1. www.agpahi.or.tz National stakeholders meeting on MNCH/HIV Giraffe Hotel, Sept 24 – 25 th,2014. HIV integration - experience from Shinyanga Region. Presenter ; Dr. Mawazo Salehe – RACC – Shinyanga & Dafrosa Chale

2. www.agpahi.or.tz OUTLINE Introduction Current situation Rationale for integration Criteria for site selection Integration process Achievements challenges Lesson leant Way forward

3. www.agpahi.or.tz SHINYANGA HEALTH PROFILE General population – 1,791,907 WRA – 412,326 Children under 5 – 322,850 Total health facilities -202 ( 5 hospitals, 18 H/C and 179 Dispensaries) out this government facilities – 127 Voluntary agency- 10, Par- 11 and private – 31. Total of 156(77%) facilities provide RH/MNCH and 146 (72%)with PMTCT service.

4. www.agpahi.or.tz CURRENT SITUATION Source of data 2013 annual RH regional report. Key MNCH & HIV IndicatorsReg. status CPR12.5% Fertility rate7.4% H/F delivery53% Skilled attend130 (64%) Postnatal care34% Penta 3 coverage95.1% HIV prevalence7.4% HIV prev. among pre. Women4.3%

5. www.agpahi.or.tz AGPAHI A S A PARTNER AGPAHI, a Tanzanian registered and managed NGO. Works to improve the health of children and families affected by HIV/AIDS through innovative, sustainable, and locally-owned solutions for improved healthcare. AGPAHI, founded in 2010 and officially registered in 2011, is an affiliate of EGPAF Was established to build local leadership and ownership for HIV programming in Tanzania

6. www.agpahi.or.tz CONT… UNFPA support 25 (100%) CTC/FP integration facilities (Ushetu, Msalala, Kahama TC and Shinyanga MC). A total of 20 VCT sites have FP integration services. USAID support Kishapu, & Shinyanga DC. A total of 89 outreach FP/Immunization integrated services, 16 CTC/FP integration. Shinyanga total CTC 39 with FP integration 28 (72%), 20 (19%) with VCT/FP.

7. www.agpahi.or.tz RATIONALE FOR SERVICE INTEGRATION  Maximizes opportunities to prevent unintended pregnancies among clients who do not wish to become pregnant and reduce mother-to-child transmission.  Provides opportunities to reach men with FP information and services.  Providers are familiar with clients’ HIV status, health status, and treatment regimen, all of which they can take into account when providing FP counseling.  HIV care and treatment settings might be a less stigmatizing or discriminating environment for PLH to discuss fertility intentions, contraception, and sexuality.

8. www.agpahi.or.tz CRITERIA FOR SITE SELECTION Selected sites for integration services based on contraceptive prevalence rate, established CTC sites and outreach CTC, sites with immunization outreach/mobile services. VCT sites with trained staff and space/privacy for FP provision.

9. www.agpahi.or.tz INTEGRATION PROCESS FP/CTC Integration services in Shinyanga started since 2010 as operational research for 10 sites there after in 2012 role out of integration done from 10 sites to date 28 (72%) in Shinyanga and 14 in Simiyu (39%) under support of UNFPA & USAID. VCT/FP integration to 20 facilities of Kahama & Shinyanga Municipal (UNFPA support) – started October 2013..

10. www.agpahi.or.tz INTEGRATION PROCESS Conducted orientation meeting to R/CHMT of all supported districts. Conducted community sensitization meeting to influential people on CTC/VCT/FP integration. Conducted training for service providers on integration. Ongoing health education at facility and service provision. Supportive supervision & trainees follow p.

11. STEPS BY STEPS FOR INTEGRATION PROCESS 1. ASSESS FP CTC 2. COUNSEL REFER (IUD, Tubal Ligation, Vasectomy) REFER (IUD, Tubal Ligation, Vasectomy) PROVIDE (Pills, Injectables, Implants, Condoms) PROVIDE (Pills, Injectables, Implants, Condoms) RECORD ACCOMPANY RECORD PROVIDE (IUD, Tubal Ligation, Vasectomy) PROVIDE (IUD, Tubal Ligation, Vasectomy) RECORD

12. www.agpahi.or.tz INTEGRATION COVERAGE DistrictNo of facilities with CTC services No of supported integrated FP/CTC % facility with integrated approach Kishapu11436 Ushetu44 100 Msalala44 100 Shinyanga DC74 57 Kahama TC22 100 Shy MC1110 91 Region3928 72

13. www.agpahi.or.tz CONTRIBUTION OF INTEGRATION 2013.

14. www.agpahi.or.tz KISHAPU FP UPTAKE BEFORE (2012) & AFTER (2013) Source of data- DHIS2

15. www.agpahi.or.tz PERFORMANCE OF INTEGRATION FROM OCTOBER 2012 TO JUNE 2014

16. www.agpahi.or.tz QUARTERLY FP INTEGRATION PERFORMANCE

17. www.agpahi.or.tz NEW FP CLIENTS QUARTERLY TREND

18. www.agpahi.or.tz FP BY METHOD VCT & CTC

19. www.agpahi.or.tz CHALLENGES Most of facilities have limited equipment's for provision of quality FP services ( eg. BP machine, examination bed, sets for IUCD insertion and implants removal, adult weighing scale and tents for mobile/outreach services). Limited number of staff trained on Long-term methods.

20. www.agpahi.or.tz CHALLENGES …….. MTUHA 8 report form does not capture information for short term FP methods for outreach/mobile services. Shortage of FP commodities especially condoms affect dual protection.

21. www.agpahi.or.tz LESSONS LEARNT Initiation of FP quality improvement project to based on national QI indicator facilitated increase in FP uptake. Increase of FP service delivery outlets increases FP uptake

22. www.agpahi.or.tz CONT…. Despite of the existing misconceptions, still the need for FP is high Integration of FP services in the existing services provides a assures sustainability in FP provision. VCT/FP integration acceptance is very high eg. Oct 013 to June 014 1832 (45%) clients received FP through VCT out of 4090 tested.

23. www.agpahi.or.tz WAY FORWARD To mobilize more resources in order to scale up integration in all district health facilities in Shinyanga Region. Scale up of VCT/FP from 19% to 50% of facility of Shinyanga.

24. www.agpahi.or.tz ACKNOWLEDGEMENT Shinyanga community RHMT CHMT Facility staff MoHSW USAID UNFPA

25. www.agpahi.or.tz LOCAL SOLUTION TO LOCAL PROBLEMS