SRH and HIV/AIDS Linkages at Policies, Programmes and Service ...
SRH and HIV/AIDS Linkages at Policies, Programmes and Service ... SRH and HIV/AIDS Linkages at Policies, Programmes and Service ...
BANGLADESHCAMBODIANEPALPHILIPPINESprovision of condoms. It also providestreatment for OI. It follows STIclients and uses VCT, FP and STIguidelines for the provision of services.It has an official collaboration withNAP+N. While FPAN counselorsreported no constraints for integratingservices, cost of the service (facility)and increased work load however wereagain mentioned as constraints.There is linkage in the provision ofservices. For example, HIV servicesare linked in SRH services (throughthe FPAN) and SRH services in HIVservices. There is a link with PLHIVand support groups. However, thereis an overall lack of capacity buildingand staff training to address attitudes.There are available guidelines ondifferent topics but these have not beenintegrated. The major constraints citedshortage of space for offering privateand confidential services and low staffmotivation. While the cost of servicesand facilities has decreased, work loadhas increased.VI. DISCUSSION ANDCONCLUSIONSuccessful linkages between RHand HIV/AIDS programmes andservices can only be achieved if theyare supported by commitment atpolicy level, the development ofappropriate institutional mechanisms,and through structured coordinationand collaboration, rather than throughattempts to simply expand and linkvertical programmes. Linked responseshould be institutionalised in all policiesrelated to RH, HIV/AIDS, gender andyoung people.Despite the growing realisation amongstakeholders, the need for policy andsystems linking to address SRHR,HIV and AIDS, particularly in thecontext of the commitment to universalaccess to prevention, treatment, careand support, efforts to systematicallylink SRH and HIV remains limited.This is partly because of the lack ofguidance from the MoHP in promotingsynergistic approaches between SRHand HIV. More significantly, existingpolicies, and institutional and financialmanagement are the barriers to linkingHIV and SRH programmes.UN agencies must continue to play akey role in the provision of technicalsupport and leadership, such as theUNAIDS Intensifying HIV Preventionstrategy which urges for strong linkageswith SRH.Support to sector-wide managementprocesses represents a major opportunityfor developing a comprehensive healthsector response to HIV and AIDS, tomeet universal access commitments.Currently, funds received for HIV andAIDS activities are mainly ‘off budget’and inflexible.HIV and AIDS and SRH strategyprocesses are still mainly managedand implemented separately. Thisreduces opportunities for developingcomprehensive linking approaches atprogramme and service delivery levels.National level SRH and HIV/AIDSresponse is separately administered,funded, and supported by differentdonors and technical agencies.The largest fund received for HIV86
is from GFATM. It sets targetsand deliverables, with fundingdisbursements linked to performance.Indicators tend to be linked to coverageand output, rather than to impactmeasurements. These create strongincentives to deliver quick wins throughvertical approaches that result in rapidcoverage increases, but not necessarilylonger term impact. Delivering wellfinanced vertical programmes that areeasier to manage, and which can achieveresults, encourages demands from manystakeholders at all levels, but leads tothe increasing separation of HIV andSRH programmes.The main constraints to effectiveimplementation of health plans arefrequent changes in the government,limited national resources for healthservices development, centralisedadministration, ineffective managementand supervision, difficult geographicconditions and slow economic growth(WHO, 2004)In addition, there is scarce resourcein terms of study. Documentation onthe cost-effectiveness and relevanceof integration and linkage of servicesfor a low prevalence and concentratedepidemic country like Nepal, is limited.In order to move forward and engagethe stakeholders for short and longterm commitment, these issues need tobe further explored.Looking into the future, entry pointfor the way forward could be themobilisation of UN agencies to beginpolicy dialogue and advocacy forinclusion of linkage issues in the HIVpolicy and strategy which are in theprocess of revision.Mechanisms for better coordinationand linkage between the two divisionsmanaging SRH and HIV and AIDSprogrammes within the MoHP shouldbe initiated through formal andinformal platforms for joint planning,financing, monitoring and reportingsystems.Training for service providers on howto deliver integrated SRH and HIVservices should be considered in preserviceand in-service training curriculaA national level standardised packagefor integration of SRH and HIVservices should be developed for thedifferent cadres of health serviceproviders, to inform them of their rolesin the process of providing integratedservices, and in managing referrals.It is encouraging to note that HIVrelated topics are mentioned in SRHprotocols and medical standards forfamily planning such as maternal andnewborn care, SBA policy and trainingguidelines.Based on the assessment throughdocument review, and in-depthinterview, the Nepal case study hasattempted to highlight some importantcritical issues.These issues should serve to articulatean agenda for collaboration andsynergy both at the policy, system andservice delivery levels, with specificrecommendations to address thegaps and challenges, to improve theeffectiveness of a linked HIV and SRHresponse in Nepal.87
