Can Social Innovation advance the PMTCT programme? A South African reflection

¿Puede la Innovación Social contribuir al avance del programa PMTCT? Una reflexión sudafricana

  • Lwando Mdleleni University of the Western Cape
  • Linda Velapi Univesity of the Western Cape
Keywords: social innovation, SIH: Social Innovation in Health, PMTCT: Prevention of Mother to Child Transmission, MTCT: Mother to Child Transmission, LMICs: Low-Middle in Countries.

Abstract

The prevention of mother to child transmission (PMTCT) programme is an initiative developed to enable health care practitioners to provide essential care to mothers in order to prevent the transmission of HIV to their infants. However, the PMTCT programme has not been reaching its intended prevention objectives. This paper identifies the social issues that elucidate the gap between PMTCT program goals and the role that Social Innovation could play in improving the status quo. Supporting Social Innovation in health helps reduce infectious diseases by empowering communities to become active participants in their health challenges through local adaptation of global strategies that facilitate the reduction of health system limitations. The article combines a review of the literature with empirical evidence extracted from research that has analyzed the postpartum experiences of mothers living with HIV in the context of the PMTCT program in Khayelitsha, Cape Town, South Africa in 2021. To address the research question, exploratory research has been adopted through a case study. The research is qualitative, exploratory and descriptive based on a case study constructed with secondary data. The results show that Social Innovation contributes to addressing healthcare challenges by providing more personal, analytical and preventive healthcare pathways. In addition, Social Innovation makes a critical contribution to addressing demographic challenges by helping those who are unable to access healthcare. This paper argues that Social Innovation in health is most effective when it occurs from the bottom up, as it is a process that engages the community and connects social change and health improvement through the diverse efforts of local actors. The article demonstrates that having local beneficiaries drive the development of a Social Innovation programme in health results in more viable and sustainable solutions. It also demonstrates that Social Innovation harnesses the ingenuity and willingness of community members, strengthening conventional health service systems and helping to achieve improved and sustainable health services. 

 

Resumen

El programa de prevención de la transmisión materno-infantil (PMTCT) es una iniciativa desarrollada para que los profesionales de la salud proporcionen atención esencial a las madres con el fin de prevenir la transmisión del VIH a sus hijos. Sin embargo, el programa PMTCT no ha alcanzado los objetivos de prevención previstos. Este documento identifica las cuestiones sociales que explican la brecha entre los objetivos del programa de PMTCT y el papel que podría desempeñar la Innovación Social para mejorar el statu quo. El apoyo a la Innovación Social en materia de salud ayuda a disminuir las enfermedades infecciosas al empoderar a las comunidades para que se conviertan en participantes activos de sus retos sanitarios, mediante la adaptación local de estrategias globales que faciliten la reducción de las limitaciones del sistema sanitario. El artículo combina una revisión de la literatura con evidencia empírica extraída de una investigación que ha analizado las experiencias posparto de las madres que viven con el VIH en el marco del programa PTMH en Khayelitsha, Ciudad del Cabo, Sudáfrica en 2021. Para abordar la pregunta de investigación se ha adoptado un diseño de investigación exploratoria mediante un estudio de casos. La investigación es cualitativa, exploratoria y descriptiva, basada en un estudio de caso construido con datos secundarios. Los resultados muestran que la Innovación Social contribuye a abordar los retos sanitarios proporcionando vías de atención sanitaria más personales, analíticas y preventivas. Además, la Innovación Social contribuye de forma decisiva a abordar los retos demográficos, ayudando a los que no pueden acceder a la asistencia sanitaria. Este documento sostiene que la Innovación Social en el ámbito de la salud es más eficaz cuando se produce de abajo hacia arriba, ya que es un proceso que involucra a la comunidad y que conecta el cambio social y la mejora de la salud a través de los diversos esfuerzos de los actores locales. El artículo demuestra que el hecho de que los beneficiarios locales impulsen el desarrollo de un programa de Innovación Social en materia de salud da lugar a soluciones más viables y sostenibles. Asimismo, demuestra que la Innovación Social aprovecha el ingenio y la voluntad de los miembros de la comunidad, fortaleciendo los sistemas convencionales de servicios sanitarios y ayudando a conseguir unos servicios sanitarios mejorados y sostenibles. 

