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KENYA: Improving PMTCT services through Millennium Villages

Photo: Manoocher Deghati/IRIN

Today, 64 percent of Sauri's mothers have their babies at health centres

SAURI, 8 October 2009 (PlusNews) - Five years ago, pregnant women in the village of Sauri, in western Kenya's Nyanza Province, had access to just one rundown and poorly staffed sub-district hospital. Few chose to use it, instead giving birth at home, risking complications during delivery and, for those living with HIV, passing it on to their child.

Sauri is now part of the Millennium Villages Project, which since December 2004, has established maternity wards in nine health facilities across Yala division, which covers Sauri; six at health facilities built by the project and three at government-run health centres.

"Not everybody could go [to the hospital in Yala] because it is very far and it could not cater for everybody," Joyce Otwere, 64, a resident of Sauri, told IRIN/PlusNews. "I saw many young mothers lose their lives delivering at home - some who were lucky to survive lost their children."

The village project, part of the UN Millennium Project, aims to lift communities out of extreme poverty through community-led initiatives to improve health, agriculture, education, gender equality and environmental sustainability.

The Sauri cluster comprises 11 villages with a population of 75,000, up to 70 percent of whom live on less than US$1 a day. The HIV prevalence in Nyanza Province is about 15.8 percent.

Lillian Ogembo* is a “millennium mother”, a term Otwere uses to describe women who have benefited from the improved healthcare. One of almost 3,000 people on anti-retrovirals at the Sauri health centre, Ogembo was able to deliver an HIV-free baby in 2008; the health centre continues to care for them, providing nutritional supplements to keep her baby HIV-free and at a healthy weight.

"With the improvement of these health facilities through the provision of free maternal services, 64 percent of expectant women in Sauri now come to deliver in health centres," said Patrick Mutuo, science coordinator and team leader of the Sauri cluster. "Right now those mothers still delivering at home are doing so not because of cost or distance... it could be due to cultural beliefs or other reasons.

"We have also initiated door-to-door voluntary testing and counselling services and health education to ensure that mothers know their status so that they make informed decisions when it comes to having a child," he added.

The testing campaigns are not just benefitting pregnant women; it is estimated that at least 50 percent of Sauri residents now know their HIV status, compared with only 16.4 percent of the general population.

Boost for PMTCT

PMTCT efforts in Sauri are set to get a boost from a recent agreement between UNAIDS and the Millennium Villages Project that will see the two organizations join forces to create “mother-to-child transmission-free zones” in the 14 millennium villages across Africa.

I saw many young mothers lose their lives delivering at home - some who were lucky to survive lost their children

The initiative will use existing infrastructure, human capacity and technical resources in the villages to help expand family- and community-centred health services to stop new HIV infections among children.

"We will work with national and multilateral partners to develop and promote safe, appropriate, and effective models that can be implemented across sub-Saharan Africa," Jeffrey Sachs, Director of the Earth Institute at Columbia University, one of the founders of the villages project, said at the launch of the agreement. "Creating these zones free of mother-to-child transmission of HIV will inform national policies and enable the transfer of these practices for implementation wherever newborns are at risk for HIV."

Research from Africa suggests that practical, locally appropriate and cost-effective clinical regimens can reduce HIV transmission from mother to child from present rates, of about 30 to 35 percent, to as low as 1-2 percent. These include “task-shifting” to address medical staff shortages, the use of effective combination anti-retroviral regimens and safe, nutritious and economical replacement foods for babies born to HIV-positive mothers.

"The new initiative will help us improve on what we already have; it will definitely be a boon to the prevention of transmission in children, which is a critical step in the fight against HIV," Mutuo said.

The project has been working with local governments to introduce a model primary health system to cover approximately 500,000 people and serve as an example to be replicated and scaled up by governments.

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*Not their real names