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Client and Provider Perspectives on Integration of Family Planning (FP) Counseling and HIV/AIDS Services 


May 1-26, 2006
http://my.ibpinitiative.org/fphivintegration

This forum provided up-to-date and state-of-the-art information on what is happening in the field and an opportunity for synergy between sharing global best practices and country-based experiences.  

Discussion Statistics


Number of participants:  477
Number of participants' countries: 58   
Number of contributions: 83
% of contributions from developing countries: 31%
Number of countries contributing: 17+

Contributing countries:

Nigeria, USA, Ethiopia, Ghana, Zimbabwe, Pakistan, Botswana, the Netherlands, Uzbekistan, Philippines, Benin, India, Uganda, unknown, Swaziland, China, South Africa


Purpose and Objectives 

Purpose:

This forum will provide up-to-date and state-of-the-art information on what is happening in the field and an opportunity for synergy between sharing global best practices and country-based experiences. One of the purposes of this forum is to facilitate ongoing networking and dialogue among program managers, researchers, and others interested in improving client-provider interaction (CPI) as it relates to clients’ family planning (FP) needs within HIV/AIDS service settings.

        

Objectives:

  • Week 1 will be a follow-up to the March [2006] videoconference on the same topic.
  • Week 2 will focus on provider perspectives on family planning in HIV/AIDS counseling.
  • Week 3 will focus on client perspectives on family planning counseling in HIV/AIDS settings.
  • Week 4 will be a discussion regarding future directions, including potential challenges and barriers to the integration of FP counseling and HIV/AIDS services.  
                                            
Week 1. Integration programs in Kenya and Ghana
The discussion this week takes a look at the experiences of two country programs (Kenya and Ghana) in integrating Family Planning Counseling and HIV/AIDS Services. Later in the week, we will be exploring the issue of “dual protection.”

Day 1 Summary:

Dr. Reynolds begins our week with a summary of “Client-Provider Interaction in the Provision of Family Planning in Voluntary Counseling and Testing (VCT) Services in Kenya.” This information was originally presented by Dr. Marsden Solomon, DRH-MOH Kenya and Ms. Jennifer Liku from FHI Kenya during the March videoconference.


Day 2 Summary:

Dr. Bonku summarizes the results of “FP/ART Integration in Ghana; Early Impressions and Interventions.” This information was originally presented by Ms. Olivia Aglah from Engenderhealth/ACQUIRE during the March videoconference.

Dr. Heidi Reynolds responded to participant postings. One participant suggested a community diagnosis for baseline data and situation analysis before integration occurs. Another asked who and what triggers the discussion of family planning in a VCT session. Someone else suggested that a checklist or some similar tool may be helpful to remind providers to raise fertility and family planning issues with their clients. Another participant noted that the facility and environment that providers work in influences their ability to apply newly gained FP-VCT integration knowledge and skills. She suggested that this fact demonstrates the need for 'whole site' and onsite training programs.

   

Day 3 Summary:

In today’s posting, Ms. Betty Farrell discussed “dual protection” counseling and Dr. Young Mi Kim discussed providers’ and clients’ views on “dual protection” and the issues associated with it. 
     

Day 4 Summary:

Today’s digest contains comments and questions from Joseph Dvora, who works with Population Services International (PSI) and Abebe Shirbru from Ethiopia. It also includes links to resources mentioned in yesterday’s digest and a summary of some of the important questions that have been raised in the past three days. 
  

Day 5 Summary:

In today’s digest, our guest expert, Betty Farrell, responds to Abebe Shibru’s comment about gender inequalities. Also, Dina Hovakmian, a TV producer and health educator, asks forum participants to share their experiences in health education about dual protection. Dr. D.A.A. Verkuyl from The Netherlands talks about the difficulties of preventing unintentional pregnancies, especially among HIV positive people, and the difficulty of using the pill properly. Feruza Fazilova from Uzbekistan comments on how it is important to involve men in counseling. Maria Ofelia Alcantara raises another question about financing and sustainability of integrated programs.
     

