets) Transferring of information upwards No feedback from higher levels Poor understanding of data elements / indicators Data elements / indicator ambiguity
Other ………………………………………………………………………………………………………
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 101 Section 11: Community outreach
What is the extent of community involvement and outreach?
1. Do facility based staff have any responsibility for home or community YN DK visiting in regard to maternal and child health? Check recorded evidence. 2. Is there a community based IMCI programme in the community? Check YN DK recorded evidence. 3. Is there a cadre of community care givers/community health workers YN DK (CCGs/CHWs) in some form that work on maternal and child health issues in the community served by this facility? 4. How many CCGs/CHWs are there in the catchment area of the facility? DK 5. Is there geographic mapping of the catchment area outlining YN DK distribution of CCGs/CHWs? 6. Are there any geographical gaps in the coverage of CCG/CHW services? Y N DK Expl ain. 7. Do facility staff sometimes accompany CCGs/CHWs on home visits? Y N DK 8. Are meetings routinely held with CCGs/CHWs to review maternal and YN DK child health problems? 9. Do staff in the facility refer maternal or child health cases to the YN DK CCGs/CHWs? 10. Do CCGs/CHWs refer maternal or child health problems to the facility? Y N DK 11. Is there a clinic advisory committee or hospital board? Y N DK 12. Do you include maternal and child health issues in the agenda of clinic YN DK committee meetings? Check minutes of the meeting.
Comments in relation to section 9: …………………………………………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 102 ANNEXURE K: PART B: Record Review Template
RECORD REVIEW OF ANC SERVICES
Sub- Province District Facility Telephone # Name and Designation of Health Worker who assisted with record review
Cell #
Name of persons conducting record review Date KEY: First booking visit before 20 weeks = N <20 weeks First booking visit at or after 20 weeks = N +>20 weeks Follow up visit = Repeats
ANC < 18 years 18 - 45 years or more TOTAL
First visits First visits First visits Data N <20 N =>20 N <20 N =>20 N <20 N =>20 source weeks weeks Repeats weeks weeks Repeats weeks weeks Repeats Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Total
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 103
RECORD REVIEW OF HIV CARE IN ANC SERVICES Sub- Province District Facility Tel # Name and Designation of Health Worker who assisted with record review Cell # Name of persons conducting record review Date
KEY: ANC first booking visit = New Follow up visit = Repeat
HIV Services Known in ANC Positive Pre Test Counselling Tested Tested HIV Positive CD4 test done Data source New New Repeat New Repeat New Repeat New Repeat Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Total
HIV Services in ANC Screened for TB # on cozole Issued AZT at New Repeat prophylaxis 28 weeks Issued sdNVP Referred for HAART Started on HAART Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Total
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 104 RECORD REVIEW OF HIV CARE IN ANC SERVICES Sub- Province District Facility Telephone # Name and Designation of Health Worker who assisted with record review
Cell #
Name of persons conducting record review Date KEY: ANC first booking visit = New Follow up visit = Repeat
HIV Services in Tested HIV Positive at ANC Tested Negative subsequent tests Data source New Repeat New Repeat
Jan-09
Feb-09
Mar-09
Apr-09
May-09
Jun-09
Total
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 105 RECORD REVIEW OF HIV CARE IN LABOUR Sub- Province District Facility Telephone # Name and Designation of Health Worker who assisted with record review
Cell #
Name of persons conducting record review Date Maternal Deaths 28 weeks gestation to 7 days LABOUR LABOUR POST DELIVERY postpartum # with HIV as 10 or 20 Data Pre-test Tested Issued Pre-test Tested HIV cause of source Counsel HIV tested HIV +ve Issued AZT NVP Counsel HIV tested +ve # of deaths death Jan-09
Feb-09
Mar-09
Apr-09
May-09
Jun-09
TOTAL
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 106 RECORD REVIEW OF SERVICES TO HIV EXPOSED BABIES Province Sub-District Facility Tel # Name and Designation of Health Worker who assisted with record review Cell #
