Health systems and the SDGs: lessons from a joint HIV and sexual and reproductive health and rights response

Warren, Charlotte E.; Hopkins, Jonathan; Narasimhan, Manjulaa; Collins, Lynn H.; Askew, Ian; Mayhew, Susannah

doi:10.1093/heapol/czx052

Cited by 24 publications

(24 citation statements)

References 32 publications

(45 reference statements)

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“…For the purposes of this review, we used the following definitions: Linkages refer to bi-directional synergies in policy, systems, and services between sexual and reproductive health and rights and HIV. It refers to a broader human rights-based approach, of which SRH service integration is a subset [18, 19]. Integration refers to the service delivery level and can be understood as joining operational programmes to ensure effective outcomes through many modalities (such as multi-tasked providers, referral, and one-stop shop services under one roof) [18].…”

Section: Methodsmentioning

confidence: 99%

Integration of HIV testing services into family planning services: a systematic review

et al. 2019

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Background Despite significant interest in integrating sexual and reproductive health (SRH) services into HIV services, less attention has been paid to linkages in the other direction. Where women and girls are at risk of HIV, offering HIV testing services (HTS) during their visits to family planning (FP) services offers important opportunities to address both HIV and unwanted pregnancy needs simultaneously. Methods We conducted a systematic review of studies comparing FP services with integrated HTS to those without integrated HTS or with a lower level of integration (e.g., referral versus on-site services), on the following outcomes: uptake/counseling/offer of HTS, new cases of HIV identified, linkage to HIV care and treatment, dual method use, client satisfaction and service quality, and provider knowledge and attitudes about integrating HTS. We searched three online databases and included studies published in a peer-reviewed journal prior to the search date of June 20, 2017. Results Of 530 citations identified, six studies ultimately met the inclusion criteria. Three studies were conducted in Kenya, and one each in Uganda, Swaziland, and the USA. Most were in FP clinics. Three were from the Integra Initiative. Overall rigor was moderate, with one cluster-randomized trial. HTS uptake was generally higher with integrated sites versus comparison or pre-integration sites, including in adjusted analyses, though outcomes varied slightly across studies. One study found that women at integrated sites were more likely to have high satisfaction with services, but experienced longer waiting times. One study found a small increase in HIV seropositivity among female patients testing after full integration, compared to a dedicated HIV tester. No studies comparatively measured linkage to HIV care and treatment, dual method use, or provider knowledge/attitudes. Conclusions Global progress and success for reaching SRH and HIV targets depends on progress in sub-Saharan Africa, where women bear a high burden of both unintended pregnancy and sexually transmitted infections, including HIV. While the evidence base is limited, it suggests that integration of HTS into FP services is feasible and has potential for positive joint outcomes. The success and scale-up of this approach will depend on population needs and health system factors. Electronic supplementary material The online version of this article (10.1186/s12978-019-0714-9) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Integration of HIV testing services into family planning services: a systematic review

et al. 2019

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“…Debate on the advantages and disadvantages of integrated health care versus vertical programming has persisted since Alma Ata ( WHO 1978 ). In the field of sexual and reproductive health integration has been increasingly promoted in low-income settings dominated by ‘vertical’ health programmes as a means to bring together related services to improve their efficiency and efficacy ( UNFPA 2004 ; WHO and UNFPA 2006; WHO/UNFPA 2017; and see Warren et al (2017 ) in this Edition for a historical review). In high-HIV prevalence settings in sub-Saharan Africa, concern grew in the 2000s to improve access to HIV testing and treatment services through mainstream, as well as HIV-specialist, health facilities.…”

Section: Introductionmentioning

confidence: 99%

Numbers, systems, people: how interactions influence integration. Insights from case studies of HIV and reproductive health services delivery in Kenya

