THE Namibia Planned Parenthood Association (NAPPA) has over the last couple of years been in the forefront of advocating for the integration of reproductive health and HIV/AIDS services.
But the most astounding question that arose has been the understanding of these concepts within the general public and most probably practitioners in the field. This article intends to clarify and help the public and the would-be users of reproductive health (RH) and HIV services to best conceptualise why integration of services is essential.
The explanations I share in this article were published in a document jointly produced by a consortium of partners working to popularise the integration concept (notably the International Planned Parenthood Federation, International HIV/AIDS Alliance, Friends Africa, Interact Worldwide, Global Aids Alliance and the Population Action International) globally.
RH/HIV integration is a proven practice in public health. With the current reduced funding for HIV/AIDS in Namibia, it can be argued that integration of services is inevitable, as the country strives to provide the best with minimum donor resources available for health programmes.
The integration concept as explicitly defined by the above consortium, refers to different types of reproductive health and HIV services or programmes that are joined together to increase and improve their results and impact.
This strategy within the context of (mainly high) HIV prevalence involves a wide range of practical services and support located in one place and/or through a system of referrals. In this manner, benefits to the service user are enormous, as this entails accessing all services under one roof. Henceforth, RH/HIV integration is a proven strategy that makes programmatic and economic sense for individuals, organisations, and health systems alike. It can serve as a pillar of effective action on HIV and RH in our country, cognisant of the epidemic context. As such, the integration is vital for accelerating progress on both Millennium Development Goals (MDG) 5 and 6, which are very essential not only for NAPPA, but other players as well, in the delivery of reproductive health and HIV services.
These targets are explicit, for example:
MDG 5: Improve maternal health
Target 1: Reduce by three-quarters the maternal mortality ratio.
Target 2: Achieve, by 2015, universal access to reproductive health.
MDG 6: Combat HIV/AIDS, Malaria, and other diseases
Target 1: Have halted by 2015 and begun to reverse the spread of HIV/AIDS.
Target 2: Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it. It has been observed in pilot countries that the alignment of RH/HIV integration services to the above MDGs resulted in greater benefits, in that it increases uptake of both sexual and reproductive health and HIV services; improves access to RH and HIV services, especially for women, youth, people living with HIV, and marginalized groups; reduces HIV-related stigma; provides greater support for dual protection from pregnancy and STIs/HIV; links HIV with maternal and infant health; reduces duplication of effort and enhances programme effectiveness and efficiency, makes best use of scarce human resources and it also reduces competition for funding.
RH/HIV integration is particularly important for women (who account for some 60 percent of HIV infections in sub-Saharan Africa) and young people (who account for 40 percent of new HIV infections worldwide). For millions of women and youth, RH services are the primary entry point into the health system. Integrating HIV into RH settings increases their access to a range of HIV information and services, reducing the stigma often associated with stand-alone (vertical) HIV services.
This process provides for privacy to service users by ensuring confidentiality when accessing these services. Integrating RH into HIV services is principally vital not only for people living with HIV, but marginalised groups as well, such as for example, sex workers, injection drug users, and men who have sex with men (MSM). HIV programmes for these communities are often well-established and user-friendly, protecting them from revealing their HIV or social status in mainstream RH services, while giving them 'tailor made' reproductive health support. Our services are geared towards integration and we hope to solicit more support to accelerate the replication of such services to other facilities.
• Sam Ntelamo is the NAPPA Country Director