Engaging Communities to Integrate SRH and HIV: Malawi showcases effective integration

Community engagement in Malawi has helped integrate HIV and SRH, with positive results.

Malawi HIV SRHR health clinic

The SRHR and HIV Linkages Project is an ambitious five-year initiative to decrease maternal mortality, reduce HIV transmission, and improve sexual and reproductive health and rights in Southern Africa. Malawi is one of seven countries to take part in the project and is a showcase for the effective involvement of communities in the integrated response.

There are early reports of positive outcomes in Malawi: in the project impact areas, the number of people defaulting on their HIV treatment (antiretrovirals/ART) has reportedly declined, the number of women accessing family planning services has increased, and a reduced workload for service providers has been observed at project pilot sites.

With support from the government of Malawi, the SRH and HIV Linkages project began in 2011 and has placed community engagement at the heart of service delivery. At 15 project sites, SRH and HIV integration committees have been formed to foster effective linkages between communities and health facilities, strengthening monitoring of integrated service provision.

To date, 30 of these community-level integration committees have been formed in Malawi, and involve a total of 300 members that include youth, traditional leaders, and other community members.

The community-level integration committees are strategically placed to serve as a bridge between communities and facilities. They monitor how integration is being provided in the facilities, including client perceptions of service provision, and work hand in hand with local health facility advisory committees to ensure that identified issues and challenges have been addressed.

The project has also worked closely with other community-level partners, including the Malawi Interfaith AIDS Association and the Family Planning Association of Malawi (FPAM), to integrate services for key populations such as adolescents living with HIV and sex workers.

Early results from the pilot sites suggest that integration and community engagement has had positive results in Malawi. Now that clients can now access ART five days a week, the number of treatment defaulters has reduced, and this has reduced stigma and discrimination. An increased number of people living with HIV receiving ARTs have transferred from non-integrating to integrating facilities, and an increased number of men are escorting their wives to antenatal care and receiving counseling on both SRH and HIV. It has also been observed that task sharing has reduced the workload for service providers at pilot sites with integrated services.

At the systems and policy level, Malawi is also developing a national strategy on SRH and HIV integration, which will guide the implementation of the project and the scale up process.

Findings from the project, which is funded by the European Union and Governments of Sweden and Norway, can be found online here or in the open access research library. Updates and findings from other partner countries -  Botswana, Lesotho, Namibia, Swaziland, Zambia, and Zimbabwe – are also available in the library or in the SRH and HIV Linkages overview here.