postnatal care for HIV-infected women and their children.

Health workers’ views on quality of prevention of mother-to-child transmission and postnatal care for HIV-infected women and their children. Nguyen TA, Oosterhoff P, Pham YN, Hardon A, Wright P. Hum Resour Health. 2009;13;7:39.

Prevention of mother-to-child transmission has been considered as not a simple intervention but a comprehensive set of interventions requiring capable health workers. Viet Nam’s extensive health care system reaches the village level, but still HIV-infected mothers and children have received inadequate health care services for prevention of mother-to-child transmission. Nguyen and colleagues report here the health workers’ perceptions on factors that lead to their failure to give good quality prevention of mother-to-child transmission services. Semistructured interviews with 53 health workers and unstructured observations in nine health facilities in Hanoi were conducted. Selection of respondents was based on their function, position and experience in the development or implementation of prevention of mother-to-child transmission policies/programmes. Factors that lead to health workers’ failure to give good quality services for prevention of mother-to-child transmission include their own fear of HIV infection; lack of knowledge on HIV and counselling skills; or high workloads and lack of staff; unavailability of HIV testing at commune level; shortage of antiretroviral drugs; and lack of operational guidelines. A negative attitude during counselling and provision of care, treating in a separate area, and avoidance of providing service at all were seen by health workers as the result of fear of being infected, as well as distrust towards almost all HIV-infected patients because of the prevailing association with antisocial behaviours. Additionally, the fragmentation of the health care system into specialized vertical pillars, including a vertical programme for HIV, is a major obstacle to providing a continuum of care. Many hospital staff were not able to provide good care or were even unwilling to provide appropriate care for HIV-positive pregnant women The study suggests that the quality of prevention of mother-to-child transmission service could be enhanced by improving communication and other skills of health workers, providing them with greater support and enhancing their motivation. Reduction of workload would also be important. Development of a practical strategy is needed to strengthen and adapt the referral system to meet the needs of patients.

This study was undertaken to find out the opinions of health care workers, who are subjected to many accusations about gaps and weaknesses in their performance, in Hanoi’s programme to prevent mother-to-child HIV transmission. The fragmentation of the health system, their own stigma from colleagues and family because of their exposure to HIV-infected patients, and their personal fear of HIV exposure in the absence of protective clothing and post-exposure kits all combine to reduce their motivation. They identified specific problems in their training and skills updating, a heavy workload, and a lack of equipment and materials. Remedying these will take varying lengths of time but seeking pragmatic solutions in the short term to produce tangible results could improve both the quality of patient care and the job satisfaction of health care personnel looking after them.