Condoms as a catalystFor integrating sexual and reproductive health (SRH) & HIV services

Condom

Is it for HIV prevention? Contraception? Protecting sexual health?

It is…… the ultimate integrated service…!

Linking SRH & HIV Policy

Addressing structural determinants of HIV and SRH

Determining the level and effectiveness of linkages between SRH and HIV-related policies, national laws, operational plans and guidelines

Systems Assessing systems to determine extent to

which they support effective SRH &HIV integration and linkages

Weakness of health systems is responsible for many gaps that impede full enjoyment of right to health

Service delivery (integration) Joining together a wide range of SRH and HIV

services to ensure collective outcomes Evaluating different models for delivering

HIV services in existing SRH facilities

Linkages: pre-Integra scenario

Real commitment at global level to intensifying linkages between SRH & HIV at programmatic and policy levels.

The rationale for doing so is clear but we need to gather evidence on how to link HIV and SRH.

The Cochrane Systematic Review conducted in 2007 showed a lack of evaluative studies on the benefits of linking HIV & SRH.

Integra goal: To strengthen the evidence of the benefits and costs of a range of models for delivering integrated HIV and SRH services in high and medium HIV prevalence settings for reducing HIV (and associated stigma) and unintended pregnancies.

Rationale and emerging themesSRH & HIV integration:1. Is an important part of the global response to HIV2. Is context specific - no blueprint3. Makes good people sense – it can reduce stigma4. Can provide an effective way to more efficiently use scarce

resources, both human and economic5. Can reach out to a ‘broader audience’ and increase uptake

of services 6. Hinges on a ‘tipping point’ at which more investment may

be needed to ensure that efficiency gains are made and services not over strained

7. May call for creative solutions.... to enhance planning, budgeting and management; the capacity or skills of health care providers; overcome fear of the unknown or fear of increased workload; and find solutions to commodity stock-outs or supply chain blockages.

• Operations research 2008-12• IPPF, Population Council and

London School of Hygiene and Tropical Medicine

• 3 countries in Africa:

The Integra initiative

Kenya: FHOK and government facilities Clinics overall: 30 government and 6

FHOKSwaziland: FLAS and government facilities Clinics overall: 14 government and 2

FLASMalawi: FPAM Clinics overall: FPAM (4 clinics, 1

community based and 55 outreach)

Family Planning Association of Malawi -FPAM an NGO providing Youth Friendly Sexual and

Reproductive Health services in Malawi affiliated to International Planned Parenthood Federation (IPPF) as a Member Association

Malawi  population  -13.1 million   Maternal Mortality Rate (per 100,000 live births) -

675  Total fertility rate - 5.7  Contraceptive Prevalence rate – 46%

(Modern= 42%,  Tradition= 4%)   Unmet need for FP - 28%

Effect of Intervention in Malawi• FPAM: 7 fold increase HIV; 11 overall

Thank youRuth KundechaHIV Focal Point and Community Based Services ManagerFamily Planning Association of Malawi (FPAM)

www.integrainitiative.org