Improving service provision:

experiences from an SRHR organisation in Swaziland

Zelda NhlabatsiExecutive Director,

Family Life Association Swaziland

Kathryn ChurchLondon School of Hygiene & Tropical

Medicine

Family Life Association of Swaziland (FLAS)

Established in 1979 NGO indigenous to

Swaziland Member of International

Planned Parenthood Federation (IPPF)

Focal areas Delivery of Integrated

sexual & reproductive health services (incl. HIV)

Youth-friendly services for 10-24 year olds

Targeted stigma-free services for key pops

Advocacy Demand creation

The Family Life Association Experience

Model 3HIV Counselling and Testing, STI and ART

Youth Family Planning Services

Key interventions Introduction of ART

Infrastructural development/adjustments Human resource Trainings of service providers

Partnership development & strengthening Housing and financial administration of local

research (London School & Population Council) Introduction of VIA (routine offer for all

WLHIV) Strengthening of youth activities

Youth centre equipment Sport activities

What changed at FLAS as a result1.New SRH and HIV services added to service list

1. Implants added to FP list2.VIA (for cervical cancer), dry blood spot and CD4 count and TB

screening added to the screening test list 3.HIV treatment, care and support added (ART initiation,

adherence counselling, treatment and management of OIs etc)2.Strengthened capacity of MA to provide quality integrated

services: 1.Trainings, mentoring and continuous medical sessions (CMEs) 2. Infrastructural improvements

3.Outreach and demand generation activities (e.g. particularly among young people)

4.Strengthened partnerships for implementation1. ICAP Swaziland2. Mothers2mothers3. Swaziland Action Group Against Abuse4. Faith based organisations; Population Services International

Increase in number of clients reached

2008 2009 2010 2011 20120

10000

20000

30000

40000

50000

60000Number of clients reached

Adults (>25)Youth (<25)

Num

ber

of c

lient

s

Increasing service uptake by males Integration seemed to have a positive effect

on the number of male clients accessing services. HIV services

Innovativeness

Sustainability of interventions after Integra?

Capacity building and policy changes has enabled FLAS to continue service provision at same level E.g. ART Initiation

Capacity building of partners at outreach and referral sites

Resource mobilisation Factory workers: financing by employers Donor support for youth activities

Cross-sectional study design to evaluate 4 models of care (N=611)

Mixed methods: Exit survey of HIV clients (n=611)

(male & female) In-depth interviews with

clients (n=22) and providers (n=16)

Manzini

Clinic A Clinic B Clinic DClinic C

Most integrated Most “stand-alone”

Swaziland Stigma Study - Design & methods

“[the nurses] announced that those who were there to get pills needed to go to Room 3...that was really bad because everyone was just sitting in the waiting room, and nobody was paying attention to what others were there for…then all of a sudden we have to get up because we’re the ones that have been called. People didn’t need to know…”[Female, partially integrated site, HIV treatment client, Swaziland]

Data from client interviews

Stigma and Integrated Care

Findings from Swaziland indicate that all types of clinic can reduce stigma through: Sensitive room labelling Naming of clinic Ensuring client HIV records are unidentifiable Dispensing ART drugs either in private or

without easy identification Separating waiting areas of VCT and ART

clients at HIV-only clinics

Key take home messages from Swaziland Integration allows for a comprehensive

package of care (widens scope) Recognition of linkages with other non-clinical

issues (social behaviour change communication; supportive legislation)

SRH and HIV programs can address socio-legal and cultural issues e.g. Stigma; gender inequality etc.

Partnerships are key Maximise resources Comparative advantage and referrals

Working with government is key for sustainability National agenda

Key Take home messages from Swaziland

Integration of services does not automatically lead to a reduction in stigma.

All health facilities can reduce HIV-related stigma through a series of practical measures.

Continuous Training & capacity building of staff is essential

HIV integration (usually well funded) can strengthen SRH programs and systems.

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