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 ...
BANGLADESHCAMBODIANEPALPHILIPPINESBACKGROUNDA. Sexual andReproductive HealthProgrammes in NepalBased on the National Health Policy(1991), the MoHP developed a 20-year Second Long-Term Health Plan(SLTHP) for 1997-2017. The SLTHPvision is a healthcare system withequitable access and quality services inboth rural and urban areas. The aimsof the plan are to guide health sectordevelopment in the improvement of thehealth of the population, particularlythose with unmet health needs,addressing disparities in healthcare,assuring gender sensitivity andequitable community access to qualityhealthcare services. The SLTHPintends to provide a guiding frameworkto build successive periodic and annualhealth plans that improve the healthstatus of the population; to developappropriate strategies, programmes,and action plans that reflect nationalhealth priorities that are affordableand consistent with available resources;and to establish co-ordination amongpublic, private and non-governmentalorganisation sectors, and developmentpartners. SRH is a focus programme inthe SLHTP.The Nepal Health Sector Programme-Implementation Plan (NHSP-IP)2004-2009 and 2010-2015, and theThree Year Interim Plan includes SRHas a priority programme under theEssential Healthcare Services (EHCS)package. The commitment of the GoNin strengthening the integrated healthprogramme to provide comprehensiveand integrated SRH services wasreflected through the development ofthe National Reproductive HealthPolicy (NRHP) in 1998, based on therecommendations from ICPD 1994.This policy included guiding directionsfor implementation of programmesfor eight health components, namely,safe motherhood, sexually transmittedinfections (STIs), family planning(FP), HIV and AIDS, RH of theelderly, adolescent reproductive health(ARH), infertility and post-abortioncare services. Based on the differentpolicy guidelines, protocols andstrategies, action plans were developedfor implementation through the formalhealth system.SRH services are available through allgovernment health facilities in Nepal,while HIV services are availablethrough selected health institutionsof the country. SRH forms part ofthe government health service deliverysystem managed by the FHD under theDoHS, delivered through the districthealth office/district public healthoffice (DHO/DPHO) from districthospitals, primary health care centres(PHCC), health posts (HP) and subhealthposts (SHP). Logistics for allhealth institutions in a district aremanaged by the Logistics ManagementDivision of the DoHS in coordinationwith the FHD and the DHO/DPHO.Some NGOs like the Family PlanningAssociation of Nepal (FPAN), NepalRed Cross Society (NRCS) andSunaulo Pariwar Nepal/Marie StopesInternational (SPN/MSI) also provideRH services in the districts throughtheir own clinics, managing theirlogistics but reporting to the DHO/DPHO. The FPAN receives family68
planning products from DHOs/DPHOs.Although the National RH strategyincludes eight components, onlythe safe motherhood and the familyplanning components have a nationalcoverage. Scaling up of adolescentsexual reproductive health (ASRH)programmes, despite the NationalAdolescent Health and Developmentstrategy (2002) and implementationguideline (2008), have still a long wayto go in Nepal. The other componentsof RH are either available throughselected health institutions or throughthe private sector only.The current statistics of key RHindicators produced from the NepalDemographic and Health Survey 2006are presented in the table below:B. HIV and AIDSProgrammes in NepalThe first case of HIV in Nepalwas reported in 1988. In 2009, theestimated number of people living withHIV in Nepal was about 64,000 (rangeof 52,000–77,000); the estimated adultHIV prevalence was 0.39 per cent,(NCASC 2010b).As of June 2010, atotal of 15,945 HIV cases and 2,403cases of AIDS have been reported(NCASC 2010a). About 31 per cent ofreported HIV cases were women aged15-49 years.Nepal has concentrated HIV epidemics,with levels of the epidemic varyingacross different geographic areas as wellas different population groups. Thecountry has been broadly divided intofour different geographic zones withinthe context of responding to HIV andAIDS. The 26 districts of the Teraihighway zone accounted for 50 per centof PLHIV in 2007.169
