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Findings from Kenya and Zambia

Status of Family Planning Programs in Countries with Severe HIV/AIDS Epidemics:. Findings from Kenya and Zambia. Purpose of the Study. To assess FPP in 6 – 8 countries hard hit by HIV/AIDS To understand how FP and HIV/AIDS programs interact

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Findings from Kenya and Zambia

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  1. Status of Family Planning Programs in Countries with Severe HIV/AIDS Epidemics: Findings from Kenya and Zambia

  2. Purpose of the Study • To assess FPP in 6 – 8 countries hard hit by HIV/AIDS • To understand how FP and HIV/AIDS programs interact • To advocate for strengthening FPP in countries severely affected by AIDS by engaging governments, USAID and other donors

  3. Potential Countries • Kenya • Zambia • Côte d’Ivoire • South Africa • Zimbabwe • Uganda • Botswana • Lesotho

  4. Methodology • Topics • Status of and Need for Family Planning • Service delivery • Funding • Staffing/personnel issues • Role of NGOs and private sector • Health Sector Reform • Expert Interviews • Ministry of Health • NACC (or equivalent) • Donors • NGOs • Private Sector • Service Providers • Cooperating agencies/projects • Focus Groups • Providers in antenatal/FP clinics • Clients in antenatal/FP clinics • HIV+ women (drawn from PWA groups) • Data Collection • Financial data • Survey statistics • Service statistics • Staffing patterns

  5. 24 36 38 27 Country Context – Kenya

  6. Country Context – Kenya

  7. Political Support – Kenya “FP has fallen off the agenda, maybe because people are dying. But it was never in govt. agenda anyway….As it is now – it is a donor driven program with donors supplying the necessary contraceptives.” “There is some element of political support though at times FPP is politicized by thinking and saying that it is a way of reducing voting power of certain people.” “Was very strong in the 1970s but has waned over the years and has taken a nosedive in the 1990s and into the 21st century.”

  8. Programmatic Changes - Kenya • Traditional FP NGOs turning attention to HIV/AIDS • HIV/AIDS NGOs not incorporating FP into their mandate • Integration not adequate

  9. Perceived Need for FP • “This may be the time when we need FP the most ..including providing information on the benefits of FP and promotion of condoms.” • “As far as I am concerned, the need for FP is demonstrated by the consumption of contraceptives. So long as there is consumption, there is need… In any case the first step to PMTCT programs starts with preventing the mother from getting pregnant.”

  10. Funding and Staffing Trends • Donor funding increasing for HIV/AIDS • Funding for FP is either stagnating or declining • Staff shortages due to AIDS deaths and overseas recruitment • Low staff morale is very low • Worker overload • Lack of protection against HIV/AIDS

  11. 31 27 14 9 Country Context – Zambia

  12. Country Context – Zambia

  13. Political Support – Zambia • Number of policy documents exist • FP integrated into RH • FP not approached multisectorally • No explicit shift from FP although perception that GOZ’s emphasis is on HIV/AIDS • Strong national FP strategy with components of HIV/AIDS • HIV/AIDS strategy weak on FP

  14. Programmatic Changes – Zambia • Most NGOs and GOZ respondents satisfied with FP achievements • FP integrated into RH • CBD and employer-based programs established • Donors dissatisfied with FP results • Persisting barriers • spousal consent • lack of FP training institutions • Some methods limited to a few urban centers • Stockouts are common

  15. Need for Family Planning – Zambia • FP enhances quality of life • All respondents reiterated need for FP services • Need is more critical because of HIV/AIDS, poverty and poor health status of the family

  16. Staffing Trends – Zambia • Acute staff shortages • AIDS deaths • Voluntary Separation Program • Deployment of staff to HIV/AIDS programs • Brain drain • Lack of trained staff in FP especially in the private sector • Low staff morale • poor protection • chronic illness and absenteeism • increased workload

  17. Funding – Zambia • Uncertain impact on funding for FP • Contraceptive security remains a major issue • Resources for HIV/AIDS programs have definitely increased • Efforts to secure funding for HIV/AIDS through SWAp but not for FP

  18. Role of NGOs and Private Sector – Zambia • Focus of NGOs has changed primarily due to funding • New NGOs focusing on HIV/AIDS • CARE Zambia discontinued its community FP programs due to lack of funds • PPAZ did not receive funding from GOZ for their CBD activities • PPAZ lost USAID funding due to GAG rule

  19. Summary and Conclusions • Strong recognition of continued need for FP • Emphasis shifting to HIV/AIDS • Government, donors and NGOs • Resource for FP may be declining • Definite impact on staff availability • Integration of HIV/AIDS services into RH/FP more common than integration of FP into HIV/AIDS programs • National AIDS Control Program and MOH are not working closely • Skepticism concerning the impact of health sector reform

  20. Recommendations so far • Advocacy efforts aimed at governments, donors and NGOs • Further research on impact of HIV/AIDS on staffing • Operational policies emphasizing the integration of FP services into HIV/AIDS programs

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