Primary Health Care (PHC)
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Primary Health Care (PHC)

In addition to our pre-existing wide range of programs, 2 new ventures were launched in 2001 that will be highlighted in this report.

The first is the Prevention of Mother to Child Transmission (PMTCT) of HIV project. This is one of the first of its kind in Malawi, and we are indebted to our partners UNICEF for their funding and technical support. In April and May, we held 23 meetings across our catchment area with local leaders (religious, political, and traditional), PHC leaders, traditional midwives and health surveillance assistants. At every event, information was given on the transmission of HIV from infected mothers to their infants. Support was sought, and received, to begin a program to reduce the incidence of mother-to-child-transmission (MTCT). All antenatal mothers would be offered voluntary counseling and testing for HIV. If positive they would be offered Nevirapine - an ante-retroviral drug that has shown great promise in Africa as a practical means of reducing MTCT. Following extensive training of community volunteers in counseling and testing, we began in August to offer HIV testing (using 'whole blood' kits as approved by WHO and the National Aids Control Program) to antenatal mothers attending the hospital. Some program performance indicators are shown in the table below. motherchild.jpg (12351 bytes)

 

Antenatal Clinic attendees: HIV testing August to December 2001.

Number Pre-tested Accepted Testing (%) HIV Positive (%)
422 320 (75.8) 16 (5)

We have been encouraged by the high percentage of women accepting testing after counseling, which suggests that the quality of the counseling is good. The relatively low HIV positive rate is probably a result of self-selection bias i.e. it is mainly women who think they are HIV negative that agree to be tested. So far, 6 mother / child pairs have received nevirapine. At first glance this may not appear that significant, but it is important to realise that one of the major project aims is primary prevention of HIV - counseling women who are HIV negative, so that they can stay negative. The MTCT program is one way we are 'breaking the silence' surrounding HIV/AIDS. Encouragingly we have seen a concomitant rise in 'clinical' HIV testing rates (i.e. those suggested by medical staff to outpatients or inpatients - increased from 369 in 2000 to 895 in 2001) and non-antenatal voluntary counseling and testing rates (those who come on their own initiative requesting testing). Prior to the PMTCT project we had on average 15 clients a month coming to be tested. Now we are averaging 44 clients per month - see table below.

 

Non-antenatal Clients requesting HIV counseling and testing:
August to December 2001

Number pre-tested Accepted Testing (%) HIV positive (%)
221 221 (100) 34 (15)

Significant interest has been shown in this project, including a poster presentation at the 12th International AIDS / STD conference in Burkina Faso.

The second major new project in 2001 was the implementation of the Child Survival Program funded by USAID through 'World Relief'. This project uses a pyramid management structure to disseminate information and health messages relating to the major causes of under 5 mortality - under-nutrition, malaria, HIV/AIDS, and pneumonia. It operates in all 3 synod units. Some of the activities were as follows: 4kids.jpg (7937 bytes)
A full population survey (head count) of our catchment area
A comprehensive survey to determine knowledge, attitudes and practices relating to the key interventions
Recruitment of over 1000 volunteers (one for every 9-10 households) and 16 full-time community based promoters, 2 health educators and an area co-ordinator (Joyce Ngoma)
Implementation of the malaria, pneumonia interventions [key messages included the need for early treatment, and the use of impregnated nets]
Part implementation of the nutrition component. This component emphasizes exclusive breast feeding, and promotes good nutrition at a village level using the 'hearth' model.

As a result of the first full year of the Child survival program we have already seen an increase in care-seeking behaviour. More parents / guardians are bringing their children earlier to a health centre or hospital. We ask for your prayers for Joyce and her team as they implement this huge project that we trust will lead to a significant reduction in under-5 mortality.

The other pre-existing elements of our PHC program include:

Drug Revolving Funds. We now have DRF's covering nearly our entire catchment, although there is need for refresher training. In 2001, these committed volunteers provided early treatment of malaria, fever and conjunctivitis to an estimated 15,000 clients.
Water and Sanitation. Around 100 shallow wells were installed in our area this year. Water Aid Malawi have assisted the synod in employing a full-time sanitation officer to oversee a pilot sanitation project in the Chizimia area.
Malaria Prevention / impregnated nets. Due to financial constraints we were unable to purchase nets for 4 months, with the result that only 750 were distributed in 2001. Our net supply is good (for now!) and we hope that we will reverse the downturn in 2002. A refresher course was held for supervisors of net committees, and 44 new committee members trained.
Mobile Clinics. Work continued at the existing 30 sites. 2 new sites were established - one from Mab'iri and one from the hospital, and 23 growth monitoring volunteers trained using funding from CHAM.
Nutrition Rehabilitation. 166 children attended the unit in 2001.
Tuberculosis control. We had a very successful 'World TB Day' celebration. Our case finding and case holding rates both improved.
Antenatal and Family Planning Activities. We provided daily clinics at the hospital, and monthly clinics at 18 mobile sites or health centres. We suffered from a shortage of nursing staff, but the return of Community Nurse Tamara Chirwa from a Diploma in Community Health Course at AMREF should improve the situation in 2002.
Finally, in keeping with our strategic plan, the first phase of the 'Wellness' PHC centre was nearly completed in 2001 (see right). This building will provide a much-needed increase in office space for the expanding department, as well as useful conference facilities.

phc.jpg (7738 bytes)
New Wellness PHC Centre

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