Saving lives and achieving value for money
Political commitment needed to turn research into action to capitalise on the potential efficiency and effectiveness of integrating sexual and reproductive health (SRH) and HIV services.
Saving lives and using investment effectively is a top global health priority around the world. New research results launched at a special session at the Houses of Parliament today shows that integrating sexual and reproductive health (SRH) and HIV services can improve health outcomes for clients. The results demonstrate that it can enhance the efficiency of health service provision depending on the context.
Politicians, academics, project partners and guests will be discussing the results of the five-year programme that was implemented in Kenya, Malawi and Swaziland.
The flagship Integra Initiative, funded by the Bill & Melinda Gates Foundation has analysed the potential benefits, effectiveness and challenges of integrating HIV and sexual and reproductive health services in Africa. The five year programme is managed by the International Planned Parenthood Federation (IPPF) in partnership with the London School of Hygiene and Tropical Medicine (LSHTM) and the Population Council.
Poor sexual and reproductive health and HIV are both driven by similar factors. There have long been assumptions that integration can lead to better health outcomes, better service experience (including decreased stigma) and cost savings, but little robust evidence, to date, to confirm these assumptions. Integra is the largest research programme of its kind trying to provide robust data on these issues.
The Integra Initiative is an embedded research or ‘programme-science’ approach – it is almost impossible to implement a “pure” intervention-control evaluation design. The Integra research developed an innovative measurement tool, a multi-dimensional ‘Index’, to account for the actual degree of integration at each facility over time. This has not been done before for something as complex as integration of services. This measurement tool has application well beyond this research project for governments interested in monitoring how well they are achieving service integration and for academics interested in evaluating the impact of integrated service delivery on service and health outcomes.
Analysis of the research results, using the Index to evaluate health outcomes data, has shown that integration leads to a reduction in unmet need for HIV prevention and shorter times between HIV testing among family planning clients in Kenya. The Integra intervention included mentoring and skills development for providers which led to improvements in care quality for family planning and post-natal care services in Kenya and Swaziland. The results also pinpoint specific areas where efficiency can be improved to make health service provision better value for money.
Analysis of a sample of women living with HIV showed that they have high needs for both family planning and HIV care which are better met through integrated services. One of the key areas the Integra Initiative explored is client choice. It details the need for people to have access to a range of service models so they can choose the best care setting for themselves.
The Integra Initiative findings have national and international policy implications offering opportunities to turn research into action. The research demonstrates the need for political support in making integrated services a reality for national contexts.
IPPF Director General, Tewodros Melesse said:
“Integra is a project based on real life on the ground. It takes on board that the country context and demonstrates the challenges people and health services face on daily basis. We know people are not getting the high quality and range of affordable and integrated services they need that should be available to men and women and young people throughout their lives. Good services need to be supported by good policies, and that’s why SRH and HIV integration – which focuses at the service level – needs to be supported by a wider linkages agenda that incorporates policies, advocacy and community engagement. People need comprehensive approaches because sex and HIV are interrelated.
"We know that integrating SRH and HIV services is an important part of the global response to HIV. We know it makes good people sense – it can reduce stigma and it can reach out to a ‘broader audience’ and increase the uptake of HIV and SRH services for a diverse clientele. We know that SRH and HIV integration can provide an effective way to more efficiently use scarce resources, both human and economic.”
Her Excellency, President Dr. Joyce Banda of Malawi, said:
"It makes all of us feel proud as we get the realities of providing sexual and reproductive health and HIV services using the evidence generated by this important research. I am very sure that all of us, governments, non - governmental organizations, the academic world, policy makers, individuals and more importantly donors will find the research very useful. In Malawi, as in every country around the world, we need to ensure that services are provided that are accessible for all clients and are free from stigma. Integrated services, provided by trusted and competent providers, can be a step in the right direction to ensuring access to more health services for all.”
Pamela Nash MP, Chair of the All- Party Parliamentary Group on HIV & Aids said:
"If we are going to make any sustained progress in the fight against HIV and maternal mortality, integrated services are essential. We are delighted to be launching this Integra research here today and honoured to hear from President Banda about the impact of the Integra project in Malawi.”
Professor Peter Piot, Director of the London School of Hygiene & Tropical Medicine and former Executive Director of UNAIDS, said:
"Provision of integrated services for sexual and reproductive health and rights can be vital for reducing transmission of HIV and other sexually transmitted infections and reducing unintended pregnancies. We at the School are delighted to play a leading role in designing and implementing the Integra Initiative, and look forward to putting research evidence into practice with partners to extend more effective services to improve health and health equity in Africa and worldwide."
Population Council President Peter Donaldson said:
“It should be easy for women to get multiple services in one place during one visit. One-stop shopping for health services is more efficient for women, providers, and health care systems too. Integra provides persuasive evidence for why and how to do this.”