By: Sara Pellegrom, Women Deliver
In the largest evaluation of different methods of HIV and sexual and reproductive health (SRH) integration to-date, results have shown clear success, particularly in Africa. The five-year project, called The Integra Initiative, is managed by the International Planned Parenthood Federation (IPPF) in partnership with the London School of Hygiene & Tropical Medicine and the Population Council and supported by the Bill & Melinda Gates Foundation.
The research was conducted within the regular activities of 42 government and IPPF health facilities in Kenya, Malawi, and Swaziland. The findings demonstrate multiple benefits of using integrated models of service delivery, including that:
Clients preferred integrated services because they save them time and money.
- Women living with HIV often preferred receiving sexual and reproductive health services, including family planning, at the same facility where they received their HIV services because they already trusted the providers at these facilities, enjoyed the continuity of care from them, and had reduced fear of stigma.
There was increased uptake of HIV counseling and testing at family planning and postnatal care facilities. Over a two-year period, the evaluation showed that people who had a greater exposure to integrated service facilities had better rates of using HIV counseling and testing services.
The findings countered arguments that integrating services may reduce the quality of care due to over-burdened and non-specialist service providers. No evidence, however, was found for a decrease in service quality and, on the contrary, an increase in the quality of family planning and postnatal care was found in some instances. More research is needed to find out whether the quality of HIV counseling and testing was compromised through integration.
- There is the potential for integrated service delivery to improve economic efficiency, although this is often not realized on the facility level.
The research also finds that integrating HIV and SRH services does not automatically lead to stigma reduction, cost, or unintended pregnancies due to the wider systems and community factors that play a role.
However, the initiative provides valuable insights that can improve how HIV testing and prevention, family planning, and maternal health services are delivered together in the future. It also calls for the scale up of integrated services throughout the health system and advises that substantial and sustained investment will be needed if the full benefits are to be realized.
The Director-General of IPPF, Tewodros Melesse, said, "We know that there is a clear and obvious link between sexual and reproductive health and HIV so providing SRH and HIV services in the same place and at the same time makes good sense.
"The reason we are excited by the Integra Initiative results is because it provides the evidence we need to help guide planners, managers, and policymakers to champion human rights and save lives. This will help them to improve health outcomes and achieve great value for money through service delivery efficiency and cost savings.
"The findings help IPPF with its advocacy too as we work to ensure sexual and reproductive health and rights sit at the heart of the next generation of Millennium Development Goals—the so-called Post-2015 framework.
"As part of our Vision 2020 initiative we are demanding governments provide comprehensive and integrated sexual and reproductive health and HIV services by the year 2020. Such work will help us argue the case for better sexual and reproductive health and rights for all."
Charlotte Warren, associate and principal investigator at the Population Council added, "These findings are encouraging and will help inform future efforts. Thanks to Integra, we now have a roadmap for health systems looking to improve the care they provide.”
Flickr photo via DFID-UK Department for International Development