Palabras clave: innovación social; SIH: Innovación Social en Salud; PMTCT: Prevención de la Transmisión Materno Infantil; MTCT: Transmisión Materno Infantil; LMICs: Países de renta media-baja.

 

DOI: https://doi.org/10.31637/epsir.22-1.4

References

Akuffo, H., & Soop, T. (2020). Funding social innovation for health with research funds for development. Infect Dis Poverty, 9, 120. https://doi.org/10.1186/s40249-020-00744-w

Anigilaje, E., Ageda, B., & Nweke, N. (2016). Barriers to uptake of prevention of mother-to-child transmission of HIV services among mothers of vertically infected HIV-seropositive infants in Makurdi, Nigeria. Patient preference and adherence, 57. https://doi.org/10.2147/ppa.s87228

AVERT. (2019). Prevention of mother-to-child transmission (PMTCT) of HIV. https://www.avert.org/professionals/hiv-programmeming/prevention/prevention-mother-child

Bacon, N., Faizullah, N., Mulgan, G. & Woodcraft, S. (2008). Transformers: How local areas innovate to address changing social needs. NESTA.

Baker, S., & Mehmood, A. (2015). Social innovation and the governance of sustainable places. Local Environment, 20(3), 321-334. https://doi.org/10.1080/13549839.2013.842964

Banja, F., & Gebrehanna, E. (2020). Determinants of Mother to Child Transmission of HIV in Public Hospitals of West Shewa Zone, Oromiya Region: mixed method study. Research Square, 1-20. https://doi.org/ 10.21203/rs.3.rs-16716/v1

Bansal, P., & Corley, K. (2012). What's different about qualitative research? Academy of Management Journal, 55(3), 509-513. https://doi.org/10.5465/amj.2012.4003

Belachew, A., Tewabe, T., & Malede, G. (2020). Prevalence of vertical HIV infection and its risk factors among HIV exposed infants in East Africa: a systematic review and meta-analysis. Tropical Medicine and Health, 48(1), https://doi.org/10.1186/s41182-020-00273-0

Benbasat, I. (2017). An Analysis of Research Methodologies. In F. Warren McFarlan (Ed.), The Information Systems Research Challenge. Harvard Business School Press.

Benneworth, P. (2013). The Evaluation of Universities and their Contributions to Social Exclusion. In P. Benneworth (Ed.), University engagement with socially excluded communities (pp. 309-326). Springer.

Buthelezi, S., Marie Modeste, R., & Phetlhu, D. (2020). Impediments and reasons for poor management of children under five exposed to HIV in South Africa. International Journal of Africa Nursing Sciences, 12, https://doi.org/10.1016/j.ijans.2019.100188

Chersich, M., Newbatt, E., Ng’oma, K., & de Zoysa, I. (2018). UNICEF’s contribution to the adoption and implementation of option B+ for preventing mother-to-child transmission of HIV: a policy analysis. Globalization and Health, 14(1).

Chomane, P., & Biljohn, M.I. (2021). A conceptual framework for using social innovation as an approach to local economic development. Africa’s Public Service Delivery and Performance Review, 9(1), a565. https://doi.org/10.4102/apsdpr.v9i1.565

Creswell, J. W. (2009). Qualitative inquiry and research design: Choosing among five traditions. Sage.

