The Zimbabwe government's HIV prevention mother-to-child transmission programme (PMTCT) has come under fire from AIDS activists over the slow pace of implementation.
But government officials have warned that there was more to the programme than just dispensing nevirapine, the drug that can cut HIV transmission rates by 50 percent.
Initially started as a pilot project in three urban sites in 1999, the PMTCT programme has been scaled-up. Thirty-five of the 59 registered health centres throughout the country are now administering nevirapine to HIV-positive pregnant women, Dr Agnes Mahobva, the programme's technical Officer, told IRIN.
The rest of the sites are still training health workers and carrying out community education campaigns.
"Our ultimate goal is to have the PMTCT programme as a standard of care in every health unit. We are not in the pilot stage anymore," she said.
Factors such as a lack of adequate infrastructure and the training of staff, were still a problem. "As far as the government is concerned, every clinic should have it, but this can't be done when the structures are not in place," she said.
"We have to understand that you can't just give nevirapine if the staff have not been trained on how to administer the drug and there are no counsellors," Mahobva added.
The Women's AIDS Support Network (WASN) earlier this year launched a campaign demanding universal roll-out of the programme.
The campaign called for the drug to be made available at all state health facilities by 1 December 2002. According to WASN information officer Matilda Moyo, a recent meeting between the NGO and the minister of health and child welfare revealed that the ministry was "optimistic" they would meet the deadline.
The government's PMTCT programme had to involve other stakeholders, such as private doctors. "The information hasn't filtered down to them and some of them don't even know how to get the drug," Moyo told IRIN.
"We are quite confident that the programme is sustainable," Mahobva said. Funds from the National AIDS Council as well as the donation of the drug by pharmaceutical company Boehringer-Ingelheim would sustain the programme.
So far, an analysis of 14 PMTCT sites showed that 90 percent of pregnant women were willing to join the programme. Mahobva attributed this high uptake to the type of counselling the women received at the clinics.
"They receive group information sessions, as well as one-to-one counselling," she explained.
Staff shortages were, however, a problem as the counselling took up a lot of time. The programme is now looking at introducing lay counsellors to decrease the burden on health workers.
The government has also been awarded a grant to introduce the PMTCT Plus project. HIV-positive mothers in four pilot sites will soon get treatment to ensure their survival after the births of their babies.
"We must also look at the bigger picture. We've got to move fast because this is a very critical programme," Mabhovo said.