Case Study Reports on Implementation and Expansion of the PMTCT Programme in the Nine Provinces of South Africa

Implementation of a pilot programme for the prevention of mother to child transmission (PMTCT) of HIV commenced in early 2001 in South Africa following a National government decision in late 2000. A total of 18 pilot sites, two in each of the 9 Provinces, were selected using broad criteria including high HIV prevalence, representation of urban and rural health services, and primary and secondary level facilities. These served as research and learning sites to assess the feasibility of implementing this programme more widely. In May 2002, the Constitutional Court of South Africa ruled that nevirapine should be available to all HIV positive pregnant women and their infants, who give birth in any public sector facility. There has subsequently been a gradual and steady expansion of the PMTCT programme beyond the original pilot sites.

In February 2002, an Interim evaluation report of the PMTCT pilot programme covering the period January to December 2001, was released by the Health Systems Trust. The interim evaluation focussed mainly on operational challenges involved with the implementation of the pilot sites. The main challenges associated with programme implementation were found to be health systems issues relating to poor infrastructure within the health system. It was emphasised that any expansion of PMTCT activities should occur simultaneously with general health system strengthening, particularly in rural, under resourced areas, to avoid widening the inequities between provinces.

This report presents progress in each of the nine provinces during the second year of the pilot programme, over the period January to December 2002. The provincial case studies document experiences and key challenges associated with the pilot sites, and initial attempts to expand this programme beyond the pilot sites. A focus of this evaluation has been to assess whether the lessons learnt and problems identified in the first evaluation have been addressed.