SRH and HIV/AIDS Linkages at Policies, Programmes and Service ...

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BANGLADESHCAMBODIANEPALPHILIPPINESVII. ISSUES ANDCHALLENGESIn the context of a rights-basedapproach to health programming,Nepal’s challenge is compounded byproblems of low coverage of overallhealth services, geographic diversityrestricting access to healthcare, widespread poverty, and ramifications ofthe decade long conflict. These requirediscussions between governmentagencies and EDPs, to clarify howNepal is going to move forward interms of approaching the rights-basedsystem of health care delivery.There is a need for greater coordinationbetween SRH and HIV during the policyand strategy formulation processes.Such coordination is necessary to betterleverage on the strengths of both fieldsin service provision, in these times ofweakened health systems and verticalprogrammes. Many of the efforts tolink the two fields have been curtaileddue to lack of interest from both SRHand AIDS organisations. Territorialinterests of stakeholders and lack ofpolicy guidance from MoHP have beenthe major barriers to better linkage.While women and adolescents have beenthe focus, provision of comprehensivesexual health services for these groupshave had limited coverage. There havebeen and continues to be a lack of sexualhealth services for men. In fact, men’ssexual health has been largely ignored.Men and women are influenced by sexualconstructs and gender norms particularto their own social contexts, leavingmen vulnerable to risky behavior andinfection with HIV or other STIs. Yetmen, unlike married women, have littleor no access to reproductive and sexualhealth services. While programmes areincreasingly including adolescent boysand girls, mainstreaming of programmesby AIDS and SRH organisations hasbeen slow to address the sexual healthneeds of adult men.Bi-directionality, both the SRH and theHIV communities addressing relevantaspects of each others’ agendas hasbeen one of the hallmarks of linkages.Therefore, it is expected that linkedresponses could favourably impact onboth SRH and HIV outcomes. Suchresponses include but are not limitedto: rights-based family planningin the context of mother-to-childtransmission of HIV programmes,ending gender-based violence and childmarriage, providing HIV voluntarycounselling and testing within antenatalcare, promoting condoms for dualprotection within family planning andHIV programmes, and comprehensivesexual education for young people.However, HIV and SRH programmesstill remain largely vertical. Severalissues and challenges have contributedto this situation, including:Very little linkage between SRHand HIV services in Nepal at policyand system level except for HIVbeing included as part of the eightcomponents of RH in the NationalRH Strategy(1998) and inclusion ofHIV and AIDS as part of EssentialHealth Care Services in NHSP–IPsNo policy guidance for linkagebetween SRH and HIV fromMOHP.88
SRH and HIV programmes are runvertically with weak coordinationmechanisms and lack of jointplanning.Policies and strategies, protocols,medical standards/SOPs, guidelinesare developed at different pointsof time hindering linkage betweenthese two programmes.Although the interim constitutionof Nepal guarantees health as afundamental right, a rights- basedapproach to SRH and HIVprogrammes has not been fullyendorsed.Funding of SRH programmes is alsovertical depending on the mandate,territorial interest and fundingmechanisms.Functional linkage between SRHand HIV services has only occurredin service centres that offer bothSRH and HIV services, especiallySTI services, condom provision,PMTCT, VCT and ART.Poor facilitation and lack of policydialogue at CCM level for linkingSRH and HIV services.VIII. RECOMMENDATIONSAt Policy and System LevelPolicy makers and programmemanagers should be sensitised toadvocate for the benefits of a linkagebetween SRH and HIV services.Multilateral, bilateral and technicalagencies should provide support forkey linkages between RH and HIV/AIDS policies, programmes, andservices.Sexual and reproductive health andHIV/AIDS reside in two separateUnited Nations MillenniumDevelopment Goals (MDGs): #5Improve Maternal Health and #6Combat HIV/AIDS, Malaria andother Diseases, respectively. UnitedNations agencies should reinforcethe synergies between the two infuture decisions and guidance relatedto achieving the MDGs.Donors and decision makers need toensure their funding and guidanceare in accord with recommendationsfor strengthening key linkagesbetween family planning and HIV/AIDS, in current international andnational policy statements.Donors should harmonisereproductive health and HIV/AIDS funding, mobilise resources tosupport integrated efforts, encouragerecipients to develop programmesthat leverage this support, andrequire that recipients report onintegration-related indicators andtargets.Develop an advocacy strategy tomobilise support for linked servicesamong policymakers, programmemanagers, service providers, clients,PLHIV, and other key stakeholders.Revise national HIV policies toinclude family planning servicesfor healthy timing and spacingof pregnancies and prevention ofunintended pregnancies as partof the standard of care for HIV89
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Published by:International Council
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Table ofContentChapter Titles Pages
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INTRODUCTIONThe 2009 AIDS Epidemic
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REVIEW OF LINKAGES BETWEEN SEXUAL A
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ROUNDTABLE MEETING ON LINKAGES BETW
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Mr Roberto M Ador, Executive Direct
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Session 3: Health Systems Strengthe
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Model for Public-Private Partnershi
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CONCLUSIONSuccessful linkages betwe
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INSTITUTIONALCAPACITY FORHIV/AIDS A
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AbstractBackground: There are a num
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the highest export earnings. The pr
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grass-roots based service deliveryi
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However, condom use was low amongho
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2and Save the Children, USA, and is
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Many important national guidelines,
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voluntarily, among project particip
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ut all sources have consistently sp
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USA) and the World Bank ledconsorti
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the Prevention of Parent to ChildTr
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access to services for their consti
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for planned prevention, treatment a
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e accomplished if there is supporta
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In addition, not all services canbe
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daily lives and take priority overH
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Promote the social acceptability of
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References20 years of HIV in Bangla
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Page 59 and 60: Annex 6: Figure 2: National AIDS Mo
Page 61 and 62: INSTITUTIONALCAPACITY FORHIV/AIDS A
Page 63 and 64: AbstractBackgroundThe HIV epidemic
Page 65 and 66: NMCHCNRHPNSRSHNational Maternal Chi
Page 67 and 68: management system, and health servi
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Page 71 and 72: In order to support the linked resp
Page 73 and 74: ased violence, unplanned pregnancy/
Page 75 and 76: The essential services package forr
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Page 79 and 80: Strategy for RSH in Cambodia 2006 -
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Page 83 and 84: ReferencesStrategic Plan for HIV/AI
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Page 87 and 88: ABSTRACTBackgroundThere are a numbe
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Page 95 and 96: guidelines especially those related
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