Dako-Gyeke, P., Amazigo, U., Halpaap, B., & Manderson, L. (2020). Social innovation for health: engaging communities to address infectious diseases. Infectious Diseases of Poverty, 9(1). https://doi.org/10.1186/s40249-020-00721-3

Dawson, P., & Daniel, L. (2010). Understanding social innovation: a provisional framework. International Journal of Technology Management, 51(1), 9-21.

de Villiers, K. (2021). Bridging the health inequality gap: an examination of South Africa’s social innovation in the health landscape. Infectious Diseases of Poverty, 10(19). https://doi.org/10.1186/s40249-021-00804-9

du Plessis, E., Shaw, S.Y., Gichuhi, M., Gelmon, L., Estambale, B. B., Lester, R., Kimani, J., & Avery, L. (2014). Prevention of mother-to-child transmission of HIV in Kenya: challenges to implementation. BMC Health Services Research, 14, S10. https://doi.org/10.1186/1472-6963-14-S1-S10

Edwards-Schachter, M., & Wallace, M. (2017). ‘Shaken, but not stirred’: Sixty years of defining social innovation. Elsevier Inc., 119, 64-79. http://dx.doi.org/10.1016/j.techfore.2017.03.012

Eisenhardt, K. M. (1989). Building theories from case study research. Academy of Management Review, 14(4), 532–50.

Elliot, G. (2013). Character and impact of social innovation in higher education. International Journal of Continuing Education and Lifelong Learning, 5(2), 1-11.

Fayorsey, R. N., Chege, D., Wang, C., Reidy, W., Peters, Z., Syengo, M., ... & Abrams, E. J. (2016). Mother Infant Retention for Health (MIR4Health): study design, adaptations, and challenges with PMTCT implementation science research. Journal of Acquired Immune Deficiency Syndromes, 72, S137-S144. https://doi.org/10.1097/qai.0000000000001060

Frith, A. (2019). Census 2011: Main Place: Khayelitsha. https://census2011.adrianfrith.com/place/199038

Goga, A., Dinh, T., Jackson, D., Lombard, C., Puren, A., Sherman, G., & Pillay, Y. (2016). Population–level effectiveness of PMTCT Option A on early mother–to–child (MTCT) transmission of HIV in South Africa: implications for eliminating MTCT. Journal of Global Health, 6(2). https://doi.org/10.7189/jogh.06.020405

Godin, B. (2015). Innovation Contested. The Idea of Innovation over the Centuries. Routledge.

Gregoire, M. (2016). Exploring various approaches of social innovation: A francophone literature review and a proposal of innovation typology. Mackenzie Management Review, 17(6), 45-71. https://doi.org/10.1590/1678-69712016/administracao.v17n6p45-71

Halpaap, B., Peeling, R. W., & Bonnici, F. (2019). The role of multilateral organizations and governments in advancing social innovation in health care delivery. Infectious diseases of poverty, 8(1), 1-5. https://doi.org/10.1186/s40249-019-0592-y

Heffron, R., Mugo, N., Hong, T., Celum, C., Marzinke, M., Ngure, K., … & Baeten, J. (2018). Pregnancy outcomes and infant growth among babies with in-utero exposure to tenofovir-based preexposure prophylaxis for HIV prevention. AIDS, 32(12), 1707-1713. https://doi.org/10.1097/qad.0000000000001867

Howaldt, J., & Schwarz, M. (2010). Social innovation: concepts, research fields and international trends. www.internationalmonitoring.com/fileadmin/Downloads/Trendstudien/

Idele, P., Hayashi, C., Porth, T., Mamahit, A., & Mahy, M. (2017). Prevention of Mother-to-Child Transmission of HIV and Paediatric HIV Care and Treatment Monitoring: From Measuring Process to Impact and Elimination of Mother-to-Child Transmission of HIV. AIDS and Behavior, 21(S1), 23-33. https://doi.org/10.1007/s10461-016-1670-9

Janesick, V. (2000). The Choreography of qualitative research design, In N. Denzin & Y. Lincolns (Eds.), Handbook of qualitative research (pp. 379-399). Sage Publications.

Kirk, J., & Miller, M. L. (2016). Reliability and validity in qualitative research. Sage.

