ࡱ> ED(( / 0LDArialܖS 0ܖ0tt<8 0@ .  @n?" dd@  @@`` T9      0AA@:m ʚ;ʚ;g4GdGdD 0 ppp@ <4dddd@k 0t8 <4BdBd@l 0tA9___PPT10 6c$yChallenges and Conditions for Integrating FP and HIV/AIDS Prevention and Management in Primary Health Services in Africa  zx((x c Technical meeting on Sexual and Reproductive Health in Africa, Barcelona, February -3rd March 2007.dPV  Outline of the PresentationBackground Interventions Approaches to integration Levels of integration Advantages Conditions for integration Challenges of Integration Opportunities for integration Options Way forwardP BackgroundVHigh unmet need for FP over 25%, high fertility and population growth rates Relatively lower Contraceptive prevalence rates in most countries in the region High Maternal morbidity and mortality (range from 0 to over 1,800 deaths per 100,000LB) High childhood morbidity and mortality High rates of sexually transmitted infections including HIVWW Backround(2)HIV sero-prevalence High scenario (up to 40%) Medium scenario (10-15%) Lower scenario (less than 5%) Marked variation within a country (regional, sub regional, rural urban etc)&Interventions (1)FP and MCH identified as an essential component of basic health package Delivery through an integrated approach within the Primary Health Care concept Defined as delivery of a number of related health interventions that address more that one priority issue May be at one outlet/provider or several outlets/providers within the same facility Prevention and management of STIs (mixed approaches) Declaration of HIV as a disasterZr5Interventions (2)Mounting of response to HIV/AIDS Levels (Global, regional and national levels) Policy level (more focused approach) Setting goals and targets Defining areas of focus Strategies and outcomes/benchmarks Institutional frameworks etc (AIDS commissions, Multi-sectoral approaches) Operational plans and costing Programmatic level Vertical programming Realignment of delivery systems to accommodate the targeted interventions (VCT, PMTCT, Health Communication, Provision of ARVs, OVCs, etc.)vPP&PPPPP&  >Interventions (3)Integrated MCH to Reproductive Health ICDP, ICDP+5 (Broad concept) Delivery of RH as a package (An integrated approach promoted) HIV and STD prevention and management part of the package Responses Review of broader population policies to embrace RH RH polices, strategies and tools development Thematic approaches addressing sub elements of RH Maternal health, neonatal health, Adolescent Health, cancers of the reproductive system, STDs etct&PP PaPP& a   *Approach to Integration of Health Services++(_National level One National health policy and plans (integration a key strategy for delivery of priority interventions) One Budget One essential drugs list Packages for various levels of the health care delivery Monitoring and evaluation systems (National Health Management Information System versus parallel systems for various programmes /projects),QQ Levels of integrationfGlobal level Global fund and other partnerships, Other International instruments Global RH strategy; HIV/AIDS strategy documents Regional and Sub regional levels Strategy for repositioning FP Maputo plan of action etc Alma ata declaration National levels Regional/zonal District Sub district Health facility (public/private) Community and individual levels PEP0P"PMPPfP E0"  M  f  AdvantagesFP and HIV prevention and management Cost effective Client satisfaction Provider satisfaction Synergy avoids duplication Spin offs e.g. Addressing issues that may have been a challenge e.g. use of condoms and other FP methods&%% Conditions for Integration;Existence of clear policies that promote the integration, strategies, and related instruments for operationalization of policies (plans, guidelines, procedure manuals, orientation manuals, supervision tools etc.) developed through consensus among stakeholders (FP/RH and HIV/AIDS interest groups) Resources earmarked for delivery of integrated services Financial Human resources for health with required skills Infrastructure Supplies and equipment Information from M&E systems and relevant Research Institutional arrangements that allow integration process/dialogue etcBaPPGPaGb  MChallenges to integration of FP into HIV/AIDS programmes and HIV/AIDS into FPNN(. Development/adoption of relevant clear guidelines/tools and approaches for integration (public and NGOs/private settings) Multiplicity of partners and demand for reporting outcomes against financial and technical inputs Limited data longitudinal surveys on issues of integration Limited cost effectiveness studies Emerging health issues e.g. TB and HIV; Malaria and HIV, HIV and cervical cancer etc and the need for some form of an integrated approach Weak mechanisms for documentation of experiences and lessons learnt Z MChallenges to integration of FP into HIV/AIDS programmes and HIV/AIDS into FPNN(. J Limited Resources Addressing the Human Resources for Health crisis (issues of training, burn out migration, retention, need for orientation on the new approaches) Review of training materials etc. inline with the several options for integration Use of earmarked funds from partners for funding integrated approaches Tapping into other sources of funding PRSP, identification of additional/ new funding agencies etc Strengthening of existing Health Information Systems (HMIS) Improving existing Infrastructure for quality services Addressing Provider/programme planners, manager biases:P8P8'    OpportunitiesExisting policy frameworks, strategies and plans, operational guides and tools others in the process of being developed (Maputo etc) Ongoing health systems reforms process Human resources Health financing Infrastructure, Supplies and commodities Health Information systems, Community based delivery systems Increasing interest from development partners to support the one national plan under stewardship of government FPPpPpOptionsFP into HIV/AIDS (VCT, PMTC, STD prevention, ARV programmme interventions at various levels of care) HIV prevention into FP HIV prevention into MNCH/FP HIV prevention into PAC services and other RH interventions Partial linkages and fully integrated1  Way ForwardDetermination of the best options for the integration at the various levels and types of services to be integrated Finalization of generic tools for MNCH/FP or FP/RH/HIV/STI integration (global and regional levels) Advocacy and resource mobilization Development/adoption/updating of relevant tools for integration (guides, manuals, training tools, modules/materials, supervision tools including reporting tools) Orientation of resources and infrastructure for delivery of services Support for appropriate operations research and cost effectiveness studies on the various options for integration. 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