1. 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

2. Presentation outline Rationale Project overview Progress
Lessons learnt

3. 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

4. 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

5. 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)

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

7. 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….

8. 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.

9. 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.

10. 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.

11. 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

12. THANK YOU
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