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 ...
BANGLADESHCAMBODIANEPALPHILIPPINESA mechanism for better coordinationand linkage between the two divisionsmanaging SRH and HIV programmeswithin the MoHFW should be initiatedthrough formal and informal platformsfor joint planning, financing, monitoringand reporting systems. At the sametime the training curriculum shouldconsider training service providers howto deliver integrated SRH and HIVservices.Major Gaps andChallengesLinked SRHR and HIV programmescan play an important role in effortsto achieve universal access to HIVprevention, treatment, care and supportand universal access to reproductivehealth. SRHR and HIV linkagesand interventions through policy andprogramming in all settings ensurethe achievement of the goals of theprogramme. Access to integrated serviceswill benefit the sector most vulnerableto HIV and sexual and reproductive illhealthlike sex workers, drug users, menwho have sex with men, adolescent girlsand boys, discordant couples, people inconcurrent partnerships, migrants andthose living in conflict situations. Somecritical issues have been raised fromthis study. An agenda for collaborationand synergy both at the policy, systemand service delivery levels needs tobe articulated. This requires specificrecommendations to address thegaps and challenges to foster betterlinkage to improve the effectiveness ofa linked HIV and SRH response inBangladesh.a. HIV/AIDSorganisationalpolicies, practices andorganisational culture• The institutional and organisationalarrangements of the nationalresponse have not been adequatelyplaced and sufficiently empoweredto facilitate more comprehensiveaction on HIV/AIDS and SRH.• HIV/AIDS issues go beyond thedomain of the health sector but arestill largely considered a problemto be dealt with mostly through thehealth sector in Bangladesh.Limited articulation and awarenessabout national policy on HIV/AIDS among government sectors.b. CoordinationLack of coordination and networkingamong NGOs involved in HIV/AIDS and SRH due to lack of apartnership framework, and capacityconstraints of the STI/AIDSnetwork.There is no clearly defined mechanismfor effective coordination amongdonor agencies working in the fieldof HIV/AIDS and SRH, resultingin duplication and overlap of someinterventions and initiatives.Lack of smooth coordinationbetween players has been a majorhindrance in providing services.Within the government, multipleministries need to be engaged toensure the active involvement of keyservices such as law enforcement; thishas not been carried out effectively.28
In addition, not all services canbe provided through the HIVprevention programmes or SRHservices separately.Inadequate resources (personnel,funding, infrastructure) for theNASP, which is the governmentbody responsible for coordinatingthe national response to HIV inBangladesh, has prevented themfrom playing a more proactiverole in effective planning andcoordination at the national level.This inadequacy has translated intointerruptions in service delivery atthe field level as well as inadequate,inappropriate and irregular suppliesof materials (condoms, lubricants,sterile injection equipment, and STIdrugs).c. Programme PlanningGoB and NGOs identified highriskpopulation groups as keypriority and emphasised targetedinterventions for HIV/AIDS. Butthere is no baseline data to set targetsto accelerate coverage.Lack of an integrated communitybased programme model thatwill enhance social mobilisationand behaviour change, as well asempowerment of the community.Planning for sustained HIVprevention programmes is essentialfor an effective response. In order todo this, not only is it important tohave knowledge and understandingof the local situation, but there alsoneeds to be capacity to developa strategic plan based on thatknowledge.d. Implementation• Quality of the interventions variesconsiderably due to lack of initiativesfor strengthening and upgrading theskills of the implementing agencies.• Lack of a comprehensive packageapproach. All programmes aresingle minded approaches to HIVprevention, leading to partial deliveryof a fully responsive preventionpackage. For example, implementersoverlook multiple risks that MARPsmay be facing. For IDUs, the stressis on safe injections, safe sex is oftenignored and condom distribution ispoor. For sex workers, drug use is notaddressed and neither is mobility.• The policies and strategies, manuals,medical standards/SOPs, guidelinesthat are developed are the mainobstructions for linkage andimplementation because they havea narrow focus and the aims aredifferent.e. Scaling upFunding of HIV/AIDS and SRHis mostly project oriented ratherthan programme related. There isno comprehensive projection and noresource mobilisation plan for scaleupof responses.Evidence shows that when the HIVprevention programmes were smallerthey were more effective. Scaling uphas possibly led to a dilution of theeffect of services in many cities; ithas also resulted in lower coveragethan in previous years.Scaling up has often been done using29
- Page 2 and 3: Published by:International Council
- Page 5 and 6: Table ofContentChapter Titles Pages
- Page 7 and 8: INTRODUCTIONThe 2009 AIDS Epidemic
- Page 9 and 10: REVIEW OF LINKAGES BETWEEN SEXUAL A
- Page 11 and 12: ROUNDTABLE MEETING ON LINKAGES BETW
- Page 13 and 14: Mr Roberto M Ador, Executive Direct
- Page 15 and 16: Session 3: Health Systems Strengthe
- Page 17 and 18: Model for Public-Private Partnershi
- Page 19 and 20: CONCLUSIONSuccessful linkages betwe
- Page 21 and 22: INSTITUTIONALCAPACITY FORHIV/AIDS A
