Reproductive health services in KwaZulu Natal, South Africa: A situation analysis study focusing on HIV/AIDS services

Abstract

System, for their support of the research. We would also like to acknowledge all district managers and their management teams for their assistance and support throughout; the fieldworkers for their tireless effort; and all the facility management and staff for their assistance and participation during data collection. We would like to thank the Italian Health Cooperation for their financial contribution to make the study possible. Lastly we would like to thank the Maternal, Child & Women's Health Sub-Directorate for the central role they played in making the study possible. The KwaZulu Natal Department of Health aims to achieve optimal health status for all persons in KZN by developing sustainable, coordinated, integrated and comprehensive health systems at all levels, based on the primary health care approach through the district health system.

Integration of STI and HIV Prevention, Care, and Treatment into Family Planning Services: A Review of the Literature

“…Conversely, recent reports also describe the persistence of missed opportunities in service delivery, including failure to counsel FP clients on dual protection or con-dom use (Population Council 1999;Mayhew et al 2000;Adeokun et al 2002;Lafort et al 2003;Ndhlovu et al 2003;Maharaj and Cleland 2005); providers' preference for promoting injectable contraceptives over condoms (Ndhlovu et al 2003); their failure to conduct pelvic examinations (Chowdhury et al1999;Population Council 1999); and their failure to conduct behavioral risk assessments (Chowdhury et al 1999;Mayhew et al 2000;Lafort et al 2003), even in cases of clients who judge themselves to be at high risk (Maharaj and Cleland 2005). Studies suggest that these omissions are due to a variety of systemic shortcomings (among them, poor referral systems, too few staff, not enough time to offer all services, and training deficiencies) and also to factors such as providers' discomfort with talking about sexual health and their being poorly prepared and supported (Population Council 1999;Mayhew et al 2000).…”

“…Moreover, evidence makes clear that integrated services can encourage the attendance and involvement of male partners, both for HIV testing (Mphuru et al 2006) and for STI treatment (Budiharsana 2002;Lafort et al 2003). Other studies from a range of SRH settings, however, found no increase in, or continuing low numbers of, male clients (Fullerton et al 2003;Ndhlovu et al 2003;EngenderHealth and UN-FPA 2006) and also found missed opportunities in cases where men attended in order to obtain STI care and were not offered FP services (Maharaj and Cleland 2005).…”

“…"Facility-level integrated care" may, in fact, be more stigmatizing than "provider-level integrated care." Several recent descriptive studies found that privacy cannot always be maintained, calling into question the presupposed confidentiality of the integrated approach (Chowdhury et al 1999;Mayhew 2000;Ndhlovu et al 2003;Maharaj and Cleland 2005). Moreover, some evidence suggests that PLWH may prefer specialized HIV care to integrated care because they have experienced poor treatment within SRH services, citing lack of confidentiality and privacy, discrimination and negative attitudes from providers, and otherwise substandard care (EngenderHealth and UNFPA 2006;PATH 2007b).…”

“…In general, integration of STI/HIV-transmission-prevention services has been more successful than has integration of care activities. Many studies demonstrate that difficulties with integrating care arise because of problems procuring and ensuring continuity of the equipment and supplies necessary for incorporating STI/HIV care into FP programs, which includes complex and expensive laboratory tests, and training or recruiting staff to use them (Askew and Maggwa 2002;Askew and Berer 2003;Fullerton et al 2003;Lafort et al 2003;Ndhlovu et al 2003). Performing complex laboratory tests is generally not considered feasible in resource-constrained settings (UNFPA 2004b); yet, as discussed above, syndromic management is also inadequate.…”

Are integrated HIV services less stigmatizing than stand‐alone models of care? A comparative case study from Swaziland

“…Some PLWH may also prefer specialized HIV care due to enacted provider stigma within SRH services [23, 24]. Furthermore, descriptive studies following service integration report that privacy is not always maintained in generalist settings, calling into question the supposed confidentiality of an integrated approach [17, 25, 26]. …”