From Policy to Practice: Stumbling Blocks and Creative Solutions in the Field

Dr Maurice Maina, USAID Kenya

July 23, 2012

AIDS 2012, Satellite session, Rhetoric to Reality: Delivering Integrated HIV and Family Planning

Services

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KAIS 2007: Knowledge of HIV Status

among HIV-infected Adults (15-64 years)

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Couples Affected by HIV

1 in 10 married/cohabiting couples were affected by HIV.

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HIV-discordance among Couples

Overall, 5.9% of couples (350,000) were in a discordant union.

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Unmet Need for Family Planning among

HIV-infected Women (KAIS 2007)

• 66.8% of women living with HIV desired to limit or space births

• Of these, 59.5% were not using a modern method of contraception

• An estimated 40% of all women living with HIV have an unmet need for modern contraception

Why focus on FP/HIV integration

• The huge unmet need for FP among PLHA• Weak referral linkages, one patient• Missed opportunities to enroll clients into FP services

• Low enrollment of mothers (and babies) into care

and treatment for HIV/AIDS• Maximize use of scarce resources (HRH,

Infrastructure)• Reduction of time required by clients seeking care

from multiple providers• Need to increase access and acceptability of FP/RH

and HIV services

Stumbling Blocks to Integration

• HRH– Inadequate motivation and support for multi-

skilled and multi-tasking health workers– Staff shortages– Lack of pre-service and in-service training on

service integration • Infrastructure

– Inadequate Clinic space for service provision that ensures privacy and confidentiality

Stumbling Blocks

• Commodities– Lack of commodity security for FP

commodities especially for long term methods• Policy, M&E, Governance

– Need for country specific policy on FP/HIV integration

– Weak M&E systems to measure progress of integration

– Weak supervision for integrated services

The Process

• 2007 2008 2009-2011

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• Documented need for integration

• Separate HIV and RH/FP services

Key staff identified by both NASCOP and DRH to lead the process

RH/HIV Integration national TWG formed

National RH and HIV Integration Strategy developed(2009)

Minimum Package of RH/HIV integrated services developed (2011)

Government led processInclusive of all stakeholdersFinancial and technical support from partners

Service delivery, Health workforce, Information, Commodities, Financing and Governance.

APHIAplus Project design

• Project assessments done• Built on lessons learnt from APHIA II projects• Project is funded by both PEPFAR and FP/RH

funds for service provision• Project required to provide integrated services• Results expected from both FP/RH and HIV

services irrespective of funding mix• Projects leverage of PEPFAR funding for health

systems strengthening activities that improve service provision for both HIV and FP/RH

• Health systems approach

Current strategies

• HRH: focus On Job training and mentorship, job aids, Funzo Project (pre & in service training)

• Infrastructure (Clinic Space):improving efficiencies on patient flow, renovations where necessary

• Service Delivery: focus on increasing access and acceptability of FP and HIV integrated services, especially at lower level health facilities

• Community: demand creation through support to community units, community outreaches with integrated services

• Commodity security: support to national F&Q, improving facilities reporting rate, procurement during shortages

Lessons Learnt

• Integration is a process not a destination• Level of integration is largely determined by level

of health facility, infrastructure and staff skills set/mix

• Not all services need to be integrated, a minimum package of service provision is required adapted to local context and level of facility

• Use a health systems approach to integration of services

• Government and stakeholders’ commitment to the process is critical

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Asante Sana

Thank you