Population Reference Bureau

This policy brief from the Population Reference Bureau (PRB) discusses developing the political will for integrating family planning/reproductive health (FP/RH) and HIV services globally through strategies at the policy level and the programme level. It describes integration of services as combining components of FP/RH and HIV services that are currently separate, with the goal of maximising coverage and health outcomes for the client and optimising the wise use of scarce resources. It includes evidence from country-level programmes, from studies on financial benefits, and from studies on client benefits of the following: integrating FP/RH into services that prevent mother-to-child transmission of HIV; integrating HIV counselling and testing into FP/RH services; integrating FP into HIV treatment, care, and support programmes; and integrating FP/RH into HIV counselling and testing.

Recommendations for advancing FP/HIV integration include the following:

Policy Level

Those who make and influence health and development policy need to:

• Establish a national integration task force drawn from both FP and HIV government officials and key stakeholders, including people living with HIV and AIDS (PLHA) and youth, to provide guidance in developing a national plan, as well as strategies for implementing integrated services.
• Gather and use country-level data and information for guiding decisions on HIV and FP integration.
• Advocate for and support integrated services at all levels: policy, facility, provider, and community.
• Focus on a broad range of policies. In addition to official policies, documents such as guidelines, strategic plans, and coordination mechanisms also need to foster effective linkages between RH and HIV programmes and services.
• Ensure that new and scaled-up services are comprehensive in addressing HIV and RH needs. A full range of services should be offered that responds to the needs of men, women, couples, and youth throughout their lives, and includes sensitivity to the client’s right to privacy and to the risk of gender-based violence.
• Involve youth in designing and expanding youth-friendly services, which helps ensure that their needs for affordable, confidential, convenient, and nonjudgmental services are met.

Programme Level

Policymakers and programme managers should:

• Elicit stakeholder support: involving relevant HIV and FP stakeholders, including PLHA, women, and youth, allows their experience to inform the ways that integrated services are provided, and including clients and service providers in the planning stage ensures that their needs can be addressed.
• Understand which strategies are feasible and responsive through a needs assessment to identify what services to integrate and what are the multiple potential entry points for HIV and FP care. The Rapid Assessment Tool for Sexual and Reproductive Health and HIV Linkages provides a useful approach for assessing policies, systems, and services.
• Foster high-quality services through in-service training and supportive supervision. Ongoing training and supportive supervision of front-line staff are critical to help staff meet the challenge of a changing client load and increased responsibilities per client.
• Secure continuous supply of RH and HIV commodities, including drugs, contraceptives, and other commodities for HIV testing and treatment. Understanding the existing supply chain will indicate where changes or improvements are needed.

The briefing concludes that careful implementation of FP and HIV services ensures greater and broader success and will attract new and underserved FP and HIV clients, avert deaths and disease, improve health and well-being, and strengthen health systems.

Population Reference Bureau website on October 28 2009.