Table 1 Using information from the RHIS, complemented with clinical audit data

What I saw within my folder audits, I noticed that there was a trend between the PNs (professional nurses) and now I wasn’t sure whether it was because they were just lazy to do the HIV test, because on average every staff member needs to do at least 3 per month (to reach our targets). If you tick off (on the pre-designed IMCI consultation sheet) one of the problems a child comes in with, it could be growth faltering, it could be pneumonia, any one of those, oral thrush, then they are writing there ‘HIV unlikely’ whereas the IMCI diagnosis should be ‘possible HIV infection’, and that should prompt the nurse to offer the mom and the child an HIV test. And in following up, we actually found 2 children who were HIV positive and that to me was very heart sore, because the one child was coming to the facility regularly and that child was growth faltering, but nobody picked it up.

I actually presented the case at the subdistrict, because just to make the other managers aware as well, because if the PN’s in my facility are doing it, ten to one they doing it in the other facilities. And when we had a discussion on it and then after the other facility managers said that they are seeing the same. And then I spoke to my staff, I told them this is the problem and I’m very heart sore because these children should have been on ARVs ages ago and then we decided together…. this can be a quality improvement (project) number 1, plus this is important, so this is one of my pet projects that I took on….We started this about 4 months ago so it’s fairly new and I’m monitoring it; the numbers are increasing in the children under 5, that they are testing…

When I go into the staff room, I always compliment them, when they’re sitting there, “Ooh! The HIV test (monthly statistics), excellent!” And I tell them also at the end of the month; do you know how much we did? We did 84. Last month I told them and Sister X was actually the one that was saying ‘Good sister, excellent, you see we are actually working’, so I said to her, ‘I’m not saying you guys aren’t working, you are and you doing good work, you know?’