New research from IPPF details success from the SRH and HIV program in South Asia, where the innovative use of media in Sri Lanka has been documented as an example of best practice. Engaging with media was a key strategy in the project, which recognised the important role that journalists can play in SRH HIV advocacy.

The Momentum Project had the unique opportunity to engage with Sinhala, Tamil, and Muslim media personnel working in print and electronic media in Sri Lanka. Covering two provinces – Uva and Southern Province – two small grants were awarded to Prathiba Media Network, a young dynamic group of media enthusiasts with experience reaching out to young people.

In the Southern Province, Prathiba Media Newtwork (PMN) was already engaged in the publication of a Newsletter – ‘Wiparama’ or ‘Inquiry – and was reaching out to young people through the radio programmes of the State Broadcasting Corporation of Sri Lanka.

PMN organized workshops where 20 journalists out of 200 applications were selected through a competitive process based on the number of articles published during the preceding 6 months.

These journalists attended three workshops, which addressed the concept of SRH HIV integration, its benefits, and human rights. The workshops also provided detailed information on at risk populations (MARPS), including the Beach Boys –a colloquial name for male sex workers who work in the tourist resorts of the Southern Province coastal belt.

The RuhunuSevaya radio programmes were well received and the broadcasters granted an additional 30 minutes of free radio time for an extra show, based on high listener satisfaction and listener requests for more programs.

In Uva Province – an area that has historically underperformed on indicators of health and economy – the project targeted medical personnel who are key opinion makers and sources of information for the general public. Newspaper articles and radio broadcasts were used to engage with all ethnicities, whilst also promoting the engagement of young people.

More information about the success and outcomes of this project, and other Best Practice Case studies from across South Asia, can be found here in the Advocacy on Integrating SRH and HIV Best Practices Document.

NarayaniSevaSanstan is a civil society group based in Bihar, India, working on health and rights for people in the region.

The group has recently been showcased as an example of best practice with Momentum for Integration, an international project designed to support linkages between sexual reproductive health and HIV in India, Afghanistan, Bangladesh, Maldives, Nepal, Pakistan and Sri Lanka.

In Bihar, NarayaniSevaSanstan has been working toward capacity development with assistance from the Family Planning Association of India (FPA) and with support from IPPF. As a result, the group has developed new strategies to further the integration of HIV and SRH in their work and policies.

Following an FPA India workshop on SRH HIV integration, key lessons were shared with board members about the need for SRH HIV integration and how it could be incorporated in the  field level activities, to the benefit of clients.

NarayaniSevaSanstan now organise regular follow-up meetings to discuss the delivery of integrated SRH HIV services, and have incorporated integration training in the induction policy for new staff.

The group has also decided to include SRH HIV integration related activities in all their new program proposals, to ensure inclusion of integrated SRH HIV at the organisational policy, practice, and delivery level.

To read more about the project, and to see all the best practice examples from the SRH HIV Advocacy report, visit the Integration Initiatives open access research library.

As part of the Momentum for Integration project in South Asia, civil society organisations (CSOs) have been supported to strengthen their capacity for linking sexual reproductive health (SRH) and HIV.

The capacity development of CSOs, with support from the EU and IPPF South Asia Region, has helped them to scale up and expand their actions, as well as facilitating a learning environment that promotes advocacy and ownership.

Aarju Foundation

Aarju, an NGO in Mumbai working with the community of men who have sex with men (MSM), utilised lessons learned from a capacity building workshop run by the Family Planning Association of India.

Aarju board members worked with FPA India to develop their capacity and as a result, started advocating for the SRH needs of married MSMs and their family members (mainly wives and partners).

Aarju field staff were trained to provide information on the importance of the diagnosis of SRH related problems, and to encourage MSMs and their partners to visit the MSM clinic for treatment and diagnosis.

After three to four months, a positive response was noted among married MSMs, who began to raise their SRH issues as well as their spouse’s problems. There was also an increased interest in getting HIV tests for children.

In addition to advocacy initiatives with clients and service providers, Aarju also conducted an advocacy workshop with 11 NGOs and CBOs also working in HIV/AIDS prevention programs.

To read more about the Best Practices in Advocacy on Integrating SRH HIV visit the Integration Initiatives open access research library.

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.

Unintended pregnancies and potential mother to child transmission of HIV are some of the challenges faced by women living with HIV. New research from the Integra Initiative examines contraceptive use and fertility intentions among women living with HIV in Kenya and Swaziland

In sub-Saharan Africa, major efforts to expand access to anti-retroviral therapy (ART) mean that many people are living longer with HIV and leading productive and sexually active lives. Therefore, understanding the fertility preferences and reproductive decisions of women living with HIV is vital for informing policy and programmatic efforts to enable them to achieve these desires effectively and safely.

