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

ABSTRACTBackgroundThere are a number of health policies andstrategies, guidelines for reproductive health(RH) and HIV/AIDS programmes in Nepal.They are the National Health Policy (1991),National AIDS Policy (1995), Second LongTerm Health Plan (1997-2017). NHSP-IP I(2004-2009), National HIV/AIDS Strategy(2006-2011), Three Year Interim Plan (2008-2010) and NHSP-IP II (2011-2015). TheMinistry of Health and Population (MoHP)includes sexual reproductive health (SRH)and HIV as a priority one programme.While the Family Health Division (FHD)under the Department of Health Services(DoHS) manages delivery of RH servicesthough primary health care delivery systemsthroughout the country, HIV programmesare managed by the National Center for AIDSand STD Control (NCASC) in selectedinstitutions predominantly for preventionof mother to child transmission of HIV(PMTCT), voluntary counselling and testing(VCT) and antiretroviral treatment (ART).The focus of the National HIV/AIDSStrategy is for the most-at-risk populationstargeted by the national response to HIVand AIDS and includes: injecting drug users(IDUs), female sex workers (FSW), men whohave sex with men (MSM), migrant workers,and sexual partners/spouses of the migrantpopulation groups. The GFATM, USAID,DfID, World Bank and INGOs are the majordonors supporting the implementation ofSRH and HIV programmes in Nepal, bothtechnically and financially.MethodsAll information for this assessment wascollected through standard questionnairesdeveloped for the bidirectional linkage(rapid assessment tool). The following healthfacilities were visited for interview with serviceproviders to ascertain the linkage between RHand HIV services (FPAN, Pulchowk, SACT,Kathmandu, Maternity Hospital, Thapathali,Kathmandu and Infectious Disease Hospital,Teku).ResultsThe findings of this study demonstrate thatthere is no systematic approach to linkingSRH and HIV at policy and system levels;there is no specific strategy for a health systemresponse to HIV and AIDS through its linkwith other SRH services. While the majorityof funding for RH services is provided by andmanaged through the government budget,the majority of HIV funding is administeredby External Development Partners (EDP),including Global Fund Principle Recipients.The HIV programmes in Nepal have beendesigned in a way that encourages rapidresponse towards most-at-risk-populationsthrough civil societies and networks of peopleliving with HIV and/or AIDS (PLHIV),and expansion of the programme, but notthrough the government health system. Thereis no national policy guidance for integrationof SRH and HIV/ AIDS services. Theresponse of the MoHP lacks clear guidelinesin relation to linkage of SRH and HIVservices. The donors have neither pushednor put any restrictions on linking SRH andHIV because of their mandate, territorialinterests and different funding mechanisms.A rights-based approach to SRH and HIVprogramming has not been fully endorsed bypolicy in Nepal, despite the commitments toseveral international declarations includingthose taken at the International Conferenceon Population and Development (ICPD), theMillennium Development Goals (MDGs)and the United Nations General AssemblySpecial Session on HIV/AIDS (UNGASS).The government of Nepal (GoN) in theInterim Constitution of Nepal has endorsedhealth as a basic human right. HIV andAIDS issues have been incorporated intodifferent medical standards and protocolsand training manuals on RH. But the HIVand AIDS strategies have not outlined howHIV services will be integrated with otherRH services. The Country CoordinatingMechanism (CCM) managing the GlobalFund grants has been weak in facilitatingpolicy dialogue and consensus for integrationof SRH and HIV services. Most of therespondents of the assessment were of theopinion that the current policy and programmeimplementation will not be successful inaddressing linkages between SRH and HIVunless there is strong leadership roles playedby the donor community.ConclusionMany of these gaps and challenges should beaddressed at the policy level by multilateraland bilateral donors, national and localgovernments, and community-based groupslooking for linkages between SRH and HIV.67