On Wednesday 27th June 2013, the Integra Initiative was launched at the Sarova Panafric Hotel. The project was conducted by the Ministry of Health through the Division of Reproductive Health and the National AIDS and STIs control Programme NASCOP in collaboration with the Population Council, Family Health Options-Kenya and the London School of Hygiene and Tropical Medicine (LSHTM).
It sought to use an evidence based and best practice approach to determine the costs and benefits of using different models for delivering integrated HIV and Sexual reproductive health services. The integrated HIV and Sexual and Reproductive Health (SRH) is a form of collaboration that give clients an opportunity to utilize a wide range of services in one visit to a health facility. For instance how do you reduce HIV infection (and associated stigma) as well as unintended pregnancies?
Four different models of integrated SRH and HIV services were evaluated in Kenya, Malawi and Swaziland which mainly embedded the day-to-day activities of the health facilities being studied. Integrating HIV services into a Family Planning model was evaluated in Kenya, Integrating HIV and SRH services in Malawi and Integrating HIV services into post-natal care and Family Planning in Swaziland.
The findings from the Integra initiative evaluated in Kenya integrated HIV services and Family planning indicate that combination of the two has the potential to facilitate efficienct gains in some contexts by optimizing provider workload in the provision of HIV counseling and testing and makes it cost effective for the client.
However, despite the progress and achievements of this integration, there were witnessed missed opportunities for meeting reproductive and HIV needs in Kenya which accounted for 31% women and 21% men. The result of a community survey conducted in Kenya showed that Family Planning need was high with 71% women and 67% men.
The unmet need was a result of non-service use for men and missed opportunities for women who accessed a health facility but did not receive Family Planning services. The HIV service need was lower (21-22% among women and 54-63% among men). The unmet need was again due to non-service use while missed opportunities accounted for 31% women and 21% men.
In brief, findings from the survey suggested high levels of unmet HIV service need at the population level because of poor service use for both sexes and missed opportunities for integrating HIV services within Family Planning and other services women already receive. Besides, there are some barriers that hinder women and their partners from accessing integrated SRH and HIV services. These incorporate lack of well-trained providers and cultural practices.
Political commitment to SRH and HIV integration is highly needed to facilitate the uptake of integrated services by providing an enabling environment. The Kenyan government has developed supportive policies in regard to this project. For instance, the Ministry of Health initiated the process of integrating Reproductive Health (RH) and HIV services more than a decade ago, where initial efforts were made to integrate HIV counseling and testing during pregnant women’s antenatal visits.
An Integration Technical Working Group (TWG) was formed in 2002, and co-chaired by the department of Reproductive Health (DRH) and the National AIDS and STIs control Programme (NASCOP). It coordinates all the efforts between partners working on RH and HIV integration in an attempt to leverage resources and advance the research agenda for evidence-informed programming.
‘We have made a lot of progress through the RH and HIV TWG and other countries are learning from us’ says the Programme Officer, NASCOP. The TWG has witnessed the inclusion of RH and HIV integration and different capacity development interventions like mentoring in various policy documents such as: National Health Strategic Plan (2005-2010); Kenya National AIDS Strategic Plan 111 (2009/10-2012/13); National Reproductive Health Policy (2007) and Strategy (2010/2015); and National RH and HIV Integration Strategy (2009)
Finally, one of the key findings from the Integra Initiative is that greater attention is needed to understand and generate demand for accessing, and reduce missed opportunities for offering, integrated SRH and HIV services services. This message, adding momentum generated from the Family Planning Summit in 2012, is a call to action to policy makers and providers to listen and to more effectively continue to meet our client’s need in a holistic and integrated way.