Many hospital staff explained their reasons for not being able to provide good care; the most frequently heard was high workload. Observation confirmed that the national and provincial hospitals' ANC caseload was high: the wards were always crowded. One of the main obstetrics hospitals provides ANC to between 200 and 400 pregnant women daily. None of the health facilities offering PMTCT services had recruited additional staff to provide counselling. However, the workload in ANC facilities at district and commune level was not so high, according to the respondents. "There are only very few health staff with only basic information on counselling in this hospital. Poor knowledge and skill is common problem here." Counsellor, ANC provincial hospital Especially at district or lower level, knowledge is limited regarding ARV prophylaxis and on follow-up care, such as continuing replacement feeding (RF) supplies, infant testing and services for HIV-infected mothers and exposed infants. Consequently, health workers cannot provide adequate counselling on these issues before women are discharged.