Khamisa, N., & Mokgobi, M. (2018). Risky sexual behavior and human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) among healthcare workers. Southern African Journal of HIV Medicine, 19(1), a744. https://doi.org/10.4102/sajhivmed.v19i1.744

Lizuka, M. (2013). Innovation systems framework: still useful in the new global context? MERIT Working Papers 2013-005. United Nations University - Maastricht Economic and Social Research Institute on Innovation and Technology (MERIT).

Mason, C., Barraket, J., Friel, S., O’Rourke, K., & Stenta, C-P. (2015). Social innovation for the promotion of health equity. Health Promotion International, 30(2), 116-125. https://doi.org/10.1093/heapro/dav076

Merriam, S.B. (1998). Qualitative Research and Case Study Applications in Education. Jossey-Bass Publishers.

Miles, M. B., & Huberman, A. M. (1994). Qualitative data analysis. Sage.

Moulaert, F., MacCallum, D., & Hillier, J. (2013). Social Innovation: Intuition, Precept, Concept, Theory and Practice. In F. Moulaert, D. MacCallum, A. Mehmood & and A. Hamdouch (Eds.), The International Handbook on Social Innovation (13-24). Edward Elgar.

Mulgan, G., Tucker, S., Ali, R., & Sanders, B. (2007). Social Innovation: What it is, Why it Matters and How it can be Accelerated. University of Oxford, Young Foundation.

Murray, R., Caulier-Grice, J., & Mulgan, G. (2010). The Open Book of Social Innovation. NESTA & Young Foundation.

Mutabazi, J.C., Zarowsky, C., & Trottier, H. 82017). The impact of programs for prevention of mother-to-child transmission of HIV on health care services and systems in sub-Saharan Africa - A review. Public Health Reviews, 38(28), 1-27. https://doi.org/10.1186/s40985-017-0072-5

Nannan, N., Groenewald, P., Pillay-van Wyk, V., Nicol, E., Msemburi, W., Dorrington, R., & Bradshaw, D. (2019). Child mortality trends and causes of death in South Africa, 1997 - 2012, and the importance of a national burden of disease study. South African Medical Journal, 109(7), 480. https://doi.org/10.7196/SAMJ.2019.v109i7.13717

Nicol, E., Dudley, L., & Bradshaw, D. (2016). Assessing the quality of routine data for the prevention of mother-to-child transmission of HIV: An analytical observational study in two health districts with high HIV prevalence in South Africa. International Journal of Medical Informatics, 95, 60-70. https://doi.org/10.1016/j.ijmedinf.2016.09.006

Nyamhanga, T., Frumence, G., & Simba, D. (2017). Prevention of mother to child transmission of HIV in Tanzania: assessing gender mainstreaming on paper and in practice. Health Policy and Planning, 32(5), v22-v30. https://doi.org/10.1093/heapol/czx080

Obai, G., Mubeezi, R., & Makumbi, F. (2017). Rate and associated factors of non-retention of mother-baby pairs in HIV care in the elimination of mother-to-child transmission programmeme, Gulu-Uganda: a cohort study. BMC health services research, 17(1), 48. https://doi.org/10.1186/s12913-017-1998-5

Pellowski, J., Wedderburn, C., Stadler, J., Barnett, W., Stein, D., Myer, L., & Zar, H. (2019). Implementation of prevention of mother-to-child transmission (PMTCT) in South Africa: outcomes from a population-based birth cohort study in Paarl, Western Cape. BMJ Open, 9(12), e033259. https://doi.org/10.1136/bmjopen-2019-033259

Polman, N., Slee, B., Kluvánková, T., Dijkshoorn, M., Nijnik, M., Gezik, V., & Soma, K. (2017). Classification of social innovations for marginalized rural areas. SIMRA.

