Lessons from Kenya: Integrating Family

Planning and HIV/AIDS Services

an overview of this presentation

Why is the integration of family planning (FP) and HIV/AIDS services important and how does it relate to the right to health?

What models of service integration are currently being implemented in Kenya?

What are the successes, outcomes and lessons learned from clients and providers in Kenya?

What can you do to advocate for the integration of FP and HIV/AIDS services and halt the feminization of AIDS?

why should services be integrated?

“Women have been split into parts - eyes, ears, heart, breasts - by the health system. We must see women holistically.”

a critical rights-based interventionAvailable: more entry points for vulnerable/rural populations and more opportunities for outreach into communities.Accessible: decreased time spent, money required and distance covered to reach services; decreased stigma and discrimination associated with standalone HIV/AIDS services. Acceptable: multiple services through fewer providers can lead to stronger client/provider relationships. Provider training necessary for integration can also lead to greater gender and cultural sensitivity.Quality: increase quality of comprehensive care by offering services that would not otherwise be provided and the space for informed decision-making.

addressing the feminization of AIDSEffective prevention: Preventing unplanned pregnancies through FP contributes to the prevention of new HIV infections and PMTCT efforts. Provides opportunities for education: By increasing info given by providers, integration can increase awareness of prevention messages among women and communities. Provides services in one-stop shop: Multiple entry points to the health system promotes early detection of HIV and expands reach and uptake of HIV services. Strengthens health systems: Integration can ease strain on health systems by streamlining resources and maximizing effectiveness of health workforce. Decreases stigma: Women who receive VCT through FP can avoid the stigma of standalone HIV facilities.

Learn from the Kenyan experience – offer lessons learned to US policymakers and advocates.

framing of the case studies

models of implementation in kenya

Family planning into VCT (Family Health Int’l) Level 1: VCT providers conduct risk assessment for

pregnancy, STIs, and HIV; provide counseling and information on FP and STIs and HIV; and provide pills and condoms to the clients.

Level 2: Level 1 + provision of injectable contraceptives. Level 3: Levels 1 & 2 + provision of intrauterine

contraceptive devices (IUCDs). Level 4: Full range of family planning methods.

VCT into family planning (Population Council) Testing model: FP clients offered VCT by the FP provider. Referral model: FP clients educated about VCT and referred

to a VCT service (within same facility or another VCT service).

lessons from emma & her health center

“Women coming for family planning services are sexually active – they need to know their status.”

-Emma

a staircase – bringing them in step by step Access - Every client who

comes for FP is offered VCT and asked to bring in their family members.

Stigma – “when women realize they have someone to talk to, it helps.”

Community - “Clients who were tested go tell others – some come specifically for VCT.”

Counseling and testing for couples - integration promotes partner involvement.

one room, one provider, many servicesFran, a nurse in the antenatal care room: Fran provides VCT to antenatal mothers. Veronica, a nurse in the child health center: Veronica provides VCT to postnatal women (at 6

weeks). “There are 220 children seen per month, and each is accompanied by a mother. Every mother coming to the facility is offered VCT”.

anne’s story – healthy and free

Once someone gets tested, they can be “free to go on with life. Free as I am now.”

Loco is close by and gives Anne the services she needs in a timely manner – if there were no VCT, she would have to go elsewhere.

emma’s wish list for loco

Supportive supervision - experienced counselors can pass on their knowledge and support others.

Sponsorship for counseling training. Support of community initiatives.

Peer led support groups. Train community health workers.

Supplies – she sees an opportunity to screen for cervical cancer, but often facilities do not have the supplies/equipment.

Funding for integrated programs.

outreach in action – a day with MSK

a health dispensary – off the beaten path About 40 people

gathered in one room - mostly women, some with babies and children, and a few men.

VCT counselor began the group counseling - held up different FP methods and spoke about VCT and HIV.

get tested - know your status!

After group counseling, clients choose services they want - VCT is given in private room.

lessons from dr. moguche

“It is obvious. If I come here, I get FP and VCT – that is access – that is a package. This is the best way - package it, make it available and take it to the community because they will not come to you.”

zipping up factors – link to communities

Bringing the health model to the people who need it:

•Connect to community leaders•Deliver care in timely manner•Provide quality services•Establish trusted relationship with clients

alice’s story – health in a package deal Alice came to the dispensary because she knew

that MSK would be there and she needs to discuss family planning options – “if you can’t talk your problems, you can’t be helped.”

She and others also come for VCT – “we are learning while we are here.”

overcoming barriers – create the space

“Mothers who come to the health facility for family planning want to take advantage of the VCT because they overcame barriers to getting here.”

key findings on need for integration Provides multiple entry points for multiple health

services - increases access. Addresses unmet needs of women and improves

the quality of care they receive. Empowers health workers to give clients

information so that the client is empowered. “As a health worker, empower me to be able to

empower my client” Establishes trust and improves client-provider

relationship. Decreases stigma – open dialogue, more

information provided, less stigma and fear. Increases health seeking behavior – spreads

awareness of services

the work ahead for advocates

Awareness/information Counseling/Skills training Supportive supervision Monitoring/evaluation

indicators Community outreach

Commodity supply Strong health workforce Infrastructure/physical

space Funding allocation for

integration Advocacy!

problems with the new PEPFAR…

“I am particularly disappointed that the bill does not explicitly encourage the close integration of HIV programs with FP and other RH services … we should be doing everything we can to encourage referrals to important health services.”

-Congressman Waxman

The bill does not mention family planning, an essential component of universal access to HIV/AIDSprevention, care and treatment.

The Health Action AIDS campaign focuses its advocacy on three specific interventions to protect rights for women, prevent HIV transmission and improve women’s overall health:

• Building rights-based health systems,

• Ensuring comprehensive prevention programs,

• Educating and empowering health workers to provide

women-friendly services.

endorse health rights = healthy women

goodbye gag rule – more work ahead! Applaud the swift repeal of the Global Gag rule. Call for continued leadership to promote the

integration of reproductive health care and HIV/AIDS services.

Show that integration of reproductive health and HIV/AIDS services breaks down barriers to care by providing access to multiple services at multiple entry points.

Spark increased public discourse and awareness on abortion-related issues, including broader family planning and reproductive health services in developing countries.

take action now: ensure women’s rights

“…..make it a one stop shop that is comprehensive, empathetic, sensitive and answering to my needs so that you recognize the many roles that I have…the multiple jobs I have to do; clean, cook, farm, raise children, care for the elders...”

thank you…

“Gender inequality is driving the pandemic, and we will never subdue the gruesome force of AIDS until the rights of women become paramount in the struggle.”—Stephen Lewis