The implementation of the Prevention of Mother-to-Child Transmission Guideline 2013 by the Western Cape Department of Health : an evaluation

Abstract

The World Health Organisation introduced Option B+ in 2012 to eliminate HIV (vertical transmission from mother to child). The Western Cape Government, Department of Health followed by releasing its Prevention of Mother to Child Transmission Guideline in 2013. The purpose of the study is to evaluate the implementation of this guideline in the province in selected delivery sites within the Western Cape. The study makes use of a mixed methods approach using a case study as its design. The study collected qualitative and quantitative data using semi-structured interviews administered to health care practitioners and patients. The results indicate that for the routine PMTCT programme indicators, antenatal clients initiated on ART, the target was exceeded, for the indicator infant 1st PCR test positive at around 6 weeks, a decrease in HIV transmission from mother to baby was noted. Implementation challenges relating to task shifting and the scope of practice of the Registered Professional Nurse who are the key drivers to implementing the PMTCT Guideline 2013 were experienced. Other resource constraints relating to infrastructure, equipment and an upgraded monitoring and evaluation system in the MOUs' to capture ART data was also identified. The study concludes by offering recommendations to address the current top down policy implementation process. To improve local accountability for policy implementation grassroots level should be involved with policy drafting and be allowed to manage the budget (practical consideration to staffing, stock and equipment procurement, task shifting, re-designing facility process flows, improving Monitoring and Evaluation systems to accommodate for the revised policy implementation) are necessary to support policy implementation.