From Policy to Practice: Stumbling Blocks and Creative Solutions in the Field Dr Maurice Maina, USAID Kenya July 23, 2012 AIDS 2012, Satellite session, Rhetoric to Reality: Delivering Integrated HIV and Family Planning Services

2 KAIS 2007: Knowledge of HIV Status among HIV-infected Adults (15-64 years)

3 Couples Affected by HIV 1 in 10 married/cohabiting couples were affected by HIV.

4 HIV-discordance among Couples Overall, 5.9% of couples (350,000) were in a discordant union.

5 Unmet Need for Family Planning among HIV-infected Women (KAIS 2007) 66.8% of women living with HIV desired to limit or space births Of these, 59.5% were not using a modern method of contraception An estimated 40% of all women living with HIV have an unmet need for modern contraception

Why focus on FP/HIV integration The huge unmet need for FP among PLHA Weak referral linkages, one patient Missed opportunities to enroll clients into FP services Low enrollment of mothers (and babies) into care and treatment for HIV/AIDS Maximize use of scarce resources (HRH, Infrastructure) Reduction of time required by clients seeking care from multiple providers Need to increase access and acceptability of FP/RH and HIV services

Stumbling Blocks to Integration HRH –Inadequate motivation and support for multi- skilled and multi-tasking health workers –Staff shortages –Lack of pre-service and in-service training on service integration Infrastructure –Inadequate Clinic space for service provision that ensures privacy and confidentiality

Stumbling Blocks Commodities –Lack of commodity security for FP commodities especially for long term methods Policy, M&E, Governance –Need for country specific policy on FP/HIV integration –Weak M&E systems to measure progress of integration –Weak supervision for integrated services

The Process Documented need for integration Separate HIV and RH/FP services Key staff identified by both NASCOP and DRH to lead the process RH/HIV Integratio n national TWG formed National RH and HIV Integration Strategy developed (2009) Minimum Package of RH/HIV integrated services developed (2011) Government led process Inclusive of all stakeholders Financial and technical support from partners Service delivery, Health workforce, Information, Commodities, Financing and Governance.

APHIAplus Project design Project assessments done Built on lessons learnt from APHIA II projects Project is funded by both PEPFAR and FP/RH funds for service provision Project required to provide integrated services Results expected from both FP/RH and HIV services irrespective of funding mix Projects leverage of PEPFAR funding for health systems strengthening activities that improve service provision for both HIV and FP/RH Health systems approach

Current strategies HRH: focus On Job training and mentorship, job aids, Funzo Project (pre & in service training) Infrastructure (Clinic Space):improving efficiencies on patient flow, renovations where necessary Service Delivery: focus on increasing access and acceptability of FP and HIV integrated services, especially at lower level health facilities Community: demand creation through support to community units, community outreaches with integrated services Commodity security: support to national F&Q, improving facilities reporting rate, procurement during shortages

Lessons Learnt Integration is a process not a destination Level of integration is largely determined by level of health facility, infrastructure and staff skills set/mix Not all services need to be integrated, a minimum package of service provision is required adapted to local context and level of facility Use a health systems approach to integration of services Government and stakeholders’ commitment to the process is critical 13

Asante Sana Thank you