Name of persons conducting record review Date KEY: NEVIRAPINE = NVP ZIVODINE = AZT Services to HIV Exposed Babies PCR test done at six weeks or later PCR Turn Around Time # of HIV # of HIV # of HIV exposed exposed exposed # of HIV # of infants # of infants infants tested infants tested infants Data # of live exposed # of infants given AZT give AZT for at 6 weeks or HIV pos at 6 LONGEST given source births babies given NVP for 7 days 28 days later weeks or later LEAST TIME TIME cozole
Jan-09
Feb-09
Mar-09
Apr-09
May-09
Jun-09
Total
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 107 RECORD REVIEW OF MTCT OUTCOME AT 18 MONTHS Sub- Province District Facility Telephone # Name and Designation of Health Worker who assisted with record review Cell #
Name of persons conducting record review Date
MTCT at 18 months
# tested HIV # lost to # HIV tested at positive at 18 follow up at Data source 18 months months 18 months
Jan-09
Feb-09
Mar-09
Apr-09
May-09
Jun-09
Total
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 108 RECORD REVIEW OF Maternal Health Service Child Health SERVICES Sub- Province District Facility Tel # Name and Designation of Health Worker who assisted with record review: Cell#
Name of persons conducting record review: Date
Population <18 years: Population 30 - 59 yrs:
Cervical Women Protection Caesarean Cancer No. of section screening Condoms No. of deliveries rate Month of Data in women deliveries in facility (hospital Review Source 30 - 59 yrs Male Female Oral Pill Depo Nur IUCD in facility <18 yrs only) Jan-09
Feb-09
Mar-09
Apr-09
May-09
Jun-09
TOTAL
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 109 RECORD REVIEW OF MATERNAL & NEONATAL HEALTH SERVICES Sub- Province District Facility Tel # Name and Designation of Health Worker who assisted with record review:
Cell #
Name of persons conducting record review: Date Female population <18 years: Female population 25 - 59 yrs: No. of perinatal Month of Number of Number of mortalities in facility Review Data Source Number of births assisted Births maternal deaths (<1000g) Number of Neonatal deaths.
Jan-09
Feb-09
Mar-09
Apr-09
May-09
Jun-09
Total
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 110 RECORD REVIEW OF Child Health SERVICES
Province Sub-District Facility Telephone # Name and Designation of Health Worker who assisted with record review:
Cell#
Name of persons conducting record review: Date
Population <5 years: Population <1yr: Child Health Data Elements (to work out Indicators)
Immunisation drop out PHC Vitamin A HeadCount No. children No. children Vitamin A given given Month of Review Data Source < 5years Immunised fully <1 year - new given DTP 1 given DTP 3 6 - 11 mnths 12-59 mnths Jan-09
Feb-09
Mar-09
Apr-09
May-09
Jun-09
TOTAL
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 111 RECORD REVIEW OF Child Health SERVICES
Province Sub-District Facility
Name and Designation of Health Worker who assisted with record review:
Name of persons conducting record review :
Tel#: Cell # Date Population < 5years:
Child Health Data Elements (to work out Indicators) Review Number of <5's Not gaining weight Under weight for age Month Data Source Diarrhoea cases < 5 yrs weighted under 5 years <5 years Severe Malnutrition <5 years Jan-09
Feb-09
Mar-09
Apr-09
May-09
Jun-09
TOTAL
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 112 ANNEXURE L: FACILITY REGISTERS AND INFORMATION REQUIRED FOR THE MNCH&N AND PMTCT ASSESSMENT
PERIOD OF ASSESSMENT: JANUARY to JUNE 2009
REGISTERS (or other source of information if your Facility does not keep a specific register)
All Tick Registers for the above period Monthly Data Input forms Facility Catchment Population estimates VCT Register ANC Register HIV Exposed Children Register (if there is one) Blood Sample Register PAP Smear Register Maternity Delivery Register PMTCT Milk Register Malnutrition Register Schedule 5 & 6 Drug Register Pre-ART Register (mainly CHC’s)
INFORMATION
ANC cards RTH cards Health Education Book Minute Book for ‘Information Sharing and Use’ Staff Meetings Graphs with MCWH and PMTCT information National Indicator Data Set 2005 Names of other NGOs supporting the Facility
BASELINE ASSESSMENT OF MNCH&N SERVICES IN SEVEN PRIORITY SUB-DISTRICTS IN FOUR PROVINCES 113