Integration of malaria and HIV/AIDS prevention services through the private sector in Uganda

This study explored whether private midwives can provide prevention of mother-to-child transmission of human immune deficiency virus (HIV) integrated with malaria prevention services in pregnancy, and assess how this affects access and equity to services. A household survey supplemented by key informant interviews was conducted in Wakiso district, central Uganda from January to April 2009. Results show that private midwives are already providing essential maternity services to women (antenatal care, 22.0% and delivery care, 19.5%); and they are trusted by their communities. Despite this, access to HIV and malaria preventive services was low among women in the lowest wealth quintile, the young and the less educated. Although private midwives understood the concept of integration, their clinics were offering limited integrated services, at 30%. The constraints experienced were inadequate skills, high costs of drugs and supplies limiting the capacity to have enough stocks, lack of support supervision, low community awareness on the importance of seeking antenatal and delivery care from trained providers and inadequate support of women by their spouses. In order to improve integration, it was recommended that private midwives be given refresher courses; improve their capacity to stock essential drugs and supplies; and receive supervision and support from the district health authorities.