Mayhew

Sweeney

Warren

et al. 2017

Health Policy and Planning

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Drawing on rich data from the Integra evaluation of integrated HIV and reproductive-health services, we explored the interaction of systems hardware and software factors to explain why some facilities were able to implement and sustain integrated service delivery while others were not. This article draws on detailed mixed-methods data for four case-study facilities offering reproductive-health and HIV services between 2009 and 2013 in Kenya: (i) time-series client flow, tracking service uptake for 8841 clients; (ii) structured questionnaires with 24 providers; (iii) in-depth interviews with 17 providers; (iv) workload and facility data using a periodic activity review and cost-instruments; and (v) contextual data on external activities related to integration in study sites. Overall, our findings suggested that although structural factors like stock-outs, distribution of staffing and workload, rotation of staff can affect how integrated care is provided, all these factors can be influenced by staff themselves: both frontline and management. Facilities where staff displayed agency of decision making, worked as a team to share workload and had management that supported this, showed better integration delivery and staff were able to overcome some structural deficiencies to enable integrated care. Poor-performing facilities had good structural integration, but staff were unable to utilize this because they were poorly organized, unsupported or teams were dysfunctional. Conscientious objection and moralistic attitudes were also barriers.Integra has demonstrated that structural integration is not sufficient for integrated service delivery. Rather, our case studies show that in some cases excellent leadership and peer-teamwork enabled facilities to perform well despite resource shortages. The ability to provide support for staff to work flexibly to deliver integrated services and build resilient health systems to meet changing needs is particularly relevant as health systems face challenges of changing burdens of disease, climate change, epidemic outbreaks and more.

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“…7 Guidelines provided by the WHO, UNAIDS, UNFPA and others, are available to support the inclusion of comprehensive SRH services into primary health care to ensure equity, accessibility, acceptability and cultural sensitivity. 8,9 Several challenges are associated with adopting integrated approaches. Lack of resources (financial, human, and technological) and absence of political commitment contribute to one dimension of this problem.…”

Section: Introductionmentioning

confidence: 99%

Integration of sexual and reproductive health services in the provision of primary health care in the Arab States: status and a way forward

Kabakian‐Khasholian

Quezada-Yamamoto

Ali

et al. 2020

Sexual and Reproductive Health Matters

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Different approaches are used for integration of sexual and reproductive health (SRH) services at the primary health care (PHC) level, aiming at providing comprehensive services leaving no one behind. This paper aims to assess gaps in the delivery of SRH in PHC services, identifying challenges and proposing action towards universal health coverage in Arab countries. The United Nations Population Fund, Arab States Regional Office (UNFPA/ASRO), in partnership with Middle East and North Africa Health Policy Forum (HPF), launched an assessment of integration of SRH into PHC in 11 Arab countries in 2017-2018. Desk reviews were conducted, using published program reports and national statistics. Data from country reports were compiled to present a regional assessment, challenges and recommendations. SRH services are partially integrated in PHC. Family planning is part of PHC in all countries except Libya, where only counselling is provided. Only Morocco, Tunisia and Oman provide comprehensive HIV services at PHC level. Jordan, Libya and Saudi Arabia rely mainly on referral to other facilities, while most of the integrated family planning or HIV services in Sudan, Morocco and Oman are provided within the same facilities. Action is required at the policy, organisational and operational levels. Prioritisation of services can guide the development of essential packages of SRH care. Developing the skills of the PHC workforce in SRH services and the adoption of the family medicine/general practice model can ensure proper allocation of resources. A presented regional integration framework needs further efforts for addressing the actions entailed.

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Health systems and the SDGs: lessons from a joint HIV and sexual and reproductive health and rights response

Cited by 24 publications

References 32 publications

Integration of HIV testing services into family planning services: a systematic review

Integration of HIV testing services into family planning services: a systematic review

Numbers, systems, people: how interactions influence integration. Insights from case studies of HIV and reproductive health services delivery in Kenya

Integration of sexual and reproductive health services in the provision of primary health care in the Arab States: status and a way forward

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