Abstract:
Defaulter tracing policies for Prevention of Mother-to-Child Transmission (PMTCT) services are vital for
achieving the global goal of zero new HIV infections. However, little is known about their implementation. This
qualitative study explores the role of tracers—community volunteers, retention workers, and mentor mother-
s—in implementing such policy across six facilities in Western Kenya. It uses the conceptual lens of ’repair work’
to unveil their ‘everyday work in keeping systems going’ ensuring care delivery to women and their infants. Data
were collected through 31 semi-structured interviews with tracers and PMTCT managers, observations, docu-
ment reviews, and analyzed using thematic network analysis. Our findings reveal significant variability in policy
implementation, influenced by integration of PMTCT services to maternal and child health clinics and facility
resources. Tracing and retaining women in PMTCT care heavily relied on tracers’ adaptive strategies and in-
genuity to compensate – through repair work – for systemic shortcomings, resulting in the delivery of differ-
entiated, person-centered care using social networks, personal funds and improvisations. Key challenges included
inadequate remuneration, lack of institutional resources and support, and insufficient information and evalua-
tion systems. Our results highlight the social nature of health systems and demonstrate the relevance of ’repair
work’ for health systems research, used in our paper to unveil the often-unrecognized efforts of tracers in
maintaining PMTCT care continuity. To ensure sustainable and effective translation of policy into practice,
policymakers, donors and program managers must allocate sufficient resources, and provide formal employment
to tracers rather than relying on repair work to keep systems going.
