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 ...
BANGLADESHCAMBODIANEPALPHILIPPINESAlthough separate funding sourcesfor SRH and HIV programmes areavailable, there is no estimation ofproportion of budget allocated to eachprogramme. According to GF Round9 HIV grant, 23 per cent of the totalbudget was allocated to implementationof a linked response approach includingrunning cost for maternal and childcare and PMTCT, HIV and SRHcare, and treatment within HIVrelatedprevention, care and treatment.The budget allocated to support mainactivities within health facilities andcommunity based services did notinclude the budget for STI and ARVdrugs, and HIV testing.SYSTEM SUPPORT FOREFFECTIVE LINKAGE OFSRH AND HIVThe linked response approach is ajoint planning framework betweenHIV and PMTCT, ANC, FP, andother reproductive and sexual healthprogrammes that focus on prevention,care, and treatment related to HIV/AIDS and sexual reproductive healthissues. The linked response approachprovides comprehensive care for patientsthrough linkages between health facilityand community based services. Thejoint planning and strategies for theimplementation of a linked responseapproach are:Strengthening referralsbetween HIV/AIDS, OI/ARV, STI,ANC, family planning, safe abortion,adolescent health, and maternal andnewborn health;Providing a core package for ANC- all pregnant women are encouragedto seek antenatal and maternity care,and receive referrals to family planningcounselingProviding VCCT and counselingto educate all clients (adult andadolescent males and females,) aboutHIV and STI, PMTCT and theavailability of health care services;referrals to HIV testing, PMTCT, FPand other health care services.STI services provided as a corepackage. In order to support linkedresponse, all clients and their respectivepartners should be encouraged toreceive HIV testing.Family planning as a core package,to support linked response. Theeducation of women on birth spacing,prevention of HIV and STIs, andPMTCT services.Maternal and newborn healthservices provided as a core package - allclients, particularly pregnant women,should be encouraged to receive HIVtesting, (or their blood samples shouldbe sent for HIV-testing).OI/ART should be provided as a corepackage - HIV-positive clients referredfor TB screening, and HIV-positivewomen referred to family planning andANC/PMTCT if pregnant.No clear procedures are evident for jointplanning of SRH and HIV programmesto be undertaken. What is available isindication of the availability of SRHand HIV information and educationdocumentation. These are: STI andHIV information in the guide onreproductive and sexual health amongadolescents, contained in the National58
Strategy for RSH in Cambodia 2006 -2010.Basic information and educationon HIV/AIDS and STI integratedinto the training curriculum fortraditional birth attendants, andtraining modules on family planningin the community.Limited joint SRH and HIVprogrammes undertaken throughCoC, PMTCT and HIV programmeimplementation on linked responseapproach.There is limited representation fromHIV programmes involved in the SRHplanning process. In some cases, theHIV programme representative wasinvited to participate in joint strategyand curriculum developments.Likewise, there is also limitedrepresentation from SRH programmesinvolved in the HIV planningprocess. Similar to the planningprocess mentioned above, the SRHprogramme representative was invitedto collaborate on a joint STI strategyand policy development, and for STI/RTI training sessions.Collaboration between SRH andHIV for programme management andimplementation exists through variouscoordination bodies including technicalworking groups and committees suchas the continuum of care committeeand PMTCT technical working group.SRH and HIV programmes havebeen improved to provide a linkagebetween facility services (HIV, SRH,ANC, FP and PMTCT) through theimplementation of the linked responseapproach.There is some evidence to suggest thatSRH services have been integrated intoHIV services, and of HIV servicesbeing integrated into SRH services. Theimplementation of the linked responseapproach is to expand to all operationaldistricts, to improve linkages betweenHIV services and SRH services.HIV counselling and testing has beenintegrated into antenatal care andmaternal and child care services. Also,the guide for implementing positiveprevention allows the integration ofbirth spacing services into HIV careand treatment services.Capacity BuildingOverall, SRH services includingANC and FP services are integratedinto health centres which are run bygovernment health institutions. Withthese services, it provides clients withcounselling on HIV, STI informationand education, and access to HIVtesting.The joint statement betweenNCHADS and NMCHC focuses onimproving PMTCT services, includingSRH, ANC, and FP, through theimplementation of the linked responseapproach in operational districts. Thepublic STI clinics established in healthcentres is the primary service entityproviding STI/RTI care and treatmentbased on a syndromic approach andintegrated with reproductive health,birth spacing/family planning andmaternal/new born healthIf the provision of integrated servicesfor HIV and SRH becomes embedded59
