Picking up the pieces: Post-conflict HIV services in Bouaké, Côte d'Ivoire

Objectives: Using Bouaké, Côte d’Ivoire, as a case study, we will examine how fledgling public health sector HIV programs, interrupted by a military coup in 1999 and again by an army-led rebellion that began in 2002, fared in the aftermath when health care workers fled conflict areas and services were offered by local and international NGOs. 

Methods: A situational analysis was conducted Oct-Dec 2007 and used informant interviews, records reviews, and the construction of patient flow analyses, which will be presented and discussed.

Results: The implementation of prevention of mother-to-child transmission (pMTCT) services was ultimately fragmented into a complex system with sporadic availability in public sector sites and inconsistent referral systems to private centers.  As shown in the patient flow analyses, pregnant women who were able to access testing at faced a complicated process of referral to different organizations for care and treatment that ultimately resulted in a large loss of follow up.  After sharing the results with local MOH officials, this analysis was used in the implementation of an integrated, onsite pMTCT program within the public health sector.

Significance:  The piecemeal implementation of pMTCT services by NGOs in Bouaké ultimately helped to undermine the strength of the local public health care sector and its potential to rebuild in the aftermath of the conflict, and we hypothesize that this resulted in fewer pregnant women accessing HIV testing and follow up services.  An integrated system of pMTCT services into public sector reproductive health programs and better coordination between Ministry of Health officials and local NGOs are the most effective, efficient ways for Bouaké’s health system to provide critical pMTCT interventions to HIV-positive women and their children.  This model can be replicated throughout Côte d’Ivoire and potentially in other post-conflict settings.