www.aids2010.org

The Global Context of Sexual and Reproductive Health & HIV: Making seamless programmes and services a reality for PLHIV

Breaking down the operational and logistical barriers

Lynn Collins (UNFPA) and Kevin Osborne (IPPF)

www.aids2010.org

“Integration is not itself an end but a means to achieve…”

• Universal access goals

• Health outcomes

• Human rights

• Programme effectiveness/efficiency

• Link between community and health interventions

• Elimination of stigma and discriminationSlide from UNAIDS PCB Thematic Session on SRH HIV Linkages 21 June 2010

3www.aids2010.org

Funding for Wider Health Initiatives

The U.S. Government’s Global Health Initiative

“We will not be successful in our efforts to end deaths from AIDS, malaria, and tuberculosis unless we do more to improve health

systems around the world, focus our efforts on child and maternal health, and ensure that best practices drive the funding for these

programs.”—President Obama, May 5, 2009

Linkages Funding Opportunities GHI

www.aids2010.org www.globalhealth.gov/initiatives/05192010b.ppt

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 d. Reduce the risks and vulnerabilities that increase women’s and girls’ susceptibility to infection by the three diseases, and mitigate the impact for those already infected (Including, gender-based violence, female genital mutilation, early or forced marriage, lack of access to education, wife inheritance, increased risk due to pregnancy, discrimination in employment, etc.)

f. Include programs that empower women and girls so they can protect themselves, by having access to sexual and reproductive health care (SRH), access to female controlled prevention measures (female condom, negotiating condom-use etc.), and access to education. In this context the Global Fund will champion activities that strengthenSRH-HIV/AIDS service integration.

www.aids2010.org

Linkages Funding Opportunities GF

http://www.theglobalfund.org/documents/strategy/TheGenderEqualityStrategy_en.pdf

• Funding has driven by artificial separation of SRH & HIV• ‘Shift in the balance of power’ - country

ownership for contextual solutions vs. restrictive/conditionality of donors

• Objective is a comprehensive responsive to clients

• Importance of global voices, especially around human rights, e.g. engagement principles

“What we need most is integration of donors!”

www.aids2010.orgSlide based on UNAIDS PCB Thematic Session on SRH HIV Linkages 21 June 2010

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• Allows continuity of care without being externally referred•Expands range of clinical services beyond ARVs•Reduces frequency/costs of appointments•Reduces HIV related stigma and discrimination•Provides increased coverage for key populations•Promotes an increased culture of rights

Linkages benefits for People Living with HIV

www.aids2010.org

Rapid Assessment Tool for SRH and HIV Linkages

Assesses HIV and SRH bi-directional linkages - policy, systems, and service-delivery

Identifies current critical gaps Contributes to the development of

country-specific action plans to strengthen linkages.

Focuses primarily on health sector

www.aids2010.org

Stand-alone activity or part of larger review Includes desk reviews & individual/group interviews Ensure at a minimum the assessment team includes:

national government SRH and HIV units networks of people living with HIV key populations civil society UN organizations donors

Estimated timeframe: 3 months Appendix 3. Budget for Estimating Cost: USD 30 – 50K Appendix 5. Next Steps for Utilization of Findings

Implementation - Rapid Assessment Tool

www.aids2010.org

Rapid Assessment Tool

Africa•         Benin •         Botswana •         Burkina Faso•         Cote D'Ivoire •         Malawi •         Swaziland •         Tanzania •         Uganda 

Latin America and Caribbean•         Belize 

Eastern Europe and Central Asia•         Kyrgyzstan •         Russian Federation  Arab States•         Lebanon •         Morocco •         Tunisia 

Asia and Pacific•         Pakistan •         Viet Nam 

Roll-out conducted in 16 countries in 5 regions

www.aids2010.org

Available languages:Arabic, English, French, Russian and Spanish 

• Insufficient attention to the full scope of linkages issues (legislative, socio-economic, cultural)

• Weak links btn natl’ AIDS & SRH strategies& plans

• Vertical programming

based on separate funding streams

• Poor linkages btn health and other sectors education, gender, economic

• No linkages strategy & implementation plan

• Absence linkages

in national

dev./health

strategieswww.aids2010.org

Linkages Barriers - Policy

• Conditionality in funding

• Laws and policies on rights requiring reform (e.g. age of consent for services; human rights, gender equality, age at marriage, gender-based violence, discrimination, treatment access, criminalisation, etc.)

• Lack of awareness of rights to health and non-discrimination

• Multiple obstacles to SRH and HIV service access for PLHIV and key populations

• Low level of male engagement in SRH and HIV

• Avoidance of sensitive issues

www.aids2010.org

Linkages Barriers – Policy cont.

• Weak coordination mechanisms

• Underutilized joint capacity building

• Absence of shared monitoring and evaluation systems

• Weak health systems

• Inadequate links with community

• Insufficient integration of PMTCT into SRH, including family planning

• Weak capacity and inadequate engagement of PLHIV, key populations, etc.

• Lack of

commodities & equipment

www.aids2010.org

Linkages Barriers - Systems

• Inadequate human resources/support

• Stigma and discrimination toward people living with HIV and key populations, by and toward health providers

• Overburdening of health providers

• Attrition of health providers

• Lack of capacity to cope with increased numbers of clients

• Weak capacity building for multi-tasking and task-shifting (need for new knowledge, skills, and non-judgemental attitudes)

www.aids2010.org

Linkages Barriers - Services

www.aids2010.org

Moving the rights agenda along•Recognize service integration is not a panacea •Go beyond the health sector•Support research to address key gaps (e.g. linkages in low/concentrated epidemics, etc.)•Keep stigma and discrimination high on the agenda•Support legal & policy reform, remove punitive laws•Direct funding & better engage community/civil society to achieve universal access