We are using condoms and I still use that pill, because condoms prevent germs to enter into me and to him, but this pill is for family planning to prevent getting pregnant if the condom bursts .

–FP client, Kenya

The research, which is part of an initiative to better understand the benefits and costs of integrated SRH and HIV services, concluded that – compared to HIV-negative women – more women living with HIV had experienced an unintended pregnancy and many have a high desire to cease childbearing. However, this desire to avoid unplanned pregnancies was not matched by appropriate family planning use.

The project also found a heavy reliance on condoms for to prevent pregnancy, and that women in the study were using short term methods rather than long-action methods prior to their most recent (unintended) pregnancy.

The research indicates that women living with HIV who are not planning on having any more children need better access to long-acting contraception.  There should also be greater use of dual protection – e.g. condoms as well as another contraceptive method. There is also a need to increase psychosocial support for women living with HIV, particularly around pregnancy intentions, and to decrease stigma in the community, especially around fears related to breastfeeding.

The study concludes that facilities and providers should do more to promote and offer a wider choice of family planning methods and improve information and access to long-term methods for women living with HIV who do not wish to have any more children.

For more information and research on family planning, stigma, and the benefits of the integration of sexual reproductive health and HIV services, visit the Integra research findings library or SRH and HIV Linkages Resource Pack.

Midwives in Iran have been showcased in a new report from IPPF South Asia and the European Union. The report, Documenting Best Practices: Advocacy on Integrating SRH HIV, captures the practice and achievements of groups working to build linkages between sexual reproductive health and HIV in Afghanistan, Bangladesh, Iran, India, Maldives, Nepal, Pakistan, and Sri Lanka.

In Iran, midwives are the main health staff to provide services to women of reproductive age. Across the country, around 36,000 midwives are front line workers and many belong to the Iran Scientific Association of Midwifery (ISAM).

As part of the Momentum Project, ISAM has worked with the Family Health Association of Iran (FHA), a member association of IPPF, to develop integration messages and promote linkages between SRH and HIV services. FHA Iran selected the association as a small grantee to advocate on the issue of SRH HIV integration. Advocacy messages were presented through meetings, workshops, and training to enhance visibility of the advocacy efforts and build strategic partnerships.

The socio-political context of Iran prompted FHA Iran to leverage on the existing health care system in order to build advocacy actions on integration. Twenty five midwives from ISAM were identified to receive training on integrated sexual reproductive health and HIV issues, with a focus on increasing understanding of integration and its importance for women. They also received training in how to integrate SRH and HIV in their day to day work, and how this approach can help them to provide services to women living with HIV without stigma and discrimination.

The successful strategy built the capacity of midwives to deliver integrated SRH HIV services and recognised the importance of preventing mother to child transmission of HIV, helping to make quality maternal and child health services more accessible to people living with HIV. It also featured youth awareness programs and highlighted access as an important part of an integrated approach.

Ultimately, the partnership between FHA IRAN and ISAM enhanced the capacity of midwives to provide integrated services to their clientele, by leveraging existing health infrastructure and systems. Read more about their work, and other studies of advocacy success, in the Momentum for Integration free research library.

Senator Sibongile Ndlela-Simelane, Minister of Health for Swaziland

Launching the Minimum Standards – developed by SADC with support from UNFPA, UNAIDS and Save the Children – the Honourable Minister of Health said “It is clear now that we need to integrate and these Minimum Standards will help us to achieve this”.

Click here to read a summary of the Minimum Standards, or the full SADC Minimum Standards. 

Dr Vitalis Chipfakacha, Technical Advisor for Capacity Building and Mainstreaming HIV and AIDS in SADC, introduced the Minimum Standards and said “The Southern Africa Development Community is the first region in the world to develop such a strategy.”

The Minimum Standards for the integration of HIV and Sexual Reproductive Health seek to promote and support efforts by Member States to better integrate SRH and HIV into national policies and frameworks. The Minimum Standards highlight opportunities for integration within a systems strengthening approach by outlining priority areas for action – for instance possible entry points, opportunities and overlaps – which can enable bi-directional linkages between SRH and HIV frameworks. Additionally, they are underpinned by a life cycle approach, whereby services reflect the different developmental stages of a person’s life, as well as the integration of specific issues relevant to key populations.

The Minimum Standards focus on six main areas:

1. Policy: Reviewing or developing policies at regional and national level to create a conducive environment for integrated HIV and SRH service delivery
2. Health delivery mechanisms: Strengthening and realigning infrastructure, human resources and processes to enable comprehensive and integrated delivery of SRH and HIV services
3. Facilities: Identifying how various SRH and HIV service delivery points can adapt to provide more integrated and comprehensive services
4. Community: Identifying strategies which can help create a demand for services and addressing negative cultural practices which hinder access to and utilisation of SRH and HIV services
5. Adolescents and youth: Identifying priorities for adolescents and youth and putting strategies in place to ensure increased provision and update of services by these groups
6. Cross-cutting standards: Issues and standards which cut across any of these categories, including key populations and gender-based violence.

