COMMITMENT LEAD TO IMPROVED HEALTH CARE SERVICE
PMTCT
NGWELEZANE CLINIC
INTRODUCTION
Health Care Improvement service delivery means that health care providers should be
committed in order to embrace quality effectively. Through mentoring, support and
encouragement the improved care can be ensured to reduce mortality and morbidity
during pregnancy for mother and baby.
BACKGROUND
Ngwelezane Clinic is a busy clinic situated at Ngwelezane Township about one km away
Ngwelezane Hospital. The monthly clinic registration at this clinic is 12000 clients
including pregnant women and children. This clinic has reduced large numbers of clients
who could have overcrowded the Ngwelezane hospital by absorbing most clients. The
clinic is also receiving referrals of pregnant mothers from Amakhumbuza HBC centre as
well as clients from Lower Umfolozi District War Memorial Hospital ( district maternity
hospitals) and other surrounding clinics.
Mrs Pretty Harrison is a Health Care Improvement Coordinator for KZN province under
Uthungulu District, with much interest and experience since 2002. Her main objective is
to is improve the continuum of care for pregnant mothers by prevention of Mother-tochild Transmission, including HIV Counselling and Testing, TB prevention and Haart.
GAPS IDENTIFIED
 Poor attitudes
 Lack of knowledge and skills
 Poor motivation.
 Staff rotation and staff turnover
 Lack of use of guidelines.
 Poor supervision
 Poor communication
 Poor recording.
 Late booking.
 Use of traditional herbs.
 Distance was far for some of the clients.
It is through years of continuous support that health care improvement has occurred
irregardless of challenges and setbacks that committed staff have managed to arrive at
this level of care. At first there was rigidity, negativity, lack of understanding of the role
of HCI and poor attitudes but the patience and encouragement has resulted in an
improved health care. The clinic staff became very enthusiastic and coorperative although
shortages were still evident. The presence of the Technical advisor was of assistance to
this team.When approached were accepting corrections and interest was created amongst
the staff.
URC INTERVENTIONS
1. Quality Assurance workshop were conducted.
2. Baseline data collection reflected that some clients were not tested during the first
ante natal visits.
3. Bi-monthly visits done and feedback on data taken.
4. In-service education was done.
5. Improved PCR at six weeks.
6. PMTCT Quality indicators improved.
7. Providing on site training.
8. Feedback on data review.
9. Influence by Amakhumbuza HBC project on clinic by home visits.
10. Strenthening of HIV integration.
11. Discussion on improvement of on going counselling.
12. Discussion on new PMTCT guidelines.
FIGURE 1
Ngwelezane 2007-09 PMTCT
120
100
80
60
40
20
0
% First ante natals tested
Jul Jan Jul Jan Oct Apr Oct Apr Sept
Mch
Sept
Mch
Dec 07
Jun 08
Dec 08
Jun 09
07
08
08
09
52
78
93
93
100
100
100
100
The discussion on testing all 1st Ante Natal Care clients has an impact on all babies at
birth as well. The pregnant women are now started on AZT at 14 weeks for saving of
babies. The VCT uptake has improved and is continuously maintainrd at 100%.
FIGURE 2
Ngwelezane Clinic 2008/09 PMTCT
Transmission rate at six weeks
70
60
50
40
30
20
10
0
# Babies PCR tested at
6/52
# Babies PCR positive at
6/52
Transmission rate:
Oct - Dec 08
Jan - Mch 09
Apr - Jun 09
27
45
64
4
0
0
15%
0%
0%
ACHIEVEMENTS
1.The VCT uptake has improved. Having discussed the importance of testing of pregnant
women during the 1st visits has yielded better results. During on site training VCT uptake
is emphasized. At baseline data collection the testing rate was 52% and now is 100%.
2. Use of guidelines. All clinics are now utilising guidelines as well as job aids which
URC are supplying to facilities complementing some guidelines issued by the DOH. The
health care workers are now using the guidelines more often than before.
3. TB/HIV integration was emphasized whereby all HIV clients are referred for TB
screening and those with TB are screened for HIV. All clients who are HIV are checked
the CD4 so that all legible mothers with the CD4 less than 350 are referred for HAART.
4. All HIV positive clients are put on HIV programmes for ensuring that they are
monitored continuously for ongoing as well as CD4 every six months. At 32 weeks all
pregnant women are re-tested for HIV before delivery.
5. All pregnant HIV positive women are clinically staged as soon as they are found to be
HIV positive.
6. All babies who are immunio compromised are done PCR at 6 weeks as well as 18
months.
CONCLUSION
The dedication and commitment of health care workers has brought about an
improvement at the facaility through working closely with the PMTCT district
coordinators and District HIV trainers. Workshops on new guidelines were conducted
jointly resulting in a joint effort to improve the womens health in the Uthungulu District.