BANGLADESHCAMBODIANEPALPHILIPPINESBackgroundThe <strong>HIV</strong> epidemic became a keyreproductive <strong>and</strong> sexual health issuebecause the majority of <strong>HIV</strong> infectionsare sexually transmitted, or associ<strong>at</strong>edwith pregnancy, <strong>and</strong> breastfeeding.According to the HSS report only1.1 per cent among pregnant women<strong>at</strong>tended ANC clincs. This indic<strong>at</strong>edth<strong>at</strong> the <strong>HIV</strong>/<strong>AIDS</strong> epidemic isbecoming generalised <strong>and</strong> familyplanning, safe motherhood, <strong>and</strong>primary <strong>HIV</strong> prevention services inhealth centres are more critical for acomprehensive response between healthservices. According to the CDHS, only12.3 per cent of married women haveever been tested for <strong>HIV</strong>, with veryfew women being tested in the courseof ANC (12 per cent in 2005). Therisk of transmission from mother tochild remains high. Among womenwho tested <strong>HIV</strong> positive in the 2005CDHS, 2.2 per cent were pregnant<strong>at</strong> the time, <strong>and</strong> 35.9 per cent were inthe less than 24 months post-partumgroup. These figures recognise th<strong>at</strong>linkages between reproductive health<strong>and</strong> <strong>HIV</strong> are crucial to comprehensivemanagement <strong>and</strong> care for p<strong>at</strong>ients whoneed concomitant care for rel<strong>at</strong>ed healthconditions.The NCHADS is responsible for thehealth sector response to <strong>HIV</strong>/<strong>AIDS</strong><strong>and</strong> sexually transmitted infection(STI) care <strong>and</strong> tre<strong>at</strong>ment, implemented<strong>at</strong> the oper<strong>at</strong>ional district level througha continuum of care package <strong>and</strong>STI control. Voluntary confidentialcounselling <strong>and</strong> testing (VCCT)<strong>and</strong> <strong>HIV</strong> testing among pregnantwomen are entry points for PMTCTservices <strong>and</strong> inp<strong>at</strong>ient <strong>and</strong> outp<strong>at</strong>ientcare for <strong>HIV</strong>/<strong>AIDS</strong>, together withopportunistic infections (OI) <strong>and</strong> antiretroviraltherapy (ART) services. Thecontinuum of care package also offerslinked services between health services<strong>and</strong> communities (HBC, Mondol MithChouy Mith (MMM), PLHASG)<strong>and</strong> <strong>HIV</strong> prevention with STI clinics.The CNMCHC is responsible forother reproductive health services,including ANC c , PMTCT, safedelivery, m<strong>at</strong>ernal <strong>and</strong> newborn health(MNBH), family planning (FP), <strong>and</strong>postpartum care.The current health system in Cambodiaprovides access to <strong>HIV</strong>/<strong>AIDS</strong>, OI/ART, STI, ANC, FP <strong>and</strong> MNBH.However, these closely rel<strong>at</strong>ed servicesare often not available <strong>at</strong> the same healthfacility, <strong>and</strong> some oper<strong>at</strong>ional districtsdo not offer the full package of services.As a result, the linkages betweenrel<strong>at</strong>ed health services are weak, aswell as those between health services<strong>and</strong> the community care services. Also,the linkage between <strong>SRH</strong> <strong>and</strong> <strong>HIV</strong> islimited <strong>and</strong> not directly linked to eachother. The linked response approachincluding PMTCT <strong>and</strong> other <strong>SRH</strong>programmes (ANC, FP, MNBH)hasbeen established <strong>and</strong> implemented bytwo n<strong>at</strong>ional programs (NCHADS<strong>and</strong> NMCHC) to strengthen thecurrent health system, to improve thelinkages between health facilities <strong>and</strong>community health services.This paper aims to assess the linkages<strong>and</strong> integr<strong>at</strong>ion of <strong>SRH</strong> <strong>and</strong> <strong>HIV</strong>services <strong>at</strong> the health facility <strong>and</strong>community services by an integr<strong>at</strong>edpolicy <strong>and</strong> str<strong>at</strong>egy, planning <strong>and</strong>46
