About 300 000 South African babies are born exposed to HIV every year. Without treatment, up to 30% of these babies will be born HIV positive.
An effective programme to prevent the transmission of HIV from mother to child (PMTCT) has the capacity to reduce transmission to less than 5%, thereby saving thousands of baby lives each year.
For this reason, PMTCT is a key strategy for achieving all four Outputs of the Negotiated Service Delivery Agreement and Millennium Development Goals 4, 5 and 6. In 2008, PMTCT became a ministerial priority, and a plan to strengthen PMTCT at facility-level was developed.
The Accelerated Plan for PMTCT combined tried-and-tested strategies to improve the quality of PMTCT at facility level (QI) with social mobilisation strategies to increase community demand and utilisation of services.
The ‘A-Plan’ was funded by DFID and managed by HLSP, initially under the Rapid Response Health Fund. Several development and technical partners working on PMTCT and HIV in both the community and health facilities combined their efforts to align with the plan.
The plan was rolled out in 161 facilities in six priority districts. During its first year (Phase One)it made impressive gains:
- 676 health workers were trained on quality improvement models, the use of QI tools and data analysis;
- 171 community health workers were trained to support the programme at facilities and reached 2739 pregnant women;
- The percentage of women seeking early antenatal care increased from 37% to 42%;
- Testing for CD4 cell counts increased from 88-98%; and
- The percentage of pregnant women on lifelong antiretroviral therapy increased from 22% to 55%.
The SARRAH programme committed to support the A-Plan for a further 18 months, and a small project management team was established at the National Department of Health.
During Phase Two, lessons from the A-Plan were used to strengthen PMTCT services nationally. For example:
- An A-Plan work plan was produced and integrated into the National PMTCT Operational Plan.
- A policy brief on lessons learned by the A-Plan was produced and shared with partners. This was used by the NDOH to mobilise resources from other partners.
- Significant progress was made on mobilising financial support, and on donor harmonisation for strengthening PMTCT nationally. This includes the reprogramming of resources from Round 6 of the Global Fund grant. The reprogramming of US government funds (PEPFAR) was also influenced by the A-Plan.
- Technical support to strengthen monitoring and reporting was provided. This included a technical support plan with baseline review and situation analysis of the 18 NDOH priority districts, and training of NDOH staff on data management.
The SARRAH Technical Lead played a significant role in supporting the NDOH to strengthen the PMTCT programme. The Global Fund Round 6 reprogramming proposal was one such contribution.
In June 2011 the Medical Research Council released the results of a new study that estimated transmission rates of HIV from mother to child, during 2010, at 3.5%. This is a great improvement on previous years and a testimony to the efforts of all partners to strengthen the national PMTCT programme.
SARRAH support for the national PMTCT programme came to an end in June 2011.
SARRAH documents on PMTCT and the A-Plan. READ...
The start of the A-Plan under DFID's Rapid Response Health Fund. READ...
SARRAH Project Brief. READ...
Case Study: Strengthening PMTCT. READ...