Achieving each of the health MDGs is closely dependent on the others. Unfortunately, HIV infection continues to remain a major barrier to the achievement of MDGs 4 and 5 on maternal health and child mortality in many low-income countries.
This calls for the renewed approach of using and strengthening HIV responses as an entry point to maternal and child health services. Opportunities exist to respond in a much more integrated and effective way.
Prevention of mother to child transmission
The prevention of mother to child transmission (PMTCT) provides a unique point of contact with a pregnant woman, a post-natal mother and a new born child and is an opportunity to deliver specific interventions that have been shown to reduce maternal and child mortality. PMTCT programs should be used to deliver or link to antenatal care, child health services, such as vaccinations, Vitamin A supplements, insecticide treated bed nets and comprehensive counselling on contraception, nutrition and breastfeeding.
PMTCT interventions, such as those implemented by the Alliance, are critical in ensuring women do not become infected with HIV in the first instance, and if infected they can space their subsequent children through contraception (an intervention which also reduces child mortality), and access treatment, care and support for themselves, their spouses and children, whether infected or not.
VCT and sexual and reproductive health services
Indeed, women with HIV are living longer and healthier lives, and need to exercise their rights to access good quality reproductive health services. There is an urgent need to respond to the increasing number of HIV infected women who desire to get pregnant and bear children by expanding reproductive health services within PMTCT and Voluntary Counselling and Testing (VCT) programs.
Integrating VCT with family planning and vice versa is an effective strategy for expanding both services and reaching a wider range of clients. Achieving target 2 of MDG 5, which aims to ensure universal access to good quality sexual and reproductive health (SRH) services, requires commitment to explore all opportunities to integrate SRH in all health services, including HIV.
In addition, promotion of widespread condom use as a child spacing contraception would have significant reductions in child mortality. Strategies to achieve MDG 5 must use this window of opportunity to scale up coordinated and integrated services within HIV responses.
Likewise, the provision of support for early and exclusive breastfeeding and newborn care including immunization, hygienic cord care and early newborn complications within community based HIV activities can have a positive impact on the more than 8 million child deaths annually. HIV accounted for 2.2% of these, of which 74% occurred in countries where the Alliance works.
There is clear evidence that children who lose their mothers at birth or in early childhood are at a high risk of ill-health and death. Unless the health MDGs are addressed together, there is a risk of a ‘health trap’ in which lack of progress on one impedes progress on the other.
HIV impacts other MDGs
Apart from adversely affecting progress on MDG 4 and 5, HIV also has a negative impact on the other MDGs. Poverty impacts on peoples’ vulnerability to HIV. It increases poverty though high economic costs at both household and national levels, threatens household food security, frustrates global efforts to achieve universal basic education by reducing school attendance and increasing mortality amongst teachers, amplifies the severity and deaths due to malaria, and remains the single most important barrier to overcoming TB.
Integrating the health MDGs in practice
In 36 countries worldwide, the Alliance implements programs which have a direct positive impact on maternal and child mortality within PMTCT and child focussed programs. These include: counselling on sexual reproductive health, provision of contraception and care and support to vulnerable children within the community.
For example, in Nigeria, the Alliance’s partner NELA runs a short-stay centre which provides basic primary health care services, including rapid malaria testing, treatment of opportunistic infections, referral systems for pregnant mothers to PMTCT services and supports 52 households and 3502 adults and children with nutritional counselling and commodities, implements counselling on breastfeeding, immunization and links HIV positive women to government hospitals for PMTCT services.
In Ethiopia the Strengthening Communities Response to HIV/AIDS (SCRHA) project supported by USAID and implemented by the Alliance, PATH and partners is working through urban health extension workers to deliver palliative care including nutrition, HIV counselling and testing and PMTCT services with a preventative and referral focus. The Alliance is also supporting post natal mothers by providing community-based care and support to HIV-positive women through the postpartum period, including drug prophylaxis for themselves and their newborn infants.
In order to deliver comprehensive services referrals are made for services that aren’t offered by the Alliances’ linking organizations such as antenatal care and management of labour. This involves the use of peer educators and community health workers to provide continuity of care and link services. This way the outreach services are extended to an even greater extent to reach marginalised and hard-to reach populations.
As leaders review the progress made, those involved need to be thinking about linking interventions to address MDGs 4, 5 and 6 together, but for this to be successful it needs to be done within the broader framework of strengthened health systems, participatory community approaches and increased financial commitment from donors. Anything less may mean that we will not achieve our goals.
A lack of progress on one MDG impedes progress on the other