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Family Planning and HIV Service Integration: Experiences and Evidence

June 1-5, 2009
http://my.ibpinitiative.org/fphivintegration

This one-week forum focused on the common language of integration and monitoring and evaluation of integrated services.

Discussion Statistics


Number of participants: 743
Number of participants' countries: 73
Number of contributions:3 contributions
% of contributions from developing countries: 0%
Number of countries contributing: 1 country

Contributing countries: United States

Purpose and Objectives

Purpose:

This one-week forum focused on the common language of integration and monitoring and evaluation of integrated services.

Objectives:

Provide an opportunity to hear about participants’ experiences, reflect on what our experience has taught us, and discuss how we can strengthen our efforts to develop successful, evidence-based integrated programs. Over the course of the week, we will focus on three key themes: 1) what it means to integrate FP and HIV services; 2) emerging best practices and lessons learned; and 3) monitoring and evaluation of integrated FP/HIV services.                     


Day 1:  Common language on integration 

Questions:

  1. How is FP/HIV integration being defined by your organization or in your program?
  2. What does FP/HIV integration mean at the facility level? At the community level?

Day 1 Summary:

The guest experts responded to one participant who asked why the term “family planning” is used rather than “sexual reproductive health and rights.”
Another participant described a useful 1998 publication titled “Integrating STD/HIV Services into RH Settings” produced by Management Sciences for Health. The publication provides a systematic approach to addressing strategic and operational issues that are critical for the successful integration of STI/HIV services into FP/RH settings, or vice versa.

A third respondent described a loophole in some service programs in which they provide one service and refer clients to a different location for other services. In these cases, the client may never reach the referral site and when she does, the referring service may not get feedback on that visit.

                                                                   

Day 2: Best practices and lessons learned in integration 

Questions:

  1. 1. What approaches have you/your organization taken to integrate services?
  2. 1. Based on your experience, what do you think are the most important inputs to well-functioning and sustainable services? For example, evidence has shown that training providers is an important input but more is needed to enable providers to practice what they have been trained to do. What other inputs are needed?

Day 2 Summary:

Ideally, efforts to integrate FP and HIV services should include a range of interventions across different levels of the health system. Experience to date suggests there has been an over-reliance on training as the primary intervention activity, and that more comprehensive approaches are needed to address needs at policy, facility, provider, and community levels. Rose Wilcher, Senior Technical Officer at Family Health International, provided an example of a best practice in Uganda. More information about this project can be found by clicking on Program Examples below.


Day 3: Monitoring and evaluation (M&E) indicators 

Questions:

If you work in HIV services, what FP indicators are being used or have been tested in monitoring systems?
What do you think are a minimum set of indicators to monitor FP in HIV services (or monitor HIV in FP services)?
What do you think are a minimum set of indicators to monitor FP in HIV services (or monitor HIV in FP services)?

Day 3 Summary:

Systems to monitor and evaluate integrated services are needed. Specifically, routine information systems for HIV have been largely implemented as parallel systems to family planning (and other health services) information systems. Indicators collected in those systems also do not typically measure non-HIV or family planning events, respectively. With the reauthorization of PEPFAR, there is a specific objective to mainstream HIV services, and hence reporting systems, into the national health system. While each vertical service has its own indicators and information systems, integrated services mean new indicators and systems need to be developed or adapted and tested. Specifically, there is a need to develop and test the validity of monitoring indicators for integrated services and to develop guidance to support the quality and completeness of the collected data. Heidi Reynolds, Senior Technical Specialist-HIV/AIDS at MEASURE Evaluation provided three examples of organizational experiences with M&E of integration services.
      

Program Examples

A pilot project carried out by EngenderHealth through the ACQUIRE Project in Uganda provides a useful case study of a multi-faceted approach to FP/ART integration. In this pilot, ACQUIRE, in collaboration with the AIDS Support Organization (TASO), implemented an integration process based on a systems approach to build or strengthen the ART site’s capacity to accommodate the addition of FP services, complemented by community-based and advocacy activities to stimulate demand for services. Intervention activities included:

  • Updating service delivery protocols to include FP within the care and treatment constellation of services
  • Developing a 2-week FP-integration training curriculum
  • Orienting 23 TASO trainers to use the curriculum and providing training technical assistance to those trainers conducting their first on-site training of 15 staff (clinicians, counselors, and field officers)
  • Conducting FP integration trainings for 12 community nurses and selected PLHIV volunteers who provide community-based services and support center-based services
  • Adapting and introducing job aids to support FP counseling
  • Working with TASO supervisors, facility managers, and heads of department to strengthen the supervisory system through Facilitative Supervision training and to establish an ongoing mechanism for quality improvement using the COPE® (client-oriented/provider efficient) process
  • Capturing FP in the center’s data collection system
  • Learning to use the Ministry of Health FP commodity supply mechanism to maintain stock
  • Formalizing the referrals between the Mbale center and the Mbale Regional Referral hospital
  • Increasing public awareness of and knowledge about FP and its benefits to PLHIV through activities such as integration of FP messages in on-site health talks and in periodic radio programs, and orientation of AIDS Community Workers to share FP information with community group.

***Please click on the References and Resources section below to view the “Evaluation of a Family Planning and Antiretroviral Therapy Integration Pilot in Mbale, Uganda” document located in the FP and HIV Service Integration: Experiences and Evidence Forum (June 2009)/publications folder. ***
Post-forum survey results

N of surveys completed - 3

% who have passed content to others - 100%

% who have or will use in their work - 100%

% very satisfied with forum content - 33%

Suggestions for improvement:

  • It might be worth determining interest from the listserve to see if the topic would be of interest and if there are any burning questions/issues that should be used to set the frame of the forum. 
  • I wish i had participated in a discussion of "dual protection" as an aspect of integrated services. 
                                                              
References and resources

Click here for related resources and references in the community library

Organizing groups

Family Health International (FHI), EngenderHealth, MEASURE Evaluation, K4Health Project based at Johns Hopkins Bloomberg School of Public Health’s Center for Communication Programs (JHU/CCP) (JHU/CCP)

Contributing experts/facilitators 

Rose Wilcher, Senior Technical Officer, Family Health International

Betty Farrell, Senior Technical Advisor for Integration, EngenderHealth

Heidi Reynolds, Senior Technical Specialist HIV/AIDS, MEASURE Evaluation

Steering committee

Family Health International (FHI), EngenderHealth, MEASURE Evaluation, K4Health Project based at Johns Hopkins Bloomberg School of Public Health’s Center for Communication Programs (JHU/CCP)

Moderators

Ashley Isabelle Spence, JHU/CCP

Megan O’Brien, JHU/CCP