CHAPTER SIX – CONCLUSION AND RECOMMENDATIONS 6.1 Conclusion The researchertherefore would like conclude that when doctors and nurses are not available,TBAs play a very huge role in providing an option in reproductive health in sub-Saharancountries like Zimbabwe which suffer high burden of HIV. These research findingsgive an idea that Zimbabwe, even though in the long run making available ANCservices should remain the responsibility adequately trained personnel, emboldeningthe involvement of TBAs in community health interventions will go a long way inelevating and widening the coverage of reproductive health care covering PMTCTas well. Such a way of doing things possesses a capability to avoid missed chancesin situations where a significant caseload of expecting mothers see homedeliveries as an alternative. One fundamental role that traditional birthattendants can play is their involvement in the devolved programmatic effects ofincluding more composite regimens in the ongoing PMTCT services especiallyfocussing on support and drug adherence follow-up. In developing countries,utilizing, to the maximum, the human resources that are available, includingthe TBAs has remained a huge challenge for policy makers, and this includesplanning as well as implementation of a definite, well thought public healthstrategy with roots in the fundamental reproductive care made available bytrained health workers.
Both ANC and PMTCTservices are under-utilized. Poor knowledge of HIV and cultural factors whichinfluence their attitude and practices are major barriers that prevent ruralwomen of Chegutu District from accessing PMTCT services because they do notattend ANC which serves as an important entry point and so the opportunity toutilize the prevention of mother-to-child transmission services is missed.Secondly, geographic accessibility is not a barrier to access of ANC. However,some health facility related factors may also contribute to theunder-utilization of ANC and PMTCT services as there seems to be a disconnectbetween the study population and the health facilities in the sense that eventhose who were found to have adequate antenatal attendance were lacking basicHIV and HIV prevention knowledge. This raises the question of the quality ofthe ANC services and whether or not HIV education is effectively deliveredduring the antennal clinics in the health facilities. It will be worthwhile tohave a closer look at what actually goes on during antenatal visits and PMTCT sessionsin these facilities, to give a better picture of the facility related barriers.Availability of PMTCT services is a good start and in line with the nationalPMTCT policy to scale up as more facilities within the district are at presentbeing equipped to carry out these services.
6.2 RecommendationsBased on the findings documented in this study,the following specific recommendations are proffered to the various bodies: 1. Rural Community:There is a need to changetheir orientation to encourage women to utilize ANC and delivery services. Thiscan be achieved by sensitizing the men and educating them on how important itis for pregnant women to utilize healthcare services.2. Chegutu DistrictMedical Office, there is a need to: a. Organize campaigns tosensitize the rural community on the type of services available in the healthfacilities and re-orient them on the importance of utilizing health services,especially with regards HIV prevention.
This can be achieved by involving theircommunity heads in the process. b. Enlighten the ruralcommunity by organizing frequent HIV education outreach sessions, highlightingthe benefits of ANC and PMTCT services and the benefits of utilizing theservices.c.
Regularly train healthworkers on quality service delivery laying emphasis on important messages onANC and PMTCT, to be conveyed to all women visiting the facilities regardlessof their purpose of visit. 3. Zimbabwe Ministry ofHealth and Child Care needs to: Strengthen HIV education,focusing on prevention especially regarding PMTCT through the media especiallythe radio, which almost all rural folk own and listen to regularly.