CHAPTER including more composite regimens in the ongoing PMTCT



6.1 Conclusion

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The researcher
therefore would like conclude that when doctors and nurses are not available,
TBAs play a very huge role in providing an option in reproductive health in sub-Saharan
countries like Zimbabwe which suffer high burden of HIV. These research findings
give an idea that Zimbabwe, even though in the long run making available ANC
services should remain the responsibility adequately trained personnel, emboldening
the involvement of TBAs in community health interventions will go a long way in
elevating and widening the coverage of reproductive health care covering PMTCT
as well. Such a way of doing things possesses a capability to avoid missed chances
in situations where a significant caseload of expecting mothers see home
deliveries as an alternative. One fundamental role that traditional birth
attendants can play is their involvement in the devolved programmatic effects of
including more composite regimens in the ongoing PMTCT services especially
focussing on support and drug adherence follow-up. In developing countries,
utilizing, to the maximum, the human resources that are available, including
the TBAs has remained a huge challenge for policy makers, and this includes
planning as well as implementation of a definite, well thought public health
strategy with roots in the fundamental reproductive care made available by
trained health workers.


Both ANC and PMTCT
services are under-utilized. Poor knowledge of HIV and cultural factors which
influence their attitude and practices are major barriers that prevent rural
women of Chegutu District from accessing PMTCT services because they do not
attend ANC which serves as an important entry point and so the opportunity to
utilize the prevention of mother-to-child transmission services is missed.
Secondly, geographic accessibility is not a barrier to access of ANC. However,
some health facility related factors may also contribute to the
under-utilization of ANC and PMTCT services as there seems to be a disconnect
between the study population and the health facilities in the sense that even
those who were found to have adequate antenatal attendance were lacking basic
HIV and HIV prevention knowledge. This raises the question of the quality of
the ANC services and whether or not HIV education is effectively delivered
during the antennal clinics in the health facilities. It will be worthwhile to
have a closer look at what actually goes on during antenatal visits and PMTCT sessions
in these facilities, to give a better picture of the facility related barriers.
Availability of PMTCT services is a good start and in line with the national
PMTCT policy to scale up as more facilities within the district are at present
being equipped to carry out these services.


6.2 Recommendations

Based on the findings documented in this study,
the following specific recommendations are proffered to the various bodies:


1. Rural Community:

There is a need to change
their orientation to encourage women to utilize ANC and delivery services. This
can be achieved by sensitizing the men and educating them on how important it
is for pregnant women to utilize healthcare services.

2. Chegutu District
Medical Office, there is a need to:


a. Organize campaigns to
sensitize the rural community on the type of services available in the health
facilities and re-orient them on the importance of utilizing health services,
especially with regards HIV prevention. This can be achieved by involving their
community heads in the process.


b. Enlighten the rural
community by organizing frequent HIV education outreach sessions, highlighting
the benefits of ANC and PMTCT services and the benefits of utilizing the

c. Regularly train health
workers on quality service delivery laying emphasis on important messages on
ANC and PMTCT, to be conveyed to all women visiting the facilities regardless
of their purpose of visit.


3. Zimbabwe Ministry of
Health and Child Care needs to:

Strengthen HIV education,
focusing on prevention especially regarding PMTCT through the media especially
the radio, which almost all rural folk own and listen to regularly.