From the Ground Up: The Case of Integrating Family Planning and HIV/AIDS Services in Tanzania Integrated Approaches, Local Answers Presenter: Ms. Christine Lasway Sunday, July 22, 2012

The Context, 2008 Growing policy momentum Growing evidence base Remaining gaps and research questions Implementation Tools High-level policies supportive of integration Lack of awareness of benefits of integration at implementation level Vertical funding and implementation of FP and HIV/AIDS programs Fragmented delivery of integrated service delivery Global Tanzania

The Process of Moving from the Ground AwarenessAcceptance Action Evidence-based Collaborative & Coordinated Policy, Program, & Service Levels Evidence-based Collaborative & Coordinated Policy, Program, & Service Levels

Evidence-based Advocacy, Awareness POLICY: Conducted a desk review of 10 national HIV and FP policies Validated General Policy Support for Integration SERVICE DELIVERY: Clients Needs Assessment SERVICE DELIVERY: Clients Needs Assessment Evidence of Unmet need among ART Clients PROGRAM: Rapid Assessment of Operational Context Evidence of gaps and missed opportunities

Stakeholder Consensus Common Understanding of Benefits & Concept of Integration Consensus to employ a Systematic Approach to Integration at all levels Establishment of a technical advisory group and coordinating body (TWG) Evidence-based, Locally Appropriate Approaches  Scope of integration defined for each platform  S.W.O.T Analysis Acceptance FP C&TPMTCTCTxHBC

Action (1) Generate Local Evidence on Effective Models for Integration Systematic Process (2) Strengthen Health System Research Capacity Building (3) Ensure an enabling policy environment Advocacy (4) Scale-up & Sustain Technical Assistance

(1) Generating Local Evidence MOH Approved: Facilitated Referral Positive impact on FP Use 85% routinely screen for risk of unintended pregnancy 40% increase in referrals Research Results

(2) Health Systems Strengthening Operational Guidelines/ Capacity building CTxFP Training curriculums and job aids Standard Operating Procedures Client Recording Tools National Master trainers

(3) An Enabling Policy Environment 2010 MOHSW mandated the scale-up of integrated service delivery Taskforce established to steer process forward Global Fund Round 10 integrated Proposal PMTCT Strategy Target: 2013 “At least 80% of HIV-infected women enrolled in PMTCT and CTx services receive FP and PWP services”

(4) Progress with Scale-up: facilities in 3 regions 116 facilities in 13 regions

 Policy Sustaining advocacy at all levels Importance of demonstrating mutual benefits of integration in both HIV and FP programs. Political commitment is crucial. FPHIV TWG is vital in moving and sustain the integration agenda  Health Systems & Service delivery Integration of both community and service delivery level is feasible It takes evidence to inform country to scale up One size doesn’t fit all Lessons learned

It takes a Village to Make a Change Asante