Now the guidelines have been launched, they must be implemented. The Honourable Minister of Health Swaziland concluded “We do not want this document to be another one that collects dust. We expect it to be used and commit to making this happen among SADC member states.” For a copy of the SADC Minimum Standards document click here.

Dr Vitalis Chipfakacha at ICASA 2015

In sub-Saharan Africa, many recently pregnant women want to delay or avoid another pregnancy, but are not using a modern contraceptive method. The postnatal needs of women are often neglected as an area of care, but services are essential for the health of both women and infants.

A new study from the Integra Initiative provides evidence on the quality of postnatal care after facility-level integration of HIV and postnatal services in Kenya and Swaziland. The postnatal model of integration encompassed the full constellation of services for both mother and baby during the first few days and weeks after delivery, including mother and baby physical check, counsel on breastfeeding, family planning, contraception, immunisations, and HIV services.

The study found that integration of HIV into PNC services can improve the quality of client-provider consultation sessions. Overall, quality of care is not negatively affected by integrating HIV and postnatal care, and integration seems to have a positive effect on quality of postnatal care in both countries.

Providers also reported that integration was beneficial to themselves and service delivery. That is, integration can have a positive motivating effect on staff and can lead to better sharing of workload. These are important opportunities that deserve to be built on.

Overall, quality of care is complex. While some of the elements may be determined by the provider, many others are determined by public health policy beyond the facility. Learn more about the findings from this and other studies at the Integration Initiatives Open Access Research library.

Namibia’s Permanent Secretary of Health has endorsed integrated health care, saying that “the Primary Health Care model (one nurse, one patient, one room) in an integrated manner should be the way forward for the Ministry of Health.”

The statement is supported by evidence from the multi-country SRH & HIV Linkages project, which has been implemented in Namibia by the Ministry of Health and Social Services with financial support from the European Union and the Governments of Sweden and Norway, and technical support from UNFPA, UNAIDS and WHO.

The aim of this catalytic project is to strengthen the linkages and integration between Sexual Reproductive Health and Rights (SRHR) and HIV and to contribute towards the Maputo Plan of Action. A key goal is to work towards achieving universal access to sexual and reproductive health and rights by linking and integrating sexual and reproductive health and HIV at policy, system and service delivery levels.

A baseline study carried out for the project in five pilot sites analyzed the four dimensions of integration: who (provider) does what (service), where (setting) and when (time). It concluded that the organization of services using the ‘one nurse, one patient, one room’ model has the potential to improve nurse productivity 2.5 times, reduce patient waiting times by half, and reduce stigma and discrimination.

The baseline study included a time-motion client flow study and results suggest that improvements in infrastructure, patient flow, and capacity building have the potential to improve efficiencies and the overall quality of care provided to clients. This will be assessed through an endline study due to be carried out by the end of 2015.

Namibia is one of seven countries in eastern and southern Africa that have implemented this regional level project; the other countries are Botswana, Lesotho, Malawi, Swaziland, Zambia and Zimbabwe. To learn more about the project and access research findings, visit the free Research Library on sexual reproductive health and HIV integration from Integration Initiatives.

Since 2011, Swaziland has been part of the SRHR and HIV Linkages project to strengthen the linkages between sexual reproductive health rights and HIV services. The Linkages project was implemented in Swaziland and 6 other countries in Southern Africa, where its key aims are to integrate SRHR and HIV linkages in national health and development plans and budgets, improve uptake and delivery of integrated quality services for HIV and SRHR, and to disseminate best practice models to support scaling up of HIV and SRHR linkages in other countries.

Swaziland conducted a Client and Provider Satisfaction Survey in 2013 and provided the project with valuable feedback on the quality of care received by clients. Findings from the study revealed that the vast majority of clients preferred a ‘one-stop shop’ model of integration, in which sexual reproductive health and HIV services are received at the same time, by the same provider, in the same facility.

Clients reported that the ‘one-stop shop’ integration model had several benefits, including reduced number of trips to health facilities, increased service efficiency, and reduced overall expenditure on health services.

The survey also revealed that while providers believed the integrated model was beneficial for the client, longer queues, staff shortages, and an increased workload made staff less effective. These findings emphasize the need to address staffing levels, staff incentives, and supplies in the healthcare centres at the same time.

The results of the satisfaction study have been instrumental in informing infrastructure development and training of health workers. With support from the project, Swaziland has made significant progress in developing promising models of integrated service delivery and reaching communities with critical SRH and HIV services.

The full results of the client satisfaction survey can be found here. Resources and updates on the project in Swaziland and the other implementing countries are available from the free Research Library of the Integration Initiative website.