Keynote address by MEC Nomonde Rasmeni during the Prevention of Mother to Child Transmission (PMTCT) awareness roadshow event held in the Bojanala District, Madibeng

Programme Director, we are gathered here today as part of an ongoing campaign to educate one another on the importance of the Prevention of Mother to Child Transmission (PMTCT) programme. We started this campaign with a road show in the Southern District where we visited clinics and had an opportunity to interact with all stakeholders in this programme. This is a provincial roadshow hence we want to assess the situation in all the districts with a view to capacitate the PMTCT programme in the entire province.

It will therefore be important to get to know of the challenges faced in this particular district so that we can together develop plans to eradicate them so that we may improve on the situation. We all now know that mothers on the programme experience a number of difficulties among which are stigma related ones. Like I emphasised during the Budget Speech, we are convinced that as we intensify this programme we can achieve the goal of having an AIDS free generation beyond the second decade of freedom.

We are also cautious of the fact that stigmatisation results in mothers staying away from the service and this cause them to mix feed (breast and formula feeding) defeating the purpose and effects of Neviripine. This may be a contributory factor to some children testing HIV positive at the age of 12 months. All these considerations confirm that PMTCT has become such a critical programme in our health service delivery priorities and it must be treated with that level of importance.

This awareness road show will therefore unfold to all the districts, spreading the messages and encourages stakeholders' commitment to the programme. I am hopeful that, as we engage one other throughout these roadshows, we will be able to critically evaluate the work we are doing as a department and as individual districts and institutions in our effort to improve the PMTCT.

The National Strategic Plan (NSP) for HIV and AIDS and Sexually Transmitted Infection (STI) for 2007-2011, adopted by Cabinet earlier this year, have made room for the introduction of dual therapy to reduce mother-to-child-transmission of HIV. Furthermore, the move from single dose nevirapine to dual therapy (nevirapine and AZT) has been discussed by the National Health Council (NHC) which is made up of the Minister and MECs for Health. The discussions centred on the recommendations of the Medical Research Council (MRC), National Essential Drugs Committee and the Medicines Control Council (MCC) to move to dual therapy.

The National Health Council took a decision to evaluate the use of Nevirapine in reducing mother to child transmission of HIV. The NHC also deliberated on implications for implementation including training and capacity of health workers, adherence counselling and support to women. Further work is being done to improve guidelines and facilitate appropriate training for health workers, stock management, monitoring of resistance and information management for the introduction of such a therapy.

As a department, we are on course in as far as improving access to HIV testing and counselling in antenatal clinics. Obviously more work still needs to be done. There is a need to also improve family planning services to known HIV positive women, to improve access to comprehensive reproductive health services for HIV positive women, to train reproductive health providers on HIV and AIDS counselling and to implement clinical guidelines to reduce the transmission of HIV during childbirth and labour.

We must also look at the importance of training all relevant midwives and medical practitioners as we continue to capacitate this programme. All these good intentions are captured in the National Strategic Plan for HIV and AIDS and it remains our responsibility to ensure that the province benefit from it.

It is important as we move forward that we take note of the challenges of that district has made us aware of in this programme which includes the following:

* that there is no HIV co-ordinator in the district
* that there is inadequate use of data analysis and information for action at facility, sub-district and district level
* not all families are part of the PMTCT programme
* that there is a challenge of mixed feeding by mothers and their families
* the challenge of migration, farm workers and mine workers
* that not all midwifes are trained on coding system
* that HIV PCR was introduced into the District Health Information System only in October 2006/07
* PMTCT training is still being conducted.

Our efforts must now be geared towards improving capacity and to strengthen this programme by addressing the challenges experienced. The appointment of district programme co-ordinators therefore becomes one of the things we need to priorities. We must continue to mobilise and educate communities about PMTCT so that they can begin to get seriously involved and assisting the situation. In this regard, our antenatal clients (the mothers) become our primary target. This will also assist the aspect of uptake improvement.

Ongoing counselling and information during the antenatal and postnatal period to support infant feeding and other decisions such as disclosing HIV status remains critical. For pregnant women to make informed decisions about reducing their risks of transmitting HIV to their infants, they must know their HIV status. Therefore, counselling and HIV testing is the entry point into the PMTCT programme. Making counselling and testing services available in our health institutions and clinics is therefore a key PMTCT programme objective.

Our support groups will also assist a lot. In this regard, the de-stigmatisation of HIV and AIDS at both the community level and the health service level may enable individuals with HIV to feel more comfortable disclosing their status to health workers. It is important that we emphasise the fact that HIV-infected women need to receive ongoing counselling and support for whichever infant feeding choice they make. So, in this case the role of community support or support groups can also go as far as enfant feeding. We got to learn that community support is especially important for women's feeding choices in contexts where decisions are not made by the mother alone and where cultural or family practices are highly influential in determining ultimate practices.

Other key areas of PMTCT include healthcare infrastructure namely human resources, training, management, information systems and management of consumables and supplies. We must really look at ensuring that lay counsellors training focus not only on counselling skills needed for HIV testing but also include counselling on infant feeding options. Of course this goes hand in hand with the supervision, support and mentoring of lay counsellors as well as their motivation in terms of remuneration. Training here also extend to health workers in this programme.

It is important that all stakeholders in this programme take seriously the challenges that still remain so that we may see continuous improvement in the reduction of mother to child transmission of HIV and AIDS.

I thank you.