Improving Maternal Care through Option B+ in Busia, Eastern Uganda

 {Photo credit: STAR-E staff/MSH}Lydia attends to a patient at Busia Health Center.Photo credit: STAR-E staff/MSH

Ms. Lydia Nakalyango is the only midwife on staff during the day at the Maternal and Child Health Department of Busia Health Center IV, which serves not just their own municipality, but clients from neighboring Kenya as well. Lydia takes care of antenatal clients while also paying attention to the labor ward for any mothers delivering. She is also on standby to care for new babies referred for early infant diagnosis.

Despite a heavy workload that she carries singlehandedly, Lydia has integrated prevention of mother-to-child transmission of HIV (PMTCT) services into her work as well. She sees nearly 400 pregnant mothers each month, of which about 20 are found HIV-positive—a client load that rivals a high volume hospital.

When Strengthening TB and AIDS Response – Eastern Region (STAR-E), a USAID-funded, MSH-led project, trained Lydia and the night shift midwives on Option B+, which provides antiretroviral therapy to all HIV-positive pregnant women regardless of the progression of their disease, the health center became even busier. But Lydia does not complain—she remains committed to providing the highest quality care available in her community. Previously, the health center had provided Option A services, which are less effective for prevention of mother-to-child transmission. Option B+ both decreases barriers to care and improves outcomes for babies.

In the past four months, Busia Health Center has initiated 152 mothers on Option B+. This is the highest number among all of the STAR-E intervention sites and Lydia has cared for almost all of them herself.

“Option A was not 100% effective—some babies were born HIV positive, even after a well monitored intervention. This was very demotivating for both the service providers and the mothers,” said Lydia. She is happy that she is now able to provide the more effective Option B+, even though it means she has more patients to treat.

Asked how she manages the work of three midwives she says, “It is all about determination and attitude. I realized that even if I complained, I would end up doing the job all by myself.”

The training and continuous coaching and mentoring Lydia received from STAR-E on Option B+ has helped her better manage her clients. She is glad to be working in a clean and welcoming environment with all the necessary equipment for monitoring pregnant mothers and is proud of the quality of care she is able to offer to both mothers and babies.

STAR-E has assisted 11 facilities in Busia in implementing Option B+.