REPOSITIONING OF POSTNATAL CARE IN SWAZILAND

From May 2006 to January 2007, CRH was involved in a pilot programme to reposition postnatal care in Swaziland's HIV prevalent environment. This type of intervention had not been done in the SADEC region prior to this, and a number of partners were involved including: the Ministry of Health Swaziland (MOHS), the Elizabeth Glazer Foundation (EGPAF), the Population Council, and consultants from Fort Hare University and CRH.

An initial analysis of Swaziland's postnatal care done by the Population Council in January and February 2006 identified a number of gaps. In response to this, BASICS (Basic Support for Institutionalising Child Survival) was requested to implement a programme that would help to reposition postnatal care, and to do this they employed consultants (including CRH) to start a postnatal care programme in Swaziland.

The BASICS operational research served as a pilot programme with the intention of refinement and roll-out to a greater number of health institutions in Swaziland. In this initial programme six institutions were involved: Raleigh Fitkin Memorial Hospital, King Sobhuza II Public Health Unit, Mbabane Hospital and Public Health Unit, and Mankanyane Government Hospital and Public Health Unit.

Objectives of the operational research were to:

1. Offer comprehensive high quality PMTCT services.
2. Increase access to postnatal care, and assist in meeting targets for national expansion of PMTCT services.
3. Enhance postnatal care, thereby contributing to the expansion of associated care and support services for PMTCT in conjunction with local and international partners.
4. Evaluate, document and disseminate best practices and lessons learned through the objectives stated above.
5. Adopt plans for scaling up the intervention to other institutions.

It was observed that where postnatal care was failing, it was largely because of cultural practices, where mothers stay at home after the birth of their child for a month to six weeks. This means that postnatal care, routine checkups and PMTCT adherence are not followed through, offering no early warnings for maternal and neonatal complications, many of which occur within the first three days following childbirth (24 to 72 hours). Therefore, much of the intervention focussed on:

• The revision of the timing of postnatal follow-up visits, and encouraging mothers to come within seven days after delivery for postnatal care checkups.
• The revision of the content of care during the immediate postnatal period.
• The revision of the content of messages provided to mothers during the antenatal period, and prior to discharge.

The operational research used site support and training sessions given to supervisors overseeing maternal and neonatal health care at the institutions mentioned above, as well as to the midwives, given the 'hands-on' role they play. Furthermore learning packages of materials were prepared addressing the continuum of maternal health care: antenatal,intrapartum, and post partum. The key approach was to skill health workers in the most important messages to give mothers to help them use the service properly and to respond to danger signs. A secondary approach passed on skills in assessing, caring for, and counselling mothers before discharge after delivery, and the identification of missed opportunities and sub-standard care using case histories.

The results of the intervention were evaluated in April 2007 and then published by the Population Council and MOHS with a view to expanding and sustaining the BASICS programme in Swaziland.