*Y.C.* Lerato Care – Love and Care

South Africa still has one of the highest maternal, child and infant morbidity and mortality. The fight to eradicate HIV and AIDS in Africa has been one of the longest and most urgent battles we have had in the history of health care.
As the former president, Nelson Mandela, said, “We are facing a challenge of unprecedented proportions, our response therefore must be unprecedented.” In South Africa many people are infected but we are all affected by HIV. One of the ways in which maternal health can be tackled and improved is by the following:
Identifying the problem: Prevention of mother to child transmission (PMTCT) of HIV relies on identification of HIV-positive pregnant women. The government has improved policy guidelines to ensure that HIV testing is routinely done during antenatal care. According to these guidelines HIV positive women have been made one of the priority groups for antiretroviral drug initiation according to set criteria (CD4 count < 350). In SA more than 90 % women attend antenatal care while more than 72% make more than four visit (“Every Death Counts” and “Saving Mothers Report”). However there are women that are diagnosed as HIV-positive only at the time of delivery. More than 90% of women are delivered in the health facility. This provides a perfect scenario for PMTCT. A huge challenge in monitoring success and ensuring ongoing maternal and child care is the fact that there is a significant loss to follow-up after delivery. Unless good measures and links are developed for both support and monitoring, this is going to have an impact on various outcomes (mortality, drug resistance, etc) since more women are going to be initiated on drugs during pregnancy.
Describing the idea: A good follow up plan of monitoring and support for such patients has to be in place. The plan should link to maternity, primary health and community elements. In South Africa midwives render a range of sexual reproductive health services in all levels of care. This puts them in position to provide a perfect link for this plan. Pregnancy offers an important opportunity to enroll women at risk of AIDS into lifelong care. It also creates an entry point for the partner’s involvement and possibility of making this a family intervention programme. PMTCT should not just be focused on antenatal and birth care but require ongoing monitoring and support from the healthcare workers particularly midwives, family and community members in order for maternal and child morbidity and mortality to be reduced.
The strengthening of these systems is the foundation of this idea. Practically the following interventions will be created or strengthened. Some interventions are already occurring on a small scale but there is a lack of coordination on a regional/provincial level.
•Development of well structured simple to use monitoring program for midwives
•Communication between clinics and staff by means of either implementing a database if there is none yet or strengthening the existing structure. This database will
oProvide weekly statistics
oFacilitate mother/child pair tracking and follow-up
 Monitor attendance
 Trigger tracing of women, children and families lost to follow-up
 Link with other relevant services such as paediatric and adult services to track mortality or morbidity of infants and women who should have attended routine follow-up
•Using cellular phone technology to communicate with mothers and track their follow-up
o Cell-phone technology is being implemented in pilot sites and the success of these projects will be monitored and applied based on their outcomes
•Introduction of community members as mentors (e.g. HIV positive mothers or elders, etc) in the organization who will do home visits when mothers/infants do not return for care.
•Monitoring and evaluation team to assist with data analyses and feedback and liaise with the “Saving Mothers Saving Babies” project as well as government statistics
•Create support group in communities for mothers who are struggling to attend or who are ill.
Conclusion: The highest mortality and morbidity rate can be seen in mothers and infants who do not attend recommended care. In order for us to build a stronger society we need to track HIV-positive mothers to discover what their needs are and assist them to access the care that is available. South Africa has a strong programme of care but the mortality figures show that not enough mothers and babies are reaching the care. This project aims to close the gap within various levels of services, between the community and the services that are available.