[Counsellors] lack knowledge. If they will be trained, who will train them?" Manager, ANC provincial hospital "We counsel from our experience. To me, our counselling may be not complete. We don't even know what might be our shortcomings". Nurse, ANC commune level An important point of the comprehensive PMTCT approach is that HIV-infected women should be provided with several different services -such as ARV prophylaxis, formula, counselling and HIV testing for exposed children -provided by different facilities. However, there are no inter-or intra-hospital linkages to make the PMTCT comprehensive. For example, family planning services at a national obstetric hospital are not linked to other departments, including the infectious disease department that provides ANC and delivery services for HIV-infected women. Women are seldom referred to ARV sites for clinical staging or immunological assessment. Referral to postnatal care and social support for both mothers and children is not available at the hospital exit point.