Ninety per cent of HIV infections in children under the age of 15 are caused by mother-to-child transmission of HIV during pregnancy, delivery and breastfeeding. In high-income countries introduction of prevention of mother-to-child HIV transmission (PMTCT) programmes substantially reduce the rate of transmission of HIV from mothers to infants. In a recent systematic review published in the Cochrane Database of Systematic Reviews, Lorraine Car and Colleagues examined the effectiveness of integrated PMTCT programmes compared to non-integrated and partially integrated care. They found very little evidence of evidence on this area and suggested that additional research is needed to allow clinicians and policy makers to make a definitive conclusion about the effectiveness of integration of PMTCT interventions with other health services.
NHS budgets are under considerable pressure. It is therefore unsurprising that many NHS Integrated Care Boards (ICBs) In England will aim to prioritise price in contract awards, But this approach is a significant threat to community-centred healthcare. While competitive tendering is a legally required, an excessive focus on costs in awarding NHS contracts risks overshadowing key factors such as established community trust, local expertise, and the long-term impact on continuity of care. This shift towards cheaper, often external, commercial providers threatens to cut the links between communities and their local health services. The argument that competitive tendering is solely about legal compliance, and not cost, is undermined by the very nature of such tendering, which by design encourages the lowest bid. This approach risks eroding the social fabric of local healthcare provision, where established relationships and understanding of specific community needs are essential. Establishe...
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