Repositioning Family Planning in West Africa:The role of FP Integration into HIV/AIDS Services

Pierre Ngom

Family Health International

Outline

• Opportunities and challenges for FP/HIV integration

• Current FP/HIV integration work by FHI

• The FHI approach to FP/HIV integration

• Key Achievements to date

• Is integration a priority in West Africa?

Opportunities for FP/HIV Integration Type of Service Concerns for HIV/AIDS

programming Concerns for RH/FP programming

Antenatal care services

Channel for information and services or referral to VCT, PMTCT, HBC

Antenatal care; FP information and counseling

Maternity services VCT and PMTCT services Delivery services; FP services or referral Postnatal care services

VCT, ARV information, service, or referral

Postnatal care, breastfeeding, neonatal care FP services – all methods

FP services FP needs of HIV+ and discordant couples; interactions between FP methods and HIV disease; ARV and TB therapy and hormonal methods

All FP; interactions of ARVs and anti-TB drugs with hormonal methods

Barrier methods Protection against HIV and sexually transmitted infections; promotion of dual protection

Contraception; promotion of dual protection

CBD services Demand creation for VCT, PMTCT, ARV therapy, HBC; referral

Demand creation for FP; provision of selected contraceptive methods

PMTCT services VCT; prophylaxis against MTCT Contraceptives to prevent future pregnancy VCT services All VCT services; risk reduction

counseling FP counseling, services, and referral Access to men, youth, and adolescents

ARV therapy services All services FP information, services, referral; access to men, youth, and adolescents

HBC services All services FP services for HIV-infected and -affected people

Challenges to FP/HIV Integration

• Train, motivate, and support multi-skilled workers

• Avoid overburdening staff at a time of severe shortage

• Mobilize resources to renovate or expand overcrowded health facilities

• Gain support of some program managers and service providers who are ambivalent toward integration

Current FP/HIV Integration Work by FHI

Ghana

Kenya

Tanzania

ZimbabweSouth Africa

Current FHI work on FP/HIV Integration

• FP into VCT

• FP into PMTCT

• RH as part of HBC

• RH needs of OVCs

• FP and ART

• Assessment of FP status in the era of HIV/AIDS

FP/HIV Integration: The FHI Approach

Baseline Assessment

Strategy development

Review of existing training manuals

Training

Country-wide rollout

Pilot scale-up

Operatio

ns Researc

h

Advocacy

Key Achievements to date(with funding from USAID/PEPFAR/REDSO)

• Kenya: FHI is now supporting the MoH to pilot the scale up of integrating FP into VCT at 50 facilities. Lessons learned will feed into the country-wide rollout of FP/VCT integration.

• South Africa: FHI is now integrating RH and HIV/AIDS services in 20 selected service delivery sites.

• Zimbabwe: FHI is supporting the national Integration Committee to identify opportunities for FP/HIV integration and devise implementation strategies

Where East meets West…

Eastern-Southern Africa• FP and HIV services must

address the twin risk of unwanted pregnancies and of contracting the HIV virus

– TFR relatively low– CPR relatively high– HIVPR relatively high

West Africa• FP and HIV services must

address the twin risk of unwanted pregnancies and of contracting the HIV virus

– TFR relatively high– CPR relatively low– HIVPR relatively low

Is integration as priority in West Africa?

Thank you