This section presents the sociodemographic characteristics of 229 service providers who were interviewed and their experiences with providing various reproductive health services in the province. Nearly all providers were female (97 percent). Their mean age was 41 years, and their mean number of children was two. Just over a half (55 percent) were married, 37 percent were single, and the rest were divorced (2 percent), widowed (5 percent), or separated (1 percent). The dominant religion of this group was Christian, with 79 percent professing to be Protestants and 18 percent Catholics. Other faiths make up only 3 percent of the group. Kwa-Zulu Natal province is predominantly Zulu-speaking and 80 percent of the providers said Zulu was their mother tongue, followed by 13 percent who mentioned Xhosa. The remainder of providers mentioned English or other languages as their mother tongue.
Training
The professional qualification of health providers, and the amount and quality of in-service training influences the quality of services provided to clients at health facilities. Most providers in KZN were professionally qualified, with 83 percent of them reporting that they were professional nurses. Other professional categories were enrolled nurses (7 percent) or advanced midwives (3 percent). A small proportion of providers were identified as assistants or some other unspecified group (7 percent).
Providers were asked if they had specific in-service training on various reproductive health topics, namely, family planning, antenatal care, sexually transmitted infections, and HIV/AIDS. While these areas are covered in basic training courses, Table 3.1 reveals that over half of the providers said they had never received an in-service training in TOP, FP, PMTCT, HIV/AIDS or the management of opportunistic infections.
Although KZN faces high HIV/AIDS prevalence rates, training of providers on topics relevant to HIV/AIDS has been slow. About a third of providers had received training in the prevention of mother-to-child transmission of HIV. Less than half of providers had received training in the management of opportunistic infections or in HIV/AIDS testing.
Another topic that appears to have been neglected in in-service training is termination of
pregnancy. In 1997 the South African government passed the Choice on Termination of Pregnancy Act. The act, which succeeds the restrictive Abortion and Sterilisation Act of 1975, is more liberal, allowing for abortion on request as long as the pregnancy is within the first trimester. Though it is
four years since the legislation was passed, only a small proportion of service providers have received training in the delivery of termination of pregnancy services.
Though a sizable number of providers had received in-service training of some kind, the majority had received the training more than three years prior to this study. Table 3.1 shows the distribution of providers who received in-service training in reproductive health; and whether the training took place within the past three years or not. The training that a large proportion of service providers had received (antenatal and postnatal care, normal maternity, and management of obstetrics complications) had taken place more than three years earlier. For the rest of the courses, only about 30 percent of providers had attended a course within the past three years. While this represents only about a third of the providers, it is important to note that increasing numbers of providers indicate that in the last three years, they have received training in such HIV/AIDS-related topics as PMTCT, opportunistic infections (OIs), and HIV testing. This suggests that courses about HIV/AIDS are receiving more emphasis.
Table 3.1 Percentage of providers who reported receiving in-service training, and when they attended the courses (n = 226)
When course was attended Course attended 3 or more years ago Less than 3 years ago Never attended Family planning 27 23 50 Termination of pregnancy 4 14 82 TOP (MVA) 1 11 88
Antenatal and postnatal care 61 21 18
Normal maternity care 61 21 19
Management of obstetrical complications 59 19 22 STI/RTI diagnosis, treatment, and
counseling 31 33 36 PMTCT 7 25 68 HIV/AIDS testing 17 27 56 Treatment of OIs 17 29 54 Pap smears 32 19 49 Any other 16 25 58
Providers were asked about reproductive health services they provided in the past three months. Table 3.2 indicates that the services most frequently provided were STI counseling, diagnosis, and
treatment (93 percent), family planning (84 percent), postpartum care (71 percent), and maternity and delivery services (67 percent). Fewer staff reported providing HIV/AIDS services.
For staff who had provided a service in the past three months, fieldworkers investigated whether they had received in-service training for it. Table 3.2 indicates that a sizable proportion of service providers who were providing a particular service had never received in-service training in this service area. For example, nearly half (46 percent) of providers delivering family planning had never received in-service training in family planning. More than a third of the staff were providing counseling, diagnosis, and treatment for STIs without in-service training on that topic. About the same proportion were treating AIDS patients for opportunistic infections or screening for cervical and breast cancer without relevant in-service training.
Table 3.2 Percentage of staff providing RH services in the last three months, and percentage of these staff who have received in-service training on the service (n = 228)
RH service Percent of staff
providing service Percent of those providing service who received in-service training
IUD insertion 12 40
Other family planning services 84 46
Termination of pregnancy counseling 18 69
Termination of pregnancy (MVA) 1 100
Normal maternity care/delivery services 67 5
Postpartum care 71 7
Management of obstetrical complications 55 Data not available
Ultrasound diagnosis 7 Data not available
STI counseling, diagnosis, and treatment 93 34
HIV/AIDS counseling and testing 39 15
PMTCT (including counseling and
providing nevirapine) 20 Data not available
Treatment of OIs (HIV/AIDS) 59 34
Post-exposure prophylaxis 20 Data not available Treatment of HIV/AIDS with antiretrovirals 10 Data not available Cervical cancer screening and breast
cancer screening 52 32