DENVER, Colorado – At the 138th Annual Meeting of the American Public Health Association here last week, one of the sessions focused on best practices for integrating care to improve health in low-income countries, which was very timely given the global health community’s renewed interest in integrated programming. During this session, Debra Jackson presented her research on integrating prevention of mother-to-child transmission (PMTCT) services in South Africa.
AIDS is the leading cause of maternal and child mortality in South Africa, and PMTCT services are key to preventing childhood infection with HIV. PMTCT is based on a “cascade” of thirteen basic services, starting at antenatal care and continuing through the postnatal period. At every step of the cascade, women “fall out” of the continuum of services, and very few women ever reach the bottom of the cascade. By integrating PMTCT into broader health services, women have increased access to the care they need at each step of the cascade.
In this context, the South African government decided to revise their PMTCT guidelines and scale-up PMTCT services across the country. Jackson and her colleagues reviewed case studies of PMTCT in South Africa and developed a handbook of best practices for the integration of PMTCT into sexual and reproductive health and antenatal care services. This handbook contains information to guide health care workers in implementing integrated PMTCT services, such as posters, algorithms and checklists, and contact information for the organizations that have successfully integrated these services so that they may serve as a resource to the broader health community. This handbook has been adopted by the Department of Health as an important part of their strategy to improve and scale-up PMTCT services.
As the global health community continues to explore integration as a strategy to improve health outcomes in low-income countries, it is important for projects such as Dr. Jackson’s to continue. Information about best practices, and about unsuccessful programs, must be disseminated widely. Policy makers, program implementers, and advocates alike need to know what works (or what does not work) and why. Ultimately, this will lead to more responsible spending and support for programs that have the best chance for success.
To learn more about the integration of global health programs, read Integrating Maternal, Newborn and Child Health and Family Planning Services: The Continuum of Care from Pregnancy through Postpartum.