Table 1 Description of the three intervention phases

Participatory assessment phase

Purpose: District programme managers gain skills in programme assessment.

Formation of task team (programme managers and supervisors)

   1. Training workshop on assessment framework and tools including piloting

   2. Formation of teams of 3-4 people

   3. Complete assessment of PHC facilities including interviews with facility managers, observation of facility functioning and interviews with lay counsellors.

   4. Collection of routine PMTCT data from district information officer.

Description of tools:

   Facility manager questionnaire

Structured interviews with facility managers of PHC clinics. This tool assesses current staffing levels within clinics, organisation of services (days of the week and hours services are available), availability of lay counsellors, counselling services, laboratory services, supervision, health information, community involvement and roles and responsibilities of staff.

   Facility observations -- PHC clinics

An observational tool -- i.e. no interviews needed. This tool assesses availability of drugs and supplies, rooms for counselling, documentation and record keeping.

   Counsellor questionnaire

Purposive sampling of at least half of the counsellors in each facility for a structured interview. This tool assess training, relationships with clinic staff, space availability, waiting times, roles and responsibilities.

Feedback and planning phase

Purpose: District programme managers identify areas of weakness and learn to set realistic targets and action plans

   1. Review of assessment results at a workshop.

   2. Identification of areas of weakness (e.g. infant PCR testing)

   3. Target setting and action plans

Implementation and monitoring phase

Purpose: Team agrees on an action plan to address programme weaknesses. Continued support to sustain motivation and momentum.

   1. Planned interventions implemented (road show to orientate staff to the PMTCT protocol and encourage joint responsibility amongst health workers)

   2. Monthly support visits by project facilitator (senior experienced professional nurse) to assess routine programme indicators and determine progress towards targets.

   3. Development of further action plans