From the Ground Up: The Case of Integrating Family Planning and HIV/AIDS Services in Tanzania

Integrated Approaches, Local AnswersPresenter: Ms. Christine LaswaySunday, July 22, 2012

The Context, 2008

• Growing policy momentum• Growing evidence base• Remaining gaps and

research questions• Implementation Tools

• High-level policies supportive of integration

• Lack of awareness of benefits of integration at implementation level

• Vertical funding and implementation of FP and HIV/AIDS programs

• Fragmented delivery of integrated service delivery

Global Tanzania

The Process of Moving from the Ground

Awareness Acceptance Action

Evidence-based Collaborative & Coordinated

Impact @ Policy, Program, & Service Levels

Evidence-based Advocacy, 2007-2008Awareness

POLICY: Conducted a desk review of 10

national HIV and FP policies

Validated General Policy Support for

Integration

SERVICE DELIVERY: Clients

Needs Assessment

Evidence of Unmet need among ART

Clients

PROGRAM: Rapid Assessment of

Operational Context

Evidence of gaps and missed

opportunities

Stakeholder Consensus

Common Understanding of Benefits & Concept of Integration

Consensus to employ a Systematic Approach to Integration at all levels

Establishment of a technical advisory group and coordinating body (TWG)

Evidence-based, Locally Appropriate Approaches

Scope of integration defined for each platform

S.W.O.T Analysis

Acceptance

FP

C&T

PMTCT

CTx

HBC

Action

(1) Generate Local Evidence on Effective Models for Integration

Systematic Process

(2) Strengthen Health System

Research

Capacity Building

(3) Ensure an enabling policy environment

Advocacy

(4) Scale-up & SustainTechnical

Assistance

(1) Generating Local Evidence

MOH Approved: Facilitated Referral

• Positive impact on FP Use• 85% routinely screen for risk of

unintended pregnancy• 40% increase in referrals

Research Results

(2) Health Systems Strengthening

Operational Guidelines/Capacity building

CTx FP

Training curriculums and job aids Standard Operating Procedures Client Recording Tools National Master trainers

(3) An Enabling Policy Environment

2010

• MOHSW mandated the scale-up of integrated service delivery

• Taskforce established to steer process forward

• Global Fund Round 10 integrated Proposal

• PMTCT Strategy Target: 2013“At least 80% of HIV-infected

women enrolled in PMTCT and CTx services receive FP and PWP

services”

(4) Progress with Scale-up: 2012

2009 2012

18 facilities in 3 regions 116 facilities in 13 regions

Policy Sustaining advocacy at all levels Importance of demonstrating mutual benefits of integration in both HIV and

FP programs. Political commitment is crucial. FPHIV TWG is vital in moving and sustain the integration agenda

Health Systems & Service delivery Integration of both community and service delivery level is feasible It takes evidence to inform country to scale up One size doesn’t fit all

Lessons learned

It takes a Village to Make a Change

Asante