Of the one million babies born in SA every year, 30% could get HIV from their mothers. But soon, due mainly to ARVs, mother-to-child transmission (MTCT) could be a thing of the past. Already there is a marked decrease in the numbers - the latest data shows only 2.7% of babies born to HIV-infected mothers test positive for HIV; where four years ago it was 8% - but major challenges remain, hindering the total eradication of MTCT. Significant potential to bringing down the numbers can be found in a lesser-considered, non-medicinal, yet pivotal resource: managers.
The basic elements of the government's Prevention of MTCT programme (PMTCT) are: the primary prevention of HIV among women of childbearing age, the prevention of unintended pregnancy among women living with HIV, the prevention of HIV transmission from an HIV-positive mother to her infant, and the provision of appropriate treatment and support of women living with HIV and their children and families. The original pilot project has now successfully been scaled up to the majority of healthcare facilities across the country, but integration between and within provinces, as well as logistics and data management relies heavily on strong leadership and management skills throughout the network of healthcare facilities.
At a workshop in Mpumalanga last year, three provincial health department and district heads listed the main issues facing hospitals in the region; issues that affect the UN and South African government's drive to eliminate MTCT by 2016. Central to all issues raised was poor management.
Richard Chivaka, Director of the Partnership for Management Development (PMD), says that there is a desperate need for well-equipped healthcare managers to run the PMTCT programme.The PMD is a leadership and management development programme that aims to strengthen healthcare systems through developing strong leadership and management skills in the healthcare sector.
"The PMTCT programme initiative has done well so far and these efforts deserve to be applauded, but now that the programme has moved out of the piloting phase, strong management skills at many levels are needed to deal with the complexity of ensuring that the treatments are available, that the support is available, and that community outreach is having an impact," says Chivaka.
He says a major problem throughout the healthcare system in the country is that top management lacks the required management training and thus important skills.
"The problems start with clinicians who rise in organisations to take up managerial or leadership roles yet have never had the experience of running a health facility as a business," he says. "We want to ensure that healthcare service in the country, is improved through leadership and management development."
Chivaka leads a partnership consisting of UCT, MAC AIDS, Johnson & Johnson, PEPFAR and the government that will offer a leadership and management development programme to provincial and district managers and supporting NGO partners responsible for service delivery.
The Partnership for Management Development is a one-year programme that involves tailoring the training modules to meet the real leadership and management gap in each country (or province in the case of South Africa). It has two main components, namely the training and implementation components. The key value proposition of the PMD is the accountability and mentorship system embedded in the implementation phase during which managers are expected to produce documented services delivery results with the help of mentors.
Late antenatal care booking, low rates of infants initiated on ART, low rates of HIV-positive women initiated on ART, high maternal deaths, challenges with community engagement, poor data quality and management, monitoring and evaluation problems, and poor staff attitude are some of the challenges the programme seeks to address.
"The managers are exposed to the latest in organisational planning, operation and supply chain management, financial management, leadership, human resources and change management, data-based management, and social marketing," says Chivaka.
Moving away from the aid model and toward a partnership model, the PMD harnesses the complementary skills and expertise of the partners; UCT GSB providing the teaching expertise, PEPFAR providing a close working relationship with the Department of Health, Johnson & Johnson and MAC AIDS contributing their combined experience of funding and implementing developmental programmes.
"The partnership is very unlike interventions that adopt aid. There is a drive to move away from the flawed aid model," says Chivaka. "We are certain that this partnership, and this programme, will contribute significantly to the national mission to totally eradicate this disease."
The PMD was first introduced in Swaziland in 2010, and in Lesotho in 2012. In both countries, the PMD has already shown that it is effective in strengthening healthcare systems and making them sustainable. Introducing the PMD into South Africa istherefore a natural progression of the initiative.
Preliminary discussions are underway to introduce the PMD to Malawi and Nigeria and other countries where the burden of HIV/AIDS is still heavy. Developing managers at all levels through healthcare facilities ensures that the greatest care is taken to use the few resources available in the most impactful way possible.
"The first AIDS-free generation could be a reality soon," says Chivaka.
