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ABSTRACTBackgroundThere are a number of health policies <strong>and</strong>str<strong>at</strong>egies, guidelines for reproductive health(RH) <strong>and</strong> <strong>HIV</strong>/<strong>AIDS</strong> programmes in Nepal.They are the N<strong>at</strong>ional Health Policy (1991),N<strong>at</strong>ional <strong>AIDS</strong> Policy (1995), Second LongTerm Health Plan (1997-2017). NHSP-IP I(2004-2009), N<strong>at</strong>ional <strong>HIV</strong>/<strong>AIDS</strong> Str<strong>at</strong>egy(2006-2011), Three Year Interim Plan (2008-2010) <strong>and</strong> NHSP-IP II (2011-2015). TheMinistry of Health <strong>and</strong> Popul<strong>at</strong>ion (MoHP)includes sexual reproductive health (<strong>SRH</strong>)<strong>and</strong> <strong>HIV</strong> as a priority one programme.While the Family Health Division (FHD)under the Department of Health <strong>Service</strong>s(DoHS) manages delivery of RH servicesthough primary health care delivery systemsthroughout the country, <strong>HIV</strong> programmesare managed by the N<strong>at</strong>ional Center for <strong>AIDS</strong><strong>and</strong> STD Control (NCASC) in selectedinstitutions predominantly for preventionof mother to child transmission of <strong>HIV</strong>(PMTCT), voluntary counselling <strong>and</strong> testing(VCT) <strong>and</strong> antiretroviral tre<strong>at</strong>ment (ART).The focus of the N<strong>at</strong>ional <strong>HIV</strong>/<strong>AIDS</strong>Str<strong>at</strong>egy is for the most-<strong>at</strong>-risk popul<strong>at</strong>ionstargeted by the n<strong>at</strong>ional response to <strong>HIV</strong><strong>and</strong> <strong>AIDS</strong> <strong>and</strong> includes: injecting drug users(IDUs), female sex workers (FSW), men whohave sex with men (MSM), migrant workers,<strong>and</strong> sexual partners/spouses of the migrantpopul<strong>at</strong>ion groups. The GFATM, USAID,DfID, World Bank <strong>and</strong> INGOs are the majordonors supporting the implement<strong>at</strong>ion of<strong>SRH</strong> <strong>and</strong> <strong>HIV</strong> programmes in Nepal, bothtechnically <strong>and</strong> financially.MethodsAll inform<strong>at</strong>ion for this assessment wascollected through st<strong>and</strong>ard questionnairesdeveloped for the bidirectional linkage(rapid assessment tool). The following healthfacilities were visited for interview with serviceproviders to ascertain the linkage between RH<strong>and</strong> <strong>HIV</strong> services (FPAN, Pulchowk, SACT,K<strong>at</strong>hm<strong>and</strong>u, M<strong>at</strong>ernity Hospital, Thap<strong>at</strong>hali,K<strong>at</strong>hm<strong>and</strong>u <strong>and</strong> Infectious Disease Hospital,Teku).ResultsThe findings of this study demonstr<strong>at</strong>e th<strong>at</strong>there is no system<strong>at</strong>ic approach to linking<strong>SRH</strong> <strong>and</strong> <strong>HIV</strong> <strong>at</strong> policy <strong>and</strong> system levels;there is no specific str<strong>at</strong>egy for a health systemresponse to <strong>HIV</strong> <strong>and</strong> <strong>AIDS</strong> through its linkwith other <strong>SRH</strong> services. While the majorityof funding for RH services is provided by <strong>and</strong>managed through the government budget,the majority of <strong>HIV</strong> funding is administeredby External Development Partners (EDP),including Global Fund Principle Recipients.The <strong>HIV</strong> programmes in Nepal have beendesigned in a way th<strong>at</strong> encourages rapidresponse towards most-<strong>at</strong>-risk-popul<strong>at</strong>ionsthrough civil societies <strong>and</strong> networks of peopleliving with <strong>HIV</strong> <strong>and</strong>/or <strong>AIDS</strong> (PL<strong>HIV</strong>),<strong>and</strong> expansion of the programme, but notthrough the government health system. Thereis no n<strong>at</strong>ional policy guidance for integr<strong>at</strong>ionof <strong>SRH</strong> <strong>and</strong> <strong>HIV</strong>/ <strong>AIDS</strong> services. Theresponse of the MoHP lacks clear guidelinesin rel<strong>at</strong>ion to linkage of <strong>SRH</strong> <strong>and</strong> <strong>HIV</strong>services. The donors have neither pushednor put any restrictions on linking <strong>SRH</strong> <strong>and</strong><strong>HIV</strong> because of their m<strong>and</strong><strong>at</strong>e, territorialinterests <strong>and</strong> different funding mechanisms.A rights-based approach to <strong>SRH</strong> <strong>and</strong> <strong>HIV</strong>programming has not been fully endorsed bypolicy in Nepal, despite the commitments toseveral intern<strong>at</strong>ional declar<strong>at</strong>ions includingthose taken <strong>at</strong> the Intern<strong>at</strong>ional Conferenceon Popul<strong>at</strong>ion <strong>and</strong> Development (ICPD), theMillennium Development Goals (MDGs)<strong>and</strong> the United N<strong>at</strong>ions General AssemblySpecial Session on <strong>HIV</strong>/<strong>AIDS</strong> (UNGASS).The government of Nepal (GoN) in theInterim Constitution of Nepal has endorsedhealth as a basic human right. <strong>HIV</strong> <strong>and</strong><strong>AIDS</strong> issues have been incorpor<strong>at</strong>ed intodifferent medical st<strong>and</strong>ards <strong>and</strong> protocols<strong>and</strong> training manuals on RH. But the <strong>HIV</strong><strong>and</strong> <strong>AIDS</strong> str<strong>at</strong>egies have not outlined how<strong>HIV</strong> services will be integr<strong>at</strong>ed with otherRH services. The Country Coordin<strong>at</strong>ingMechanism (CCM) managing the GlobalFund grants has been weak in facilit<strong>at</strong>ingpolicy dialogue <strong>and</strong> consensus for integr<strong>at</strong>ionof <strong>SRH</strong> <strong>and</strong> <strong>HIV</strong> services. Most of therespondents of the assessment were of theopinion th<strong>at</strong> the current policy <strong>and</strong> programmeimplement<strong>at</strong>ion will not be successful inaddressing linkages between <strong>SRH</strong> <strong>and</strong> <strong>HIV</strong>unless there is strong leadership roles playedby the donor community.ConclusionMany of these gaps <strong>and</strong> challenges should beaddressed <strong>at</strong> the policy level by multil<strong>at</strong>eral<strong>and</strong> bil<strong>at</strong>eral donors, n<strong>at</strong>ional <strong>and</strong> localgovernments, <strong>and</strong> community-based groupslooking for linkages between <strong>SRH</strong> <strong>and</strong> <strong>HIV</strong>.67
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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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- Page 47 and 48: e accomplished if there is supporta
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- Page 55 and 56: References20 years of HIV in Bangla
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- 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 83 and 84: ReferencesStrategic Plan for HIV/AI
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