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BANGLADESHCAMBODIANEPALPHILIPPINESBACKGROUNDA. Sexual <strong>and</strong>Reproductive Health<strong>Programmes</strong> in NepalBased on the N<strong>at</strong>ional Health Policy(1991), the MoHP developed a 20-year Second Long-Term Health Plan(SLTHP) for 1997-2017. The SLTHPvision is a healthcare system withequitable access <strong>and</strong> quality services inboth rural <strong>and</strong> urban areas. The aimsof the plan are to guide health sectordevelopment in the improvement of thehealth of the popul<strong>at</strong>ion, particularlythose with unmet health needs,addressing disparities in healthcare,assuring gender sensitivity <strong>and</strong>equitable community access to qualityhealthcare services. The SLTHPintends to provide a guiding frameworkto build successive periodic <strong>and</strong> annualhealth plans th<strong>at</strong> improve the healthst<strong>at</strong>us of the popul<strong>at</strong>ion; to developappropri<strong>at</strong>e str<strong>at</strong>egies, programmes,<strong>and</strong> action plans th<strong>at</strong> reflect n<strong>at</strong>ionalhealth priorities th<strong>at</strong> are affordable<strong>and</strong> consistent with available resources;<strong>and</strong> to establish co-ordin<strong>at</strong>ion amongpublic, priv<strong>at</strong>e <strong>and</strong> non-governmentalorganis<strong>at</strong>ion sectors, <strong>and</strong> developmentpartners. <strong>SRH</strong> is a focus programme inthe SLHTP.The Nepal Health Sector Programme-Implement<strong>at</strong>ion Plan (NHSP-IP)2004-2009 <strong>and</strong> 2010-2015, <strong>and</strong> theThree Year Interim Plan includes <strong>SRH</strong>as a priority programme under theEssential Healthcare <strong>Service</strong>s (EHCS)package. The commitment of the GoNin strengthening the integr<strong>at</strong>ed healthprogramme to provide comprehensive<strong>and</strong> integr<strong>at</strong>ed <strong>SRH</strong> services wasreflected through the development ofthe N<strong>at</strong>ional Reproductive HealthPolicy (NRHP) in 1998, based on therecommend<strong>at</strong>ions from ICPD 1994.This policy included guiding directionsfor implement<strong>at</strong>ion of programmesfor eight health components, namely,safe motherhood, sexually transmittedinfections (STIs), family planning(FP), <strong>HIV</strong> <strong>and</strong> <strong>AIDS</strong>, RH of theelderly, adolescent reproductive health(ARH), infertility <strong>and</strong> post-abortioncare services. Based on the differentpolicy guidelines, protocols <strong>and</strong>str<strong>at</strong>egies, action plans were developedfor implement<strong>at</strong>ion through the formalhealth system.<strong>SRH</strong> services are available through allgovernment health facilities in Nepal,while <strong>HIV</strong> services are availablethrough selected health institutionsof the country. <strong>SRH</strong> forms part ofthe government health service deliverysystem managed by the FHD under theDoHS, delivered through the districthealth office/district public healthoffice (DHO/DPHO) from districthospitals, primary health care centres(PHCC), health posts (HP) <strong>and</strong> subhealthposts (SHP). Logistics for allhealth institutions in a district aremanaged by the Logistics ManagementDivision of the DoHS in coordin<strong>at</strong>ionwith the FHD <strong>and</strong> the DHO/DPHO.Some NGOs like the Family PlanningAssoci<strong>at</strong>ion of Nepal (FPAN), NepalRed Cross Society (NRCS) <strong>and</strong>Sunaulo Pariwar Nepal/Marie StopesIntern<strong>at</strong>ional (SPN/MSI) also provideRH services in the districts throughtheir own clinics, managing theirlogistics but reporting to the DHO/DPHO. The FPAN receives family68
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