management system, <strong>and</strong> health servicedelivery. This assessment also aimsto ensure th<strong>at</strong> health care services<strong>at</strong> all levels provide comprehensivereproductive health <strong>and</strong> <strong>HIV</strong>/<strong>AIDS</strong>prevention, care, <strong>and</strong> tre<strong>at</strong>ment, <strong>and</strong>find the gaps <strong>and</strong> needs in order toimprove, strengthen <strong>and</strong> scale-up theintegr<strong>at</strong>ed <strong>HIV</strong> <strong>and</strong> <strong>SRH</strong> services.ObjectivesThe purpose of this paper is to assesspolicies <strong>and</strong> str<strong>at</strong>egies, planning <strong>and</strong>management, <strong>and</strong> health servicedelivery rel<strong>at</strong>ed to <strong>SRH</strong> <strong>and</strong> <strong>HIV</strong>, <strong>and</strong>to find the gaps <strong>and</strong> needs for <strong>SRH</strong> <strong>and</strong><strong>HIV</strong> programmes.Method <strong>and</strong> ProcedureReview of policies, str<strong>at</strong>egic plans,guidelines <strong>and</strong> st<strong>and</strong>ard oper<strong>at</strong>ingprocedures (SoPs) rel<strong>at</strong>ed to <strong>HIV</strong><strong>and</strong> <strong>SRH</strong> collected from n<strong>at</strong>ionalinstitutions <strong>and</strong> non-governmentalorganis<strong>at</strong>ions (NGOs) involved in<strong>HIV</strong> <strong>and</strong> <strong>SRH</strong> programmes.Key informant interviews for inputon <strong>SRH</strong> <strong>and</strong> <strong>HIV</strong>Keys FindingsPOLICY AND STRATEGY1. N<strong>at</strong>ional <strong>HIV</strong> Str<strong>at</strong>egy <strong>and</strong>PolicyThe str<strong>at</strong>egic plan for <strong>HIV</strong>/<strong>AIDS</strong>prevention <strong>and</strong> care programme wasdeveloped since the first detection of<strong>HIV</strong> in Cambodia in 1991. This wasthen revised every two or three yearsaccording to the needs <strong>and</strong> trends of the<strong>HIV</strong> epidemic.Since 1998 the NCHADS, underthe Ministry of Health (MOH), hasbeen coordin<strong>at</strong>ing <strong>and</strong> collabor<strong>at</strong>ingto develop a policy <strong>and</strong> str<strong>at</strong>egic planfor the implement<strong>at</strong>ion of an <strong>HIV</strong>/<strong>AIDS</strong> <strong>and</strong> STI prevention <strong>and</strong> careprogramme in the health sector asfollows:The N<strong>at</strong>ional Str<strong>at</strong>egic Plan for<strong>HIV</strong>/<strong>AIDS</strong> <strong>and</strong> STI Prevention <strong>and</strong>Care 1998 – 2000, was developedby the MOH, <strong>and</strong> identified 12str<strong>at</strong>egic areas in which activitieswere to be undertaken.Early in 2000, as a result ofanalysis of the epidemiological <strong>and</strong>behavioral d<strong>at</strong>a from the HSS <strong>and</strong>Behavioural Surveillance Surveys(BSS), NCHADS undertook areview of the N<strong>at</strong>ional <strong>HIV</strong> <strong>and</strong>STI Str<strong>at</strong>egic Plan. This led to thehealth sector Str<strong>at</strong>egic Plan for<strong>HIV</strong>/<strong>AIDS</strong> <strong>and</strong> STD Prevention<strong>and</strong> Care, 2001-2005. Underthis Str<strong>at</strong>egic Plan, NCHADSdeveloped a series of specificpolicies, str<strong>at</strong>egies <strong>and</strong> guidelinessuch as <strong>HIV</strong> counselling <strong>and</strong> testingfor surveillance, for <strong>AIDS</strong> care, foroutreach, for STD case management,<strong>and</strong> guidelines for the introduction<strong>and</strong> implement<strong>at</strong>ion of variousprogrammes <strong>and</strong> interventions (e.g.100 per cent condom use, homebasedcare, counselling <strong>and</strong> testing,STD services).In 2003, NCHADS undertook amid-term assessment of its str<strong>at</strong>egicplan, with technical assistancefrom the US Center for DiseaseControl (US-CDC) the WorldHealth Organis<strong>at</strong>ion (WHO), the47
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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
- 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,
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- 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 and 48: e accomplished if there is supporta
- Page 49 and 50: In addition, not all services canbe
- 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
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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
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- Page 71 and 72: In order to support the linked resp
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- Page 81 and 82: Logistics management proceduresfor
- 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 99 and 100: 34building on the technical strengt
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- Page 103 and 104: in hill and mountain districts. Fre
- Page 105 and 106: uilding for home-based care through
- Page 107 and 108: is from GFATM. It sets targetsand d
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- Page 111 and 112: IX. REFERENCES1. Adolescent Health
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BANGLADESHCAMBODIANEPALBackgroundTh
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