More than two million HIV-positive women become pregnant each year. Health needs relating to HIV, opportunistic infections and pregnancy are closely linked and integrated responses are vital. So why is progress in linking prevention of mother-to-child transmission (PMTCT) and maternal health services in sub-Saharan Africa slower than planned?

PMTCT remains central to reducing the impact of HIV on maternal and child health. A paper from the HLSP Institute and Options Consultancy, in the UK, explores progress in linking HIV prevention and maternity services. It summarises two reviews involving internet searches, literature searches and 106 key informant interviews.

International policy-makers have emphasised the importance of linking sexual and reproductive health (SRH), maternal health, HIV/AIDS and other key services. In March 2006, the UN Inter-Agency Task Team on mother to child transmission, which involves UNICEF, UNFPA, WHO, the World Bank and UNAIDS, launched a global strategy focusing on country level efforts to scale up PMTCT. Although the new strategy has the potential to turn international commitment into action, progress in scaling up services for HIV-positive pregnant women has been slower than hoped for. In 2005, PMTCT reached just 11 percent of HIV-positive pregnant women in much of Africa, less than half the coverage of anti-retroviral treatment programmes for adults, although recent figures are more encouraging. Barriers to scaling up include:

• weak health systems
• limited human resources
• lack of supplies, including drugs
• stigma
• low levels of male involvement
• weak community mobilisation
• falling donor financing for SRH and maternal health services relative to AIDS-related funding.

HIV-related interventions tend to be financed, managed and supervised as additional or poorly integrated activities, alongside often weak maternal and neonatal services. Vertical financing mechanisms for targeted programmes can increase this separation of HIV and SRH services. Policy and programmatic processes for HIV and maternal health have also developed separately, both nationally and internationally. National HIV and AIDS policy and coordination structures often failed to include reproductive and maternal health stakeholders.

The researchers look at reviews of success stories in a number of African countries. These studies identify decentralised approaches, strong national leadership and political commitment, and a comprehensive approach to integrating PMTCT into maternal health services as factors leading to success. These examples show that financing and institutional constraints can be overcome. To achieve such success, the authors recommend:

• strengthening routine maternal, neonatal and child care services
• reinforcing systems for basic service delivery, including human resources, commodity supplies and infrastructure
• increasing access to screening and treatment for sexually-transmitted infections
• improving post-partum care and post-natal follow-up for mother and baby
• enhancing access for pregnant women and mothers in need of ongoing ART
• addressing health worker shortages, especially at the peripheral level.

Funding for integrated programmes, national efforts to develop strategies and proposals, and better guidance from technical and implementing agencies are also needed.

Source(s):
‘Seizing the Big Missed Opportunity: Linking HIV and Maternity Care Services in sub-Saharan Africa’, Reproductive Health Matters 15:30, pages190-201, by Nel Druce and Anne Nolan, 2007

Funded by: UK Department for International Development

id21 Research Highlight: 05 June 2008

Further Information:
Nel Druce
HLSP Institute
London
UK

Contact the contributor: nel.druce@hlsp.org

HLSP Institute, London, UK

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