SRHR-HIV Linkages project in Southern Africa Interagency Working Group (IAWG) on SRH and HIV Linkages 9-10 March 2015 New York Asa Andersson Regional Programme Coordinator (SRHR-HIV Linkages) ESA UNFPA Lynn Collins Senior Technical Adviser, HIV UNFPA SRHR-HIV Linkages project in Southern Africa EU funded regional UNAIDS/UNFPA initiative to support seven Southern African countries (Botswana, Lesotho, Malawi, Namibia, Swaziland, Zambia and Zimbabwe), 2011 – 2014 Project objectives: Support to 7 countries in Southern Africa for integration of HIV and SRHR, in the national health and broader development strategies, plans and budgets Enable 3 countries in Southern Africa to better link and effectively scale up efforts in SRHR and HIV integration Stimulate formulation and dissemination of lessons learned in the Southern Africa Region, documentation of best practices and South-South Cooperation

Presentation outline Rationale Project overview Progress Lessons learnt

Link between HIV & SRHR Majority of HIV infections sexually transmitted, or associated with pregnancy, childbirth & breastfeeding Target groups for SRH and HIV services are generally the same Potential to minimize missed health opportunities, increase access and coverage of services for more people Common root causes Poverty and income inequality Gender inequality Gender-based violence Human rights violations Marginalisation of key populations Stigma and discrimination services

UNAIDS/UNFPA SRHR-HIV Linkages project in Southern Africa 7 countries: Botswana, Lesotho, Malawi, Namibia, Swaziland, Zambia, Zimbabwe Project period: 2011 – 2014/5 Budget: Approx. 15 MUSD

Overall aim To promote efficient and effective linkages between HIV and Sexual and Reproductive Health and Rights policies and services as part of strengthening health systems and to increase access to and use of quality services to achieve the goals of universal access to reproductive health (MDGs 3, 4 and 5) and HIV prevention, treatment, care and support (MDG 6)

Result areas Result Area Three Result Area One Result Area Two Documentation, strengthening of M&E, good practices & South-South Cooperation SRHR and HIV linkages integrated in national health & development plans in 7 seven countries Improved uptake and delivery of integrated quality services for HIV and SRHR in three countries

Progress – result area 1 Review of SRH& HIV policies and frameworks (6) Development of Strategic plans (3) & guidelines (7) Broader health plans (2) Budgets- NO Number of countries in brackets i.e. 6/7 countries have completed the policy reviews and firmly managed to place integration into these plans as and when revised. 3 countries have developed strategic plans of SRH-HIV integration & all countries have developed/adapted guidelines (SOPs). 2 countries (Bot/Swaz – my star countries – have included integration into their national health plans). No countries have developed joint budgets (SRHR & HIV). Stil a challenge to part monnies….

Progress – Result area 2 Models of integration Increased uptake of critical HIV and SRH services (3) Increased efficiencies (1) Reduced stigma and discrimination (7 anecdotal experiences) No. of service providers trained Increased male involvement & young people (3) Community mobilisation/demand generation (7) Engagement of CSOs + PLWH (7) Models of integration We have service data suggesting that when delivering services in an integrated manner in the demo sites in BOT/MAL/SWAZ there is an increased uptake of HIV services, such as VCT & ART as well as SRH services such as FP commodities and cervical cancer screening. Namibia suggest increased efficiencies, all HCWs suggest decreased S&D for PLWH, 3 countries report increased male involvement and young people uptake of integrated services, all countries report community mobilsation being an important vehicle for demand generation, all countries engage CSOs (IPPFs Mas and positive networks in their technical committees or as implementing partners). Note in all the countries Govt. is leading and steering this initiative.

Progress – result area 3 Strengthening of M&E Output Outcome Impact Generate evidence: Cost-efficiency studies, Client satisfaction, CSO study, project evaluation Theory of change for SRH/HIV linkages Compendium of SRH/HIV linkages indicators (with indicators on outputs, outcomes and impact level) Rapid assessment tool to provide guidance on how to measure SRH/HIV linkages indicators Countries developed indicators to measure SRH/HIV linkages at impact, outcome, and output level Output Outcome Impact We have already submitted the info on our studies. Note that we adopted the ToC from the IAWGs work, which has helped us a lot when describing and building capacity of this project in the countries and beyond in the region. FYI – we are slightly modifying this based on our experiences for the 2nd phase of this project. We are building capacity and advocating for the compendium in all countries.

Progress – result area 3 Documentation of good practices Country good practices (1) Country pagers & regional booklet completed 4 country videos finished South-South Cooperation (3) One country has document its good practice – all other are documenting this year. See and PLEASE disseminate the attached printed material. The short (3 min+) videos are with the countries for endorsement, so unfortunately can’t shre until endorsed by respective MOHs. 3 countries have undertaken exchange learning visits, 3 more are planning for it this year. All 7 countries project teams in regular contact with each other to share experiences and findings. Note that the SADC minimum standards on SRH-HIV integration were endorsed this Jan. by the council of Ministers of Health. Big achievement! Took a lot of work and 2 years….but they are built upon the experience of this project.

Lesson learnt Integration is process oriented and context specific, so no straight formula for success Political buy-in is a must in moving the integration agenda Advocacy is needed to get agency/partners buy-in Community mobilisation is important in the start of integration programmes in health facilities (a case of Malawi) Integration can increase access and uptake, improve efficiencies ( nurse productivity, work load, patient waiting times) and address stigma reduction, improve male involvement and reach to young people

THANK YOU Visit our joint website in collaboration with IPPF - www.integrainitiative.org www.srhhivlinkages.org All our material are accessible on the integrainitiative website.