Bringing women’s voices to PMTCT CARE: adapting CARE’s Community Score Card© to engage women living with HIV to build quality health systems in Malawi

Table 1 PMTCT CSC Indicators by locus of control and component of high-quality health system

PMTCT^a CSC Indicator	Locus of control^b	Component of High-Quality Health System^c
Attitude and commitment of PMTCT service providers	Provider	Positive user experience
Disclosure support and maintenance of confidentiality of HIV^a positive status	Provider	Positive user experience
Prevalence of stigma and discriminatory behaviors towards women living with HIV	Provider	Positive user experience
Level of male involvement on PMTCT Issues	Community	Population
Availability of adequate infrastructure, equipment and supplies to deliver PMTCT services	Health System	Tools
Availability of trained health workers capable of providing PMTCT services	Health system	Workforce
Adherence to clinical advice and ART^a treatment by service user	Individual / Patient	Confidence in systems
Access to high quality PMTCT counseling and information	Health System	Competent care and systems
Accessibility to facilities providing PMTCT services	Healthy System	Platforms
Influence of cultural and religious beliefs on access to and utilization of HIV testing and treatment services	Community	Population
Availability of social support from leaders, community-based organizations and relatives at community level	Community	Population
Convenient and timely access to HTC¹/ART/PMTCT/EID^a services and results at facility level	Health Facility	Competent care and systems
Availability of integrated services	Health System	Competent care and systems
Follow-up of defaulters	Health System	Competent care and systems
Level of supervisory support	Health System	Tools

^a PMTCT: prevention of mother-to-child transmission; HIV: human immunodeficiency virus; ART: antiretroviral therapy; HTC: HIV testing and counseling; EID: early infant diagnosis
^b Locus of control was assigned as either individual / patient, provider, health facility, community or health system based on where / who had the highest capacity and authority to effect change in the indicator
^c Component was assigned based on Kruk et al.’s high quality health system framework components

ISSN: 1472-6963