Poor sexual and reproductive health as well as the HIV/AIDS pandemic are major contributing factors to morbidity and mortality among women of reproductive age and their children in many developing countries. In addition, both poor SRH and HIV/AIDS are rooted in the same problems, such as lack of access to health information and services, gender disparity, sexual violence and cultural taboos and stigmatization. There is widespread agreement that integrating/linking services for SRH with those for HIV/ AIDS can substantially help improve the health of young people, mothers, new-borns and children.
In a number of international agreements and obligations, such as the International Conference on Population and Development (ICPD) in1994 in Cairo and the Glion Call to Action in 2004, the international community proclaimed its commitment to a comprehensive integrated approach to SRH including HIV/AIDS. The German Development Cooperation through GIZ has been supporting the government of Kenya, in close and on-going collaboration with other supporting partners, in the context of the sector-wide approach (SWAp), in the integration of SRH and HIV services.
The International Planned Parenthood Federation (IPPF), in collaboration with the London School of Hygiene and Tropical Medicine (LSHTM) and Population Council, has been implementing a Special Initiative Project with support from the Bill & Melinda Gates Foundation. The five year research project, named Integra Initiative (2008-2012), has been gathering evidence to determine the costs and benefits of using different models for delivering integrated HIV and Sexual and Reproductive Health (SRH) services in high and medium HIV prevalence settings, including Kenya.
On June 25, 2013 the Integra Initiative held a stakeholders workshop in Nairobi to disseminate the findings of the research project and to launch national mentorship guidelines for HIV and SRH services integration. The meeting was attended by senior government officials from the National Aids and STI Control Program (NASCOP), the Division of Reproduction Health (DRH) as well as various development and implementing partners.
Four different models for delivering HIV services in existing SRH facilities were evaluated in Kenya, Swaziland and Malawi in both IPPF and government facilities. The four models tested were; integrating HIV services into family planning (Kenya), integrating HIV services into post-natal care and family planning (Kenya and Swaziland), integrated HIV and SRH services (Kenya, Malawi and Swaziland) and comparison of integrated and stand-alone HIV services (Swaziland). Using a combination of routine service statistics, behavioral research, community surveys and economic analysis, the project assessed the benefits and costs of these different models for delivering HIV and SRH services.
Results from the Integra Initiative research project show that clients benefit from the integration of HIV and SRH services. In Kenya, unintended pregnancies for women accessing integrated services in post-natal care in the study sites was reduced, as was the unmet need for family planning among women living with HIV. In addition, although the initial cost of HIV and SRH service integration may be higher, findings from the Integra costing study indicate that integration has the potential to facilitate efficiency gains in some contexts.
Key findings from the research project also indicate that mentorship of service providers, reorganization of service delivery, strengthening of health systems as well as adequate supplies are crucial for successful HIV and SRH services integration. In his opening address, the director of the National Aids and Sexually Transmitted Infection Control Programme (NASCOP), Dr. William Maina highlighted the importance of integrated Sexual and Reproductive Health (SRH) and HIV services in increasing the uptake of services and decreasing costs. He further noted that the country has an HIV and SRH services integration strategy, which is yet to be scaled up and that the findings from the Integra initiative would come in handy during the scale up of HIV and SRH services integration.
The main objective of the GIZ health sector program is that access to SRH services, particularly for the poor is improved. The program supports the government to improve access to SRH services, including integrated SRH and HIV services, in five districts through innovative capacity building approaches. . Linking SRH services with services for the care and treatment of HIV-positive people, including women, men and children, requires health services that are equally accessible to everyone, no matter what their gender or age.2013-08-05