Psaros, C., Remmert, J., Bangsberg, D., Safren, S., & Smit, J. (2015). Adherence to HIV Care After Pregnancy Among Women in Sub-Saharan Africa: Falling Off the Cliff of the Treatment Cascade. Current HIV/AIDS Reports, 12(1), 1-5. https://doi.org/10.1007/s11904-014-0252-6

Ramoshaba, R., & Sithole, S. (2017). Knowledge and Awareness of MTCT and PMTCT Post-Natal Follow-up Services among HIV Infected Mothers in the Mankweng Region, South Africa. The Open AIDS Journal, 11(1), 36-44. https://doi.org/10.2174/1874613601711010036

Reeder, J.C., Kieny, MP., Peeling, R., & Bonnici, F. (2019). What if communities held the solutions for universal health coverage? Infectious Diseases of Poverty, 8(74). https://doi.org/10.1186/s40249-019-0586-9

Singh, A., & Singh, S. (2008). Diseases of Poverty and Lifestyle, Well-Being and Human Development. Mens Sana Monographs, 6(1), 187. https://doi.org/10.4103/0973-1229.40567

Stinson, K., Goemaere, E., Coetzee, D., van Cutsem, G., Hilderbrand, K., Osler, M., & Boulle, A. (2016). Cohort Profile: The Khayelitsha antiretroviral programme, Cape Town, South Africa. International Journal of Epidemiology, 46(2), dyw057. https://doi.org/10.1093/ije/dyw057

Thomas, G., Bassi, T., Continoho, M., & Goyal, A. (2017). Unit-5 Various Modes of Transmission of HIV. http://14.139.40.199/bitstream/123456789/6341/1/Unit-5.pdf

UNAIDS. (2010). Report on the global AIDS Epidemic. http://www.unaids.org/globalreport/documents/20101123_GlobalReport_full_en.pdf

UNICEF. (2017). Prevention of Mother to Child Transmission (PMTCT). https://www.unicef.org/supply/index_42855.html

United Nations. (2015). The World’s Women 2015: Trends and Statistics. Sales No. E.15.XVII.8. https://unstats.un.org/unsd/gender/downloads/worldswomen2015_report.pdf

van Niekerk, L., & Chater, R. (2016). Drug Shop Integrated Management of Childhood Illness, Uganda. World Health Organization - WHO.

van Niekerk, L., Manderson, L., & Balabanova, D. (2021). The application of social innovation in healthcare: a scoping review. Infect Dis Poverty, 10, 26 https://doi.org/10.1186/s40249-021-00794-8

Western Cape Government. (2018). The Western Cape Consolidated Guidelines for HIV Treatment: Prevention of Mother- to- Child Transmission of HIV (PMTCT), Children, Adolescents and Adults. https://www.westerncape.gov.za/text/2018/November/pmtct_guidelines_23112018.pdf

World Health Organization - WHO. (2011). Prevention of Mother-to-child transmission of HIV-1. http://www.who.int/HIV-1/topics/mtct/en/nm

Woelk, G., Ndatimana, D., Behan, S., Mukaminega, M., Nyirabahizi, E., J Hoffman, H., & Phelps, B. (2016). Retention of mothers and infants in the prevention of mother-to-child transmission of HIV programmeme is associated with individual and facility-level factors in Rwanda. Journal of the International AIDS Society, 19(5). https://doi.10.7448/ias.19.5.20837

Yehia, B., Stewart, L., Momplaisir, F., Mody, A., Holtzman, C., Jacobs… Shea, J. (2015). Barriers and facilitators to patient retention in HIV care. BMC Infectious Diseases, 15(1). https://doi.10.1186/s12879-015-0990-0

Yin, R. (2009). Case Study Research: Design and Methods, Applied Social Research Methods Series. Sage.

Published
2022-07-28
How to Cite
Mdleleni, L., & Velapi, L. (2022). Can Social Innovation advance the PMTCT programme? A South African reflection. European Public & Social Innovation Review, 7(1), 43-56. Retrieved from https://pub.sinnergiak.org/esir/article/view/165
Section
Research articles