Strengthening Integration between RMNCH and HIV services Nuhu Yaqub WHO Tanzania

UNAIDS: Gap report 2014

WHO 2013: Global Update on HIV Treatment 2013: Results, impact and opportunities Pregnant women living with HIV receiving ARV

WHO 2013: Global Update on HIV Treatment 2013: Results, impact and opportunities Children < 15 receiving treatment

Rationale RMNCH services are still the Primary Access point for women and children Poor HTC Coverage for pregnant mothers and infants – 44% of women get HTC during ANC (WHO 2013) – 42% of Infants get tested within 2 months (WHO 2013) Effective provision of PMTCT services Rights based Approach to providing care

Integration “The management and delivery of health services so that clients receive a continuum of preventive and curative services, according to their needs over time and across different levels of the health system” Integrating HIV and MNCH “Integration of HIV interventions into maternal, newborn and child health (MNCH) services involves the reorganization and reorientation of health systems to ensure the delivery of a set of essential interventions for HIV prevention, treatment and care as part of the continuum of care for women, newborn, children and families.”

Benefits Patient – Improved access and uptake of HIV/RMNCH Services – Increased access to better tailored RMNCH services – Family Centered care and involvement of the Male Spouse Health Services – Improved coverage of underserved population – Improved quality of care of services provided Health system – Enhanced programme effectiveness and efficiency

Opportunities for Integration PMNCH 2013: Promoting women's & children's health Integrating HIV, TB, malaria and Reproductive, maternal, newborn and child health programmes

Ref: PMNCH 2012: Integrating HIV/AIDS and RMNCH programmes: Best practices What needs to be done

Steps in Integration Advocacy – Identify key stakeholders – Involvement of PLWHA – Build Consensus Baseline Assessment – Policies – Systems – Services

Example of SRH - HIV Integration Assessment A summary of HIV and SRH linkages in Tanzania 5 regions and 15 districts Findings- – National Health Policies emphasized integration however in most cases funding was vertical – Systems: Limited human resources for delivering integrated services, Parallel HMIS systems – Services: Integrated services mainly a feature of hospitals, service users showed preference for facilities with integrated services

Services Identify a comprehensive and integrated package for women and children – FP, MNCH, PMTCT, Rights based Use of evidence based guidelines to guide service delivery Review Human resource capacity Develop information system for adequate monitoring

Involve the Community Invest in community advocacy, information, education and communication interventions to raise awareness of HIV/AIDS and RMNCH linkages. Reach out and involve vulnerable groups Establish teams of counselors/patient advocates to accompany women and children needing to access services Capacity building for community teams to also provide integrated HIV/AIDS, RMNCH and other services (e.g. PMTCT, VCT, contraception, harm reduction).

More countries are documenting experiences on Integration

Summary Integration represents an opportunity to achieve greater impact in improving HIV services Integration is a rights based approach that places the patient at the centre of care Reducing vertical HIV programmes and integrating into RMNCH programmes strengthens the overall health system More countries are reporting some form of integration taking place at different levels and with experiences increasingly being documented