- Page 23 and 24: AbstractBackground: There are a num
- Page 25 and 26: the highest export earnings. The pr
- Page 27 and 28: grass-roots based service deliveryi
- Page 29 and 30: However, condom use was low amongho
- Page 31 and 32: 2and Save the Children, USA, and is
- Page 33 and 34: Many important national guidelines,
- Page 35 and 36: voluntarily, among project particip
- Page 37 and 38: ut all sources have consistently sp
- Page 39 and 40: USA) and the World Bank ledconsorti
- Page 41 and 42: the Prevention of Parent to ChildTr
- Page 43 and 44: access to services for their consti
- Page 45 and 46: for planned prevention, treatment a
- Page 47: e accomplished if there is supporta
- Page 51 and 52: daily lives and take priority overH
- Page 53 and 54: Promote the social acceptability of
- Page 55 and 56: References20 years of HIV in Bangla
- Page 57 and 58: 337
- 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
- Page 69 and 70: universal access to HIV prevention,
- 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
- Page 77 and 78: care, and VCCT and ANC;Family plann
- Page 79 and 80: Strategy for RSH in Cambodia 2006 -
- Page 81 and 82: Logistics management proceduresfor
- Page 83 and 84: ReferencesStrategic Plan for HIV/AI
- Page 85 and 86: INSTITUTIONALCAPACITY FORHIV/AIDS A
- Page 87 and 88: ABSTRACTBackgroundThere are a numbe
- Page 89 and 90: planning products from DHOs/DPHOs.A
- Page 91 and 92: priority. A large part of the preve
- Page 93 and 94: the major breakthrough in linking t
- Page 95 and 96: guidelines especially those related
- Page 97 and 98: Court responded to the petition byi
BANGLADESHCAMBODIANEPALPHILIPPINESA mechanism for better coordin<strong>at</strong>ion<strong>and</strong> linkage between the two divisionsmanaging <strong>SRH</strong> <strong>and</strong> <strong>HIV</strong> programmeswithin the MoHFW should be initi<strong>at</strong>edthrough formal <strong>and</strong> informal pl<strong>at</strong>formsfor joint planning, financing, monitoring<strong>and</strong> reporting systems. At the sametime the training curriculum shouldconsider training service providers howto deliver integr<strong>at</strong>ed <strong>SRH</strong> <strong>and</strong> <strong>HIV</strong>services.Major Gaps <strong>and</strong>ChallengesLinked <strong>SRH</strong>R <strong>and</strong> <strong>HIV</strong> programmescan play an important role in effortsto achieve universal access to <strong>HIV</strong>prevention, tre<strong>at</strong>ment, care <strong>and</strong> support<strong>and</strong> universal access to reproductivehealth. <strong>SRH</strong>R <strong>and</strong> <strong>HIV</strong> linkages<strong>and</strong> interventions through policy <strong>and</strong>programming in all settings ensurethe achievement of the goals of theprogramme. Access to integr<strong>at</strong>ed serviceswill benefit the sector most vulnerableto <strong>HIV</strong> <strong>and</strong> sexual <strong>and</strong> reproductive illhealthlike sex workers, drug users, menwho have sex with men, adolescent girls<strong>and</strong> boys, discordant couples, people inconcurrent partnerships, migrants <strong>and</strong>those living in conflict situ<strong>at</strong>ions. Somecritical issues have been raised fromthis study. An agenda for collabor<strong>at</strong>ion<strong>and</strong> synergy both <strong>at</strong> the policy, system<strong>and</strong> service delivery levels needs tobe articul<strong>at</strong>ed. This requires specificrecommend<strong>at</strong>ions to address thegaps <strong>and</strong> challenges to foster betterlinkage to improve the effectiveness ofa linked <strong>HIV</strong> <strong>and</strong> <strong>SRH</strong> response inBangladesh.a. <strong>HIV</strong>/<strong>AIDS</strong>organis<strong>at</strong>ionalpolicies, practices <strong>and</strong>organis<strong>at</strong>ional culture• The institutional <strong>and</strong> organis<strong>at</strong>ionalarrangements of the n<strong>at</strong>ionalresponse have not been adequ<strong>at</strong>elyplaced <strong>and</strong> sufficiently empoweredto facilit<strong>at</strong>e more comprehensiveaction on <strong>HIV</strong>/<strong>AIDS</strong> <strong>and</strong> <strong>SRH</strong>.• <strong>HIV</strong>/<strong>AIDS</strong> issues go beyond thedomain of the health sector but arestill largely considered a problemto be dealt with mostly through thehealth sector in Bangladesh.Limited articul<strong>at</strong>ion <strong>and</strong> awarenessabout n<strong>at</strong>ional policy on <strong>HIV</strong>/<strong>AIDS</strong> among government sectors.b. Coordin<strong>at</strong>ionLack of coordin<strong>at</strong>ion <strong>and</strong> networkingamong NGOs involved in <strong>HIV</strong>/<strong>AIDS</strong> <strong>and</strong> <strong>SRH</strong> due to lack of apartnership framework, <strong>and</strong> capacityconstraints of the STI/<strong>AIDS</strong>network.There is no clearly defined mechanismfor effective coordin<strong>at</strong>ion amongdonor agencies working in the fieldof <strong>HIV</strong>/<strong>AIDS</strong> <strong>and</strong> <strong>SRH</strong>, resultingin duplic<strong>at</strong>ion <strong>and</strong> overlap of someinterventions <strong>and</strong> initi<strong>at</strong>ives.Lack of smooth coordin<strong>at</strong>ionbetween players has been a majorhindrance in providing services.Within the government, multipleministries need to be engaged toensure the active involvement of keyservices such as law enforcement; thishas not been carried out effectively.28
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