Week 1 wrap up:

We would like to thank everyone who participated in our first week of discussion. We are especially grateful to our experts for the week. This digest contains additional comments, questions and resources related to week one of our online forum:
  • Dr. Jim Shelton of USAID talks about the problems relying only on condom
  • promotion to prevent HIV and unwanted pregnancies.
  • Dr. Edward Bonku of Ghana responds to some questions from Marian Amoa.
  • Josephat Avoce, who runs an NGO in Benin, asks about research methodologies for
  • measuring the impact of condom use for dual protection.
  • Maria Ofelia Alcantara comments on integration in the Philippines.

                                                    

Week 2. Provider perspectives
The discussion this week takes a look at the experiences of two country programs (Kenya and Ghana) in integrating Family Planning Counseling and HIV/AIDS Services. Later in the week, we will be exploring the issue of “dual protection.”

Day 7 Summary:

We continue our discussion of provider perspectives which began yesterday. We start with a posting from another guest expert, Dr. Gina Brown, and follow that with three comments from forum participants in Ethiopia, Pakistan and Zimbabwe on Dr. Joachim Osur’s comments from yesterday.


Day 8 Summary:

Today we have a posting from another guest expert, Dr. James Shelton, who raises an important question with respect to provider perspective – “What’s in it for them?” Other participants, including Irina Jacobsen at Family Health International, Maureen Kwikiriza in Uganda, and Konjit Kifetew in Ethiopia, also provide comments and questions.
   
 

Day 9 Summary:

In today's digest, we include: 
  • Comments from Dr. Joachim Osur on Maureen Kwikiriza's question from yesterday.
  • Comments from John Howson on questions from Arif Bashir, counselor, National AIDS
  • Contol Programme, NIH, Islamabad (from Day#4).
  • Some resources related to the question of the psychological reasons/beliefs for not
  • wanting to use condoms and how this can be an important barrier to use which could be explored.
  • A request to forum participants to send comments on Josephat Avoce's question to the
  • group about how to measure whether people are using condoms to prevent unwanted pregnancies or HIV/AIDS/STIs or both.
     

Day 10 Summary:

Today is the last day that we will be focusing on provider perspectives. In today's e-mail we include:
  • A comment from Dr. Rajat Kumar Das about the status of integration in India. He
  • suggests that the best way to integrate HIV/AIDS with reproductive and child health projects is through local government bodies and asks for feedback on this idea.
  • A comment from Bernadette Kazibwe, President of the Clare Nsenga Foundation, that  talks about the problem of providing health education and health care in rural areas and about the Foundation's work in Uganda.
  • A comment from Pastor Michael Mwandha about the work of the Beroya Gospel
  • Fellowship in Uganda.
  • Information on an upcoming conference in October in Ethiopia on integration/linkages
  • between reproductive health and HIV/AIDS.
  • Resources for statistics on HIV status and contraceptive use.
     

Day 11 Summary:

At this time we would like to thank everyone who participated in our discussion during week two which focused on provider perspectives. A special thank-you to our guest experts.

This digest includes the following:
  • A comment from Dr. Gina Brown on Dr. Jim Shelton’s point about barriers to integration
  • and practical approaches to overcoming some of those barriers. Dr. Brown also addresses comments from Dr. Irina Jacobson and Konjit Kifetew.
  • A second comment from Dr. Gina Brown on postings by Rajat Kumar Das and
  • Bernadette Kazibwe.
  • A comment from Dr. Julitta Onabanjo on the work of UNFPA and its partners on the links between HIV/AIDS and SRH. Dr. Onabanjo also summarizes discussions on a previous online forum about attitudes of health service providers and discrimination.
  • Dr. Di Cooper of the Women's Health Research Unit at the University of Cape Town in
  • South Africa shares some results of a provider survey they are conducting.
  • And finally, a brief comment from Peter Esekon on Maureen Kwikiriza’s posting.
                                                  