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BANGLADESHCAMBODIANEPALPHILIPPINESprovision of condoms. It also providestre<strong>at</strong>ment for OI. It follows STIclients <strong>and</strong> uses VCT, FP <strong>and</strong> STIguidelines for the provision of services.It has an official collabor<strong>at</strong>ion withNAP+N. While FPAN counselorsreported no constraints for integr<strong>at</strong>ingservices, cost of the service (facility)<strong>and</strong> increased work load however wereagain mentioned as constraints.There is linkage in the provision ofservices. For example, <strong>HIV</strong> servicesare linked in <strong>SRH</strong> services (throughthe FPAN) <strong>and</strong> <strong>SRH</strong> services in <strong>HIV</strong>services. There is a link with PL<strong>HIV</strong><strong>and</strong> support groups. However, thereis an overall lack of capacity building<strong>and</strong> staff training to address <strong>at</strong>titudes.There are available guidelines ondifferent topics but these have not beenintegr<strong>at</strong>ed. The major constraints citedshortage of space for offering priv<strong>at</strong>e<strong>and</strong> confidential services <strong>and</strong> low staffmotiv<strong>at</strong>ion. While the cost of services<strong>and</strong> facilities has decreased, work loadhas increased.VI. DISCUSSION ANDCONCLUSIONSuccessful linkages between RH<strong>and</strong> <strong>HIV</strong>/<strong>AIDS</strong> programmes <strong>and</strong>services can only be achieved if theyare supported by commitment <strong>at</strong>policy level, the development ofappropri<strong>at</strong>e institutional mechanisms,<strong>and</strong> through structured coordin<strong>at</strong>ion<strong>and</strong> collabor<strong>at</strong>ion, r<strong>at</strong>her than through<strong>at</strong>tempts to simply exp<strong>and</strong> <strong>and</strong> linkvertical programmes. Linked responseshould be institutionalised in all policiesrel<strong>at</strong>ed to RH, <strong>HIV</strong>/<strong>AIDS</strong>, gender <strong>and</strong>young people.Despite the growing realis<strong>at</strong>ion amongstakeholders, the need for policy <strong>and</strong>systems linking to address <strong>SRH</strong>R,<strong>HIV</strong> <strong>and</strong> <strong>AIDS</strong>, particularly in thecontext of the commitment to universalaccess to prevention, tre<strong>at</strong>ment, care<strong>and</strong> support, efforts to system<strong>at</strong>icallylink <strong>SRH</strong> <strong>and</strong> <strong>HIV</strong> remains limited.This is partly because of the lack ofguidance from the MoHP in promotingsynergistic approaches between <strong>SRH</strong><strong>and</strong> <strong>HIV</strong>. More significantly, existingpolicies, <strong>and</strong> institutional <strong>and</strong> financialmanagement are the barriers to linking<strong>HIV</strong> <strong>and</strong> <strong>SRH</strong> programmes.UN agencies must continue to play akey role in the provision of technicalsupport <strong>and</strong> leadership, such as theUN<strong>AIDS</strong> Intensifying <strong>HIV</strong> Preventionstr<strong>at</strong>egy which urges for strong linkageswith <strong>SRH</strong>.Support to sector-wide managementprocesses represents a major opportunityfor developing a comprehensive healthsector response to <strong>HIV</strong> <strong>and</strong> <strong>AIDS</strong>, tomeet universal access commitments.Currently, funds received for <strong>HIV</strong> <strong>and</strong><strong>AIDS</strong> activities are mainly ‘off budget’<strong>and</strong> inflexible.<strong>HIV</strong> <strong>and</strong> <strong>AIDS</strong> <strong>and</strong> <strong>SRH</strong> str<strong>at</strong>egyprocesses are still mainly managed<strong>and</strong> implemented separ<strong>at</strong>ely. Thisreduces opportunities for developingcomprehensive linking approaches <strong>at</strong>programme <strong>and</strong> service delivery levels.N<strong>at</strong>ional level <strong>SRH</strong> <strong>and</strong> <strong>HIV</strong>/<strong>AIDS</strong>response is separ<strong>at</strong>ely administered,funded, <strong>and</strong> supported by differentdonors <strong>and</strong> technical agencies.The largest fund received for <strong>HIV</strong>86
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