Population Council Research that makes a difference

2011 International Conference on Family Planning
29 November–2 December 2011

Abstract

"Taking RH/HIV integration to scale: Experience and lessons from Kenya"
Margaret Gitau, Shiphrah Kuria, Marsden Solomon, Wilson Liambila, and Jennifer Liku

Background
Linking reproductive health (RH) and HIV policies, programs and services is essential to advancing comprehensive health care service delivery. The process of integrating RH and HIV services began in Kenya more than a decade ago under MOH leadership. Several approaches to RH/HIV integration have been systematically implemented, including: integration of STI screening and treatment into MCH services; provision of HIV counseling and testing (CT) for pregnant women attending antenatal services; integration of FP into CT services and CT into FP services; and integration of FP into ART clinics. Over time, the Kenyan government has addressed factors affecting RH/HIV integration at all levels of the health system in pursuit of establishing routine integrated service delivery at scale. This paper shares the government’s lessons from systematically rolling out RH/HIV integration.

Methodology
Building on studies demonstrating the feasibility, acceptability and effectiveness of RH/HIV integration, the government—with leadership from both the National AIDS/STI Control Program and the Division of Reproductive Health—constituted the National RH/HIV Integration Committee to assist in developing the necessary policy support for integration. The government and its partners also developed national training materials for capacity building in RH/HIV integration and created a set of national indicators for M&E of integrated services. They have accelerated the process of rolling out RH/HIV integration through advocacy meetings with regional and district stakeholders, supportive supervision visits at facilities, and newsletters to providers and program managers.

Results
MOH leadership on RH/HIV integration has culminated in the creation of a National RH/HIV Integration Strategy, as well as the national guidelines, "Minimum Package for Service Provision on RH/HIV Integration in Kenya." Field reports and site visits indicate that all regions are implementing integrated RH/HIV services to some degree at the community, dispensary, health center, district, provincial, and tertiary levels of the health system. The types of RH and HIV services integrated and the extent of the integration vary depending on regional and district priorities. Factors that have facilitated delivery of basic RH/HIV integrated packages of care at scale include improvements to the infrastructure, building human resource capacity, securing proper equipment, ensuring commodity availability, and modifying M&E tools.

Conclusion
MOH leadership in developing a policy and programmatic framework for RH/HIV integration is crucial to galvanizing support for integration among key stakeholders at all levels of the health system. However, at the service delivery level, RH/HIV integrated approaches must be tailored to the specific regional and district contexts.

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