Week 3. Client perspectives.
On Monday, we will begin to focus our discussion on the client perspective. Our first posting next week will come from Anne Namwamba-Ntombela in South Africa. Anne has been living with HIV for the past 15 years. She is a widow and mother of one child. She started on ARVs in 2002 and is currently doing okay. Anne is the project manager and co-founder of Springs of Hope Support Group. In today’s posting, Anne shares with us her own experiences with counseling and sexual and reproductive health services/providers. She also talks about what typically happens to women and what issues are most pressing.

Day 12 Summary:

In today’s digest, we have four comments and some resources from UNFPA on integration. Konjit Kifetew, Maria de Bruyn, and Chris Aynamene comment on Anne Namwamba-Ntombela's introduction to week #3. Lynda Stranix comments on Jim Shelton's introduction to Week #2.


Day 13 Summary:

In today’s digest, we have two comments from from Asfawesen G/Yohannes and Abebe Shibru, both from Ethiopia, on Anne Namwamba-Ntombela's introduction to this week's discussion on client perspectives. Asfawesen asks forum participants what systemic adjustments are needed to boost the skills of providers, improve working conditions, and give clients a better experience. Abebe shares information on a mother-to-mother support group for HIV positive women in Ethiopia.
     
 

Day 14 Summary:

Today’s digest includes a question from Peggy D’Adamo (USA) and a comment from Ward Rinehart (Switzerland). It also includes links to some useful counseling training resources and information on the USAID Family Planning and Integration Working Group meeting taking place in Washington DC.
    

Day 15 Summary:

Today’s digest includes responses from:
  • Anne Ntombela to Asfawesen Yohannes and Abebe Shibru.
  • A comment from Margaret Butau on training service providers in counseling.
  • A comment and request for more discussion on youth and integration from David Rivett,
  • WHO Ukraine.
  • A comment and request from Caroline Tran (ESD Project, USA) for more information
  • from Abebe Shibru on the mother-to-mother support groups in Ethiopia. Caroline also asks for other successful examples of community-based FP-HIV integration activities focusing on PMTCT.
  • A short summary of Thursday's USAID Family Planning and Integration Working Group
  • meeting taking place in Washington DC. 
   

Day 16. Week 3 Wrap Up:

We would like to thank Anne Namwamba-Ntombela for serving as our expert for week #3 which focused on client perspectives. Many thanks as well to all the forum participants who shared their experiences and ideas. Today’s digest includes Dr. Young Mi Kim’s welcome and introduction to week #4 of the forum, responses to last week’s discussion from Anupam Raizada and Janaki Sankaran – both working in India – and a short summary of Friday’s USAID Family Planning and Integration Working Group meeting in Washington DC.
   

Week 4. Future directions
Week 4 will focus on future directions, including potential challenges and barriers, to the integration of FP counseling and HIV/AIDS Services. As our expert for this week, we bring back Dr. Young Mi Kim of Johns Hopkins. Dr. Kim asks participants during this last week of the online forum to discuss three particular aspects of the way forward: 1) any additional recommendations, 2) suggestions for future forums or discussions, and 3) and spin off small discussion groups.

Day 17 Summary:

 In today’s posting, we have three comments from Dr. Arzum Ciloglu, Health Communication Partnership, JHU/CCP, USA, Dr Lynda Stranix-Chibanda, Zimbabwe, and Marian Amoa, Health Communication Partnership, JHU/CCP, USA. 

 

Day 18 Summary:

In today’s posting, we have a response from Dr. Young Mi Kim and two comments from participants. Victoria Masuku of PSI in Swaziland describes her own experiences as a VCT counselor and Li Dongli of the China Population and Development Research Center describes research being done in China on stigma and how services are being integrated.
  
