Table 3 Responses to weak areas identified during the assessment from group work undertaken with the assessment teams and key district management.
Reasons for the low coverage of nevirapine to women and infants | Reasons for the low coverage of CD4 testing amongst HIV positive women | Reasons for the low coverage of PCR testing amongst HIV exposed infants at 6 weeks |
|---|---|---|
Client factors: clients not clear about when to take nevirapine. unbooked patients/late booking Health system factors: lack of training of nursing staff lack of privacy in labour wards thus difficult to ask about HIV status nurses not checking HIV status on medical records lack of ownership of the PMTCT programme by staff poor recording of nevirapine doses during ANC/labour. nevirapine not available or locked in a cupboard | Health system factors: shortage of staff unclear roles & responsibilities poor recording of HIV status on antenatal records some facilities only 1 person in charge of HIV and responsible for all CD4 testing lack of staff knowledge and motivation lack of clarity on the PMTCT protocol low confidence in interpretation of policies/protocols | Client factors: mothers fear of disclosing status or of knowing child's status infants brought to clinic by nanny or grandmothers which results in consent issues for testing mothers not being adequately informed Health system factors: no tracing system for defaulters staff shortages whose role is it? registered nurse/enrolled nurse too few staff trained to do PCR -- seen as complicated procedure coding system on RTHC difficult to understand poor/no recording on RTHC |