MINISTRY OF HEALTH AND SOCIAL WELFARE RCHS & NACP COLLABORATION Maurice Hiza, FP Coordinator, MOHSW MNCH/HIV integration stakeholders’ Annual meeting Giraffe Hotel, DSM 24 th -25 th September,

Background of Integration in Tanzania The first MNCH/HIV service integration model in Tanzania started with PMTCT PMTCT – in Tanzania started in 5 consultant Hospital in 2000 currently more than 4,914 of RCH clinics provide PMTCT PMTCT model allows integration of HIV services in ANC, labor/delivery, PNC and FP service delivery settings with linkage to HBC and CTC services Currently PMTCT services are well integrated at all levels of health care delivery 2

3 Background of Integration in Tanzania cont…  The FP/HIV integration model FP & HIV integration ideas started in 2008 with Stakeholders consultation meeting - Focused on FP and HIV integration  Result of 2008 consultative meeting: Agreed on the local definition of FP – HIV integration Agreed to establish the FP/HIV TWG to coordinate the process: Co -chaired by RCHS and NACP 1 st secretariat – FH360 (2009 – 2011) 2 nd Secretariat - EngenderHealth ( 2012 to date)

Tanzania’s bi-direction linkage between SRH and HIV services  Tanzania implemented WHO-Rapid Assessment Tool for SRH and HIV Linkages in 2009 to assess the state of bi- directional linkages between SRH and HIV at Policy, Systems and Service delivery levels NIMR was contracted to conduct the assessment, with funding from WHO and FHI RCHS and NACP Co-chaired the process National FP and HIV Technical Working Group provided guidance during the assessment 4

Methodology Desk review covered 41 strategies, policies, guidelines and legislations on SRH and HIV Seven data collection instruments were adapted to suit local context The process was sensitive to gender, equity and human rights components The implementation of the Tool resulted in a positive /strategic shift in National Priorities particularly those related to Family Planning and HIV integration 5

Results Overall, emerging perspectives on SRH and HIV linkages from the implementation of the Tool included the following: Policy level : Policy documents for both SRH and HIV did not show integration Funding for SRH and HIV was vertical (from government, donors and NGOs) which hindered delivery of integrated service 6

Results cont… Systems level: The FP/HIV integration TWG was established to guide the roll out process. This helped to bring together two MOHSW Units (RHCs and NACP) to Co-chairs the TWG FP/HIV Training modules were developed by MOHSW with support from partners Training on service integration conducted for trainers, supervisors and service providers National Operational Guidelines on Integration (NOGI) of MNCH and HIV services developed and data collection tools were modified to incorporate the integration indicators 7

Family Planning Counseling & Testing PITC Care, Treatment and support PMTCT Tanzania’s four FP/HIV integration service areas

Flow chart: Bringing FP to HIV service sites Reception Welcome & told about available services Reception Welcome & told about available services Waiting Room Health Education on HIV, SRH & FP Waiting Room Health Education on HIV, SRH & FP HIV Service provision room Counselling and Testing for HIV Provision of HIV services Screening for needs and Counselling on FP Provision of Condoms, pills, injectable DMPA and Implants Referral to Family Planning service site for IUCD and surgical methods Recording and Reporting HIV Service provision room Counselling and Testing for HIV Provision of HIV services Screening for needs and Counselling on FP Provision of Condoms, pills, injectable DMPA and Implants Referral to Family Planning service site for IUCD and surgical methods Recording and Reporting

Flow chart: Bringing HIV to FP service sites Reception Welcome & told about available services Reception Welcome & told about available services Waiting Room Education on FP, SRH & HIV Waiting Room Education on FP, SRH & HIV FP Service provision room Counselling on FP Provision of FP services Testing and counselling on HIV Referral to Care and Treatment for ARTs or VCT Recording and Reporting FP Service provision room Counselling on FP Provision of FP services Testing and counselling on HIV Referral to Care and Treatment for ARTs or VCT Recording and Reporting

Tanzania experience: What is required for effective integration? TRAIN TRAINERS SUPERVISORS AND SERVICE PROVIDERS INFRASTRUCTURE, PLANNING AND RESOURCE MOBILIZATION M&E and tools Supervision tools Reporting tools FP/HIV Supplies and Commodities TRAINING CURRICULUMS & JOB AIDS

Lesson Learned Baseline assessment, pilot studies, capacity building supportive supervisions and monthly/annually TWG meeting are critical in fostering integration Development of a National Operational Guidelines for integration NOGI broad RMNCH/HIV services was an a very important momentum for linking the integration frameworks more broadly The guidelines needs adequate dissemination to all levels of service delivery 12

Why the Momentum to link national MNCH and HIV frameworks more broadly is important? 13  NOGI provides guidance on how to improve coordination and collaboration among key stakeholders offering MNCH/HIV services  It promotes a more efficient and effective response to the MNCH and HIV challenges facing Tanzania  It provide instructions to healthcare providers on practices that will lead to delivery of integrated MNCH and HIV services

Momentum to link national RMNCH and HIV frameworks more broadly  It also provides guidance in addressing issues of human resources, support and supervision and functional referral systems as well as monitoring and evaluation  It gives directions on how to address gaps and weaknesses in the current state of MNCH and HIV integration  The next step therefore should be dissemination of NOGI to all the 8 zones 14

THANK YOU 15