HEALTH
Safe Motherhood Initiative
The UNICEF-led Safe Motherhood Initiative (SMI) combines three elements: Antenatal Care (ANC), Emergency Obstetric Care (EmOC) and the Prevention of Mother to Child Transmission of HIV/AIDS (PMTCT) in a closely monitored pilot programme, working up to 18 sites across southern Sudan. For the first time, PMTCT treatment is available in some areas of southern Sudan through this programme, which aims also to reduce maternal mortality.
Data analysis: In September, three analysts responsible for processing data from the SMI sites have started to process the backlog of data that has built up over the past six months. The data analysts are funded by CDC and contracted by the SMI implementing partners and are located in Yei, Maridi and Rumbek. Two more data analysts based in Yambio with implementing partners have been trained on EpiInfo (statistical software for health information) and the PMTCT software specifically developed by CDC in support of the SMI.
Training: The most recent SMI training cycle in Arua, Uganda, finished on 16 September 2005, bringing the total of health care workers trained on ANC/PMTCT/EmOC to 46. Due to insecurity connected to movements of the Lord's Resistance Army (LRA), the trainees were unable to travel back to Sudan immediately and were forced to stay in Arua until the end of September.
Policy: Technical advice was provided to the Federal Ministry of Health (GOSS) in the development of National Preventive and Treatment Guidelines for PHCC and hospitals. PMTCT interventions are now presented in the first draft of these guidelines as a routine component of ANC and obstetric care.
New site: Standard SMI supplies have been delivered to Nyal (Western Upper Nile), the 13th of 18 SMI sites, after an agreement was signed with health NGO COSV. Implementation of the full maternal health care package has started with the exception of routine HIV testing and counseling. Local authorities and COSV decided to conduct community activities to raise awareness about HIV/AIDS for six months before starting HIV testing as a routine component of maternal health care services. Knowledge of HIV/AIDS in the general public is thought to be very low.
Monitoring during September shows that the quality of ANC services at the SMI sites has improved since the project started; the number of deliveries at the health facility increased; the numbers of women accepting HIV testing remain high.
Counselling: There are insufficient numbers of counselors to deal with the large number of women that want to get tested, stock-outs of test-related supplies, and absenteeism of counselors. Overall, it was noted that the quality of counseling needs to be improved. In order to improve the quality of counseling and testing in the SMI sites, UNICEF has recruited a consultant for a six months period to conduct intensive field monitoring and on-the-job training at the SMI sites.
Syphilis: Through UNICEF support, safe motherhood services continued in Rumbek through the international NGOs CCM and Diakonie. About 100 HIV tests were administered. Meanwhile, rates of syphilis infection (which is also monitored and is treatable) are worryingly high at about 15% of the pregnant mothers tested. Very few men accept testing.
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