 

Day 19 Summary:

In today’s posting, we have several comments and information on a publication that may be useful to forum participants. Abebe Shibru, working for IntraHealth in Ethiopia, tells us more about the mothers’ support groups mentioned earlier in the forum. Ward Rinehart poses a question for Dr. Li on integration in China. Margaret Gitau makes a comment on integration in Kenya and Theresa Lynne makes a comment on working with young people in South Africa.

We have also included information on a new guide for submitting proposals to the Global Fund for integrated programming from Lisa Schechtman of the Global AIDS Alliance. The Guide explains how to develop a proposal for the Global Fund that could include sexual and reproductive health programming under the HIV component of funding.
 

Day 20. Week 4 Wrap Up :

This is the final formal digest of postings. It will be followed by an e-mail that summarizes the forum and invites participants to complete a short online survey about the forum.  
     

                                                 

Final forum summary.

This four week-long forum has been a rich and rewarding experience. We hope that it has provided you with up-to-date and state-of-the-art information on what is happening in the field and an opportunity for synergy between sharing global best practices and country-based experiences, personal experiences, skills, and useful tools, etc.

Post-forum survey results

Number of surveys completed 68

% who have passed content to others 64%

% who have or will use in their work  90%

% very satisfied with forum content 68%

Suggestions for improvement :  

          • Try and ensure more participation by field people through additional publicity in advance of the forum. If field people don't have internet access, ask the people who have signed up to gather responses from their field colleagues about specific topics and questions that will be covered and to hold a weekly meeting to discuss the postings as they happen. Then have the designated responder summarize and respond.
          • Try to organize this event on annual basis.
          • Maybe having a moderator specifically guide comments after each day instead of having the forum float a bit.
          • There is a lot of information to digest. It would be nice to have a more readable format. I know some email systems don't support anything other than text, but it made it difficult to skim.

  Other comments:

  • The best comments were from people working at the field level--more of them would have been very valuable.
  • The issues raised in the forum gave me a clear picture how to integrate FP and HIV/AIDS.
  • I really enjoyed the range of responses and information from a variety of stakeholders and groupings involved in HIV/AIDS and contraception.
References and resources

Click here for related resources and references in the community library

Organizing groups

The Health Communication Partnership (HCP) and the INFO Project, based at Johns Hopkins Bloomberg School of Public Health’s Center for Communication Programs.

Contributing experts/facilitators 

Dr. Heidi Reynolds, Family Health International

Dr. Edward Bonku from Engenderhealth/ACQUIRE, Ghana

Betty Farrell from Engenderhealth/ACQUIRE, New York

Dr. Young Mi Kim, Health Communication Partnership (HCP), Johns Hopkins Bloomberg School of Public Health’s Center for Communication Programs (JHU/CCP)

Dr. Joachim Osur, Family Health Options, Kenya

Dr. Gina Brown, New York City Department of Health and Mental Hygiene

Dr. James Shelton, USAID,Washington.

Dr. Marsden Solomon, DRH-MOH Kenya

Ms. Jennifer Liku, FHI, Kenya

Ms Olivia Agla, EngenderHealth/ACQUIRE

Dr. Irina Jacobson, FHI

Ms. Anne Namwamba-Ntombela, ICW, Springs of Hope Support Group, South Africa

Mr. John Howson, Health Communication Partnership (HCP), Johns Hopkins Bloomberg School of Public Health’s Center for Communication Programs (JHU/CCP)

Steering committee

This online forum will build upon existing partnerships and activities among three groups: the Implementing Best Practices in Reproductive Health Initiative (IBP) Initiative, the Maximizing Access and Quality Subcommittee on Client-Provider Interaction (CPI), and the Family Planning and HIV/AIDS Integration Working Group.

Other acknowledgements

We would like to thank Dr. Arzum Ciloglu, (HCP) and Ms. Peggy D’Adamo (INFO) who coordinated this online forum.

Moderators

Louise Manning, JHU/CCP