Operationalising Integrated Postnatal Care in Primary Health Systems: Evidence from a Public-Sector Implementation Science Study in Tshwane District, South Africa
1
Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
2
Department of Paediatrics, University of Pretoria, South Africa, University of Pretoria, Pretoria, South Africa
3
Tshwane District Health Services, Gauteng Health, Pretoria, South Africa
4
National Department of Health, Pretoria, South Africa, Republic of South Africa, Pretoria, South Africa
5
City of Tshwane Health Department, City of Tshwane, Pretoria, South Africa
6
Department of Family Medicine, University of Pretoria, Pretoria, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A1855
ABSTRACT
BACKGROUND:
Despite major gains in preventing vertical HIV transmission, South Africa faces a persistent “last-mile” challenge, with approximately 70% of transmissions occurring during breastfeeding. Fragmented postnatal services limit access to HIV prevention, treatment, and contraception for breastfeeding women. While national policies define required services, the operationalisation of integrated postnatal care within routine primary healthcare remains insufficiently defined.
METHODS:
The Sihamba Kunye implementation science study (July 2024–June 2026) implemented integrated postnatal care in eight primary healthcare facilities in Tshwane District. The intervention used nurse-oriented clinical decision-support tools, structured maternal interviews, and time-and-motion studies to assess workflows and provider workload. Cycle time was measured for 1,618 maternal and child health consultations. Infant measles vaccination, HIV-PCR testing, and maternal HIV viral load monitoring at the six-month postnatal visit were used as a composite measure of postnatal care integration (“TripleCare@6”). Descriptive analyses assessed changes in service coverage, and implementation barriers and facilitators were examined using the Consolidated Framework for Implementation Research.
RESULTS:
A key facilitator of integrated postnatal care was ensuring sufficient nurse consultation time to manage increased per-visit workload when seeing mother–infant pairs at child health service points. Time-and-motion studies identified modifiable process inefficiencies reducing effective consultation time and established average consultation durations of 13m00s for well-baby visits (n=552), 26m00s for well-mother–baby visits (n=252), and 21m30s for sick-baby visits (n=249). Workload optimisation through waste reduction, task shifting, and aligning nurse capacity with under-five headcount enabled efficient one-stop care. Missed opportunities for six-month infant HIV PCR testing at measles immunisation visits declined from 81% (995/1236) at baseline to 37% (299/814) in April–December 2025 (p<0.001).
CONCLUSIONS:
Integrated postnatal care can be operationalised through redesigned workflows, embedded decision support, and data-informed workload optimisation, and offers a practical, person-centred pathway to strengthen postnatal HIV services and accelerate elimination of vertical transmission during breastfeeding.
Despite major gains in preventing vertical HIV transmission, South Africa faces a persistent “last-mile” challenge, with approximately 70% of transmissions occurring during breastfeeding. Fragmented postnatal services limit access to HIV prevention, treatment, and contraception for breastfeeding women. While national policies define required services, the operationalisation of integrated postnatal care within routine primary healthcare remains insufficiently defined.
METHODS:
The Sihamba Kunye implementation science study (July 2024–June 2026) implemented integrated postnatal care in eight primary healthcare facilities in Tshwane District. The intervention used nurse-oriented clinical decision-support tools, structured maternal interviews, and time-and-motion studies to assess workflows and provider workload. Cycle time was measured for 1,618 maternal and child health consultations. Infant measles vaccination, HIV-PCR testing, and maternal HIV viral load monitoring at the six-month postnatal visit were used as a composite measure of postnatal care integration (“TripleCare@6”). Descriptive analyses assessed changes in service coverage, and implementation barriers and facilitators were examined using the Consolidated Framework for Implementation Research.
RESULTS:
A key facilitator of integrated postnatal care was ensuring sufficient nurse consultation time to manage increased per-visit workload when seeing mother–infant pairs at child health service points. Time-and-motion studies identified modifiable process inefficiencies reducing effective consultation time and established average consultation durations of 13m00s for well-baby visits (n=552), 26m00s for well-mother–baby visits (n=252), and 21m30s for sick-baby visits (n=249). Workload optimisation through waste reduction, task shifting, and aligning nurse capacity with under-five headcount enabled efficient one-stop care. Missed opportunities for six-month infant HIV PCR testing at measles immunisation visits declined from 81% (995/1236) at baseline to 37% (299/814) in April–December 2025 (p<0.001).
CONCLUSIONS:
Integrated postnatal care can be operationalised through redesigned workflows, embedded decision support, and data-informed workload optimisation, and offers a practical, person-centred pathway to strengthen postnatal HIV services and accelerate elimination of vertical transmission during breastfeeding.
| eISSN: | 2654-1459 |
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