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BANGLADESHCAMBODIANEPALPHILIPPINESAlthough separ<strong>at</strong>e funding sourcesfor <strong>SRH</strong> <strong>and</strong> <strong>HIV</strong> programmes areavailable, there is no estim<strong>at</strong>ion ofproportion of budget alloc<strong>at</strong>ed to eachprogramme. According to GF Round9 <strong>HIV</strong> grant, 23 per cent of the totalbudget was alloc<strong>at</strong>ed to implement<strong>at</strong>ionof a linked response approach includingrunning cost for m<strong>at</strong>ernal <strong>and</strong> childcare <strong>and</strong> PMTCT, <strong>HIV</strong> <strong>and</strong> <strong>SRH</strong>care, <strong>and</strong> tre<strong>at</strong>ment within <strong>HIV</strong>rel<strong>at</strong>edprevention, care <strong>and</strong> tre<strong>at</strong>ment.The budget alloc<strong>at</strong>ed to support mainactivities within health facilities <strong>and</strong>community based services did notinclude the budget for STI <strong>and</strong> ARVdrugs, <strong>and</strong> <strong>HIV</strong> testing.SYSTEM SUPPORT FOREFFECTIVE LINKAGE OF<strong>SRH</strong> AND <strong>HIV</strong>The linked response approach is ajoint planning framework between<strong>HIV</strong> <strong>and</strong> PMTCT, ANC, FP, <strong>and</strong>other reproductive <strong>and</strong> sexual healthprogrammes th<strong>at</strong> focus on prevention,care, <strong>and</strong> tre<strong>at</strong>ment rel<strong>at</strong>ed to <strong>HIV</strong>/<strong>AIDS</strong> <strong>and</strong> sexual reproductive healthissues. The linked response approachprovides comprehensive care for p<strong>at</strong>ientsthrough linkages between health facility<strong>and</strong> community based services. Thejoint planning <strong>and</strong> str<strong>at</strong>egies for theimplement<strong>at</strong>ion of a linked responseapproach are:Strengthening referralsbetween <strong>HIV</strong>/<strong>AIDS</strong>, OI/ARV, STI,ANC, family planning, safe abortion,adolescent health, <strong>and</strong> m<strong>at</strong>ernal <strong>and</strong>newborn health;Providing a core package for ANC- all pregnant women are encouragedto seek anten<strong>at</strong>al <strong>and</strong> m<strong>at</strong>ernity care,<strong>and</strong> receive referrals to family planningcounselingProviding VCCT <strong>and</strong> counselingto educ<strong>at</strong>e all clients (adult <strong>and</strong>adolescent males <strong>and</strong> females,) about<strong>HIV</strong> <strong>and</strong> STI, PMTCT <strong>and</strong> theavailability of health care services;referrals to <strong>HIV</strong> testing, PMTCT, FP<strong>and</strong> other health care services.STI services provided as a corepackage. In order to support linkedresponse, all clients <strong>and</strong> their respectivepartners should be encouraged toreceive <strong>HIV</strong> testing.Family planning as a core package,to support linked response. Theeduc<strong>at</strong>ion of women on birth spacing,prevention of <strong>HIV</strong> <strong>and</strong> STIs, <strong>and</strong>PMTCT services.M<strong>at</strong>ernal <strong>and</strong> newborn healthservices provided as a core package - allclients, particularly pregnant women,should be encouraged to receive <strong>HIV</strong>testing, (or their blood samples shouldbe sent for <strong>HIV</strong>-testing).OI/ART should be provided as a corepackage - <strong>HIV</strong>-positive clients referredfor TB screening, <strong>and</strong> <strong>HIV</strong>-positivewomen referred to family planning <strong>and</strong>ANC/PMTCT if pregnant.No clear procedures are evident for jointplanning of <strong>SRH</strong> <strong>and</strong> <strong>HIV</strong> programmesto be undertaken. Wh<strong>at</strong> is available isindic<strong>at</strong>ion of the availability of <strong>SRH</strong><strong>and</strong> <strong>HIV</strong> inform<strong>at</strong>ion <strong>and</strong> educ<strong>at</strong>iondocument<strong>at</strong>ion. These are: STI <strong>and</strong><strong>HIV</strong> inform<strong>at</strong>ion in the guide onreproductive <strong>and</strong> sexual health amongadolescents, contained in the N<strong>at</strong>ional58
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