Strengthening Integration betweenRMNCH and HIV services
Nuhu Yaqub
WHO Tanzania
UNAIDS: Gap report 2014
WHO 2013: Global Update on HIV Treatment 2013: Results, impact and opportunities
Pregnant women living with HIV receiving ARV
WHO 2013: Global Update on HIV Treatment 2013: Results, impact and opportunities
Children < 15 receiving treatment
Rationale
•RMNCH services are still the Primary Accesspoint for women and children
•Poor HTC Coverage for pregnant mothers andinfants
–44% of women get HTC during ANC (WHO 2013)
–42% of Infants get tested within 2 months (WHO2013)
•Effective provision of PMTCT services
•Rights based Approach to providing care
Integration
“The management and delivery of health services so thatclients receive a continuum of preventive and curativeservices, according to their needs over time and acrossdifferent levels of the health system”
Integrating HIV and MNCH
“Integration of HIV interventions into maternal, newbornand child health (MNCH) services involves the reorganizationand reorientation of health systems to ensure the delivery ofa set of essential interventions for HIV prevention, treatmentand care as part of the continuum of care for women,newborn, children and families.”
Benefits
•Patient
–Improved access and uptake of HIV/RMNCH Services
–Increased access to better tailored RMNCH services
–Family Centered care and involvement of the MaleSpouse
•Health Services
–Improved coverage of underserved population
–Improved quality of care of services provided
•Health system
–Enhanced programme effectiveness and efficiency
Opportunities for Integration
PMNCH 2013: Promoting women's & children's health Integrating HIV, TB, malaria andReproductive, maternal, newborn and child health programmes
Ref: PMNCH 2012: Integrating HIV/AIDS and RMNCH programmes: Best practices
What needs to be done
Steps in Integration
•Advocacy
–Identify key stakeholders
–Involvement of PLWHA
–Build Consensus
•Baseline Assessment
–Policies
–Systems
–Services
Example of SRH - HIV Integration Assessment
•A summary of HIV and SRHlinkages in Tanzania
•5 regions and 15 districts
•Findings-
–National Health Policiesemphasized integration howeverin most cases funding was vertical
–Systems: Limited human resourcesfor delivering integrated services,Parallel HMIS systems
–Services: Integrated servicesmainly a feature of hospitals,service users showed preferencefor facilities with integratedservices
Services
•Identify a comprehensive andintegrated package for womenand children – FP, MNCH,PMTCT, Rights based
•Use of evidence basedguidelines to guide servicedelivery
•Review Human resourcecapacity
•Develop information systemfor adequate monitoring
Involve the Community
•Invest in community advocacy, information, educationand communication interventions to raise awareness ofHIV/AIDS and RMNCH linkages.
•Reach out and involve vulnerable groups
•Establish teams of counselors/patient advocates toaccompany women and children needing to accessservices
•Capacity building for community teams to also provideintegrated HIV/AIDS, RMNCH and other services (e.g.PMTCT, VCT, contraception, harm reduction).
More countries are documentingexperiences on Integration
Summary
•Integration represents an opportunity to achievegreater impact in improving HIV services
•Integration is a rights based approach that placesthe patient at the centre of care
•Reducing vertical HIV programmes andintegrating into RMNCH programmes strengthensthe overall health system
•More countries are reporting some form ofintegration taking place at different levels andwith experiences increasingly being documented