Abstract:
This report provides a review of the current
literature on integration of HIV-related
services with other areas of service delivery
that have important synergies with HIV
services. The review indicates that while
there remain concerns about integration, such
as degradation of the quality of services,
insufficient health system capacity, and
financial implications, the balance of the
literature finds that clinical, service
delivery, cost-effectiveness, and rights-
based benefits accrue from integration. This
report also presents a descriptive analysis
that uses national health facility survey
data from the
MEASURE DHS project‘s Service Provision
Assessment (SPA) surveys to establish an
HIV/FP service integration baseline in five
countries in sub-Saharan Africa that have
been hard-hit by the HIV epidemic: Kenya,
Namibia, Rwanda, Tanzania, and Uganda. We
highlight areas where integration can be
strengthened in line with international
recommendations and national policies, and
provide recommendations for strengthening
health facility survey data collection
approaches to ensure optimal monitoring of
HIV/FP service delivery integration in the
future. Using data from the SPA‘s health
worker interviews, facility inventories, and
client-provider observations, we describe
baseline levels of HIV- and FP-related
service integration. This report documents
considerable disparities between the
availability of elements of integrated HIV/FP
services, and the actual delivery by a health
care provider of ANC or STI services that are
fully integrated—where both HIV- and FP-
related elements are actually incorporated
into the visit.. This report also provides
recommendations for adjustments to health
facility survey questionnaires that would
allow for more complete measurement of HIV/FP
service delivery integration.