From Policy to Practice: Stumbling Blocks and Creative Solutions in the Field

1. From Policy to Practice: Stumbling Blocks and Creative Solutions in the Field Dr Maurice Maina, USAID Kenya July 23, 2012 AIDS 2012, Satellite session, Rhetoric to Reality: Delivering Integrated HIV and Family Planning Services

2. KAIS 2007: Knowledge of HIV Status among HIV-infected Adults (15-64 years)

3. Couples Affected by HIV 1 in 10 married/cohabiting couples were affected by HIV.

4. HIV-discordance among Couples Overall, 5.9% of couples (350,000) were in a discordant union.

5. Unmet Need for Family Planning among HIV-infected Women (KAIS 2007) • 66.8% of women living with HIV desired to limit or space births • Of these, 59.5% were not using a modern method of contraception • An estimated 40% of all women living with HIV have an unmet need for modern contraception

6. Why focus on FP/HIV integration • The huge unmet need for FP among PLHA • Weak referral linkages, one patient • Missed opportunities to enroll clients into FP services • Low enrollment of mothers (and babies) into care and treatment for HIV/AIDS • Maximize use of scarce resources (HRH, Infrastructure) • Reduction of time required by clients seeking care from multiple providers • Need to increase access and acceptability of FP/RH and HIV services

7. Stumbling Blocks to Integration • HRH • Inadequate motivation and support for multi-skilled and multi-tasking health workers • Staff shortages • Lack of pre-service and in-service training on service integration • Infrastructure • Inadequate Clinic space for service provision that ensures privacy and confidentiality

8. Stumbling Blocks • Commodities • Lack of commodity security for FP commodities especially for long term methods • Policy, M&E, Governance • Need for country specific policy on FP/HIV integration • Weak M&E systems to measure progress of integration • Weak supervision for integrated services

9. The Process • 2007 2008 2009-2011 RH/HIV Integration national TWG formed National RH and HIV Integration Strategy developed (2009) Minimum Package of RH/HIV integrated services developed (2011) Key staff identified by both NASCOP and DRH to lead the process • Documented need for integration • Separate HIV and RH/FP services Government led process Inclusive of all stakeholders Financial and technical support from partners Service delivery, Health workforce, Information, Commodities, Financing and Governance.

10. APHIAplus Project design • Project assessments done • Built on lessons learnt from APHIA II projects • Project is funded by both PEPFAR and FP/RH funds for service provision • Project required to provide integrated services • Results expected from both FP/RH and HIV services irrespective of funding mix • Projects leverage of PEPFAR funding for health systems strengthening activities that improve service provision for both HIV and FP/RH • Health systems approach

11. Current strategies • HRH: focus On Job training and mentorship, job aids, Funzo Project (pre & in service training) • Infrastructure (Clinic Space):improving efficiencies on patient flow, renovations where necessary • Service Delivery: focus on increasing access and acceptability of FP and HIV integrated services, especially at lower level health facilities • Community: demand creation through support to community units, community outreaches with integrated services • Commodity security: support to national F&Q, improving facilities reporting rate, procurement during shortages

13. Lessons Learnt • Integration is a process not a destination • Level of integration is largely determined by level of health facility, infrastructure and staff skills set/mix • Not all services need to be integrated, a minimum package of service provision is required adapted to local context and level of facility • Use a health systems approach to integration of services • Government and stakeholders’ commitment to the process is critical

14. Asante Sana Thank you