RAPID ASSESSMENT TOOL FOR SEXUAL & REPRODUCTIVE HEALTH AND HIV LINKAGES A GENERIC GUIDE

SRH & HIV Linkages Agenda Political Commitment Priority Framework Evidence Review Rapid Assessment Tool Indicators The global agenda on linkages began formally in 2004 with the Glion Call to Action and the New York Call to Commitment. The strategic direction included these five related elements. The focus of this presentation is on the rapid tool which is currently being implemented in about 20.

Benefits of SRH & HIV Linkages Improved access to and uptake of key HIV and SRH services Better access of PLHIV to SRH services tailored to their needs Reduction in HIV–related stigma and discrimination Improved coverage of underserved/vulnerable/key populations Greater support for dual protection Improved quality of care Decreased duplication of efforts and competition for scarce resources Better understanding and protection of individuals’ rights Mutually reinforcing complementarities in legal and policy frameworks Enhanced programme effectiveness and efficiency Better utilization of scarce human resources for health. These are considered potential benefits of linking SRH and HIV. Some of them have been demonstrated through a systematic review (see related power point Linkages: Evidence review and recommendations). For example, increased access to SRH and HIV services, dual protection, improved quality of care, and enhanced effectiveness/efficiency). There is no single model for linkages and the rapid assessment tool will only provide some ideas on the status of linkages at a country level.

Principles of the Tool Address structural determinants Focus on human rights and gender Promote a coordinated and coherent response Meaningfully involve people living with HIV Foster community participation Reduce stigma and discrimination Recognise the centrality of sexuality These principles represent the foundation and commitment upon which linkages policies and programmes must be built. See page 9 of Rapid Assessment Tool for a description of these principles.

Purpose of Tool Assess HIV and SRH bi-directional linkages at the policy, systems, and service-delivery levels Identify current critical gaps in policies and programmes Contribute to the development of country-specific action plans to forge and strengthen these linkages Focus primarily on the health sector (READ SLIDE)

Definitions Used in the Tool Linkages - The bi-directional synergies in policy, programmes, services and advocacy between sexual and reproductive health and HIV. It refers to a broader human rights based approach, of which service integration is a subset. Integration - Different kinds of sexual and reproductive health and HIV services or operational programmes that can be joined together to ensure and perhaps maximize collective outcomes. This would include referrals from one service to another, for example. It is based on the need to offer comprehensive services. As is so often the case when two programme areas are brought together, there is still confusion about the terms. These are the two agreed definitions on integration and linkages. While integration refers to service delivery and is a subset of linkages, linkages refers to a broader policy and systems agenda, including human rights, gender equality, etc.

Application of the tool Can be used as a stand-alone activity or be part of a larger review of national response 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 This tool can be used as a stand alone activity or be part of a larger review. The tool is generic and does not attempt to cover all aspects of HIV and SRH. It is important to ensure key stakeholders are involved in the process, particularly representatives from Ministry of Health SRH and HIV units; networks of people living with HIV; key populations; NGOs working on SRH and HIV issues as well as donors and UN Agencies.

Implementation Steps Establish an assessment team Select a coordinator Conduct a desk review Outline the process of assessment Host group discussions with policy and programme stakeholders and programme managers Train & supervise field interviewers Analyse data and compile report Review findings and decide on next steps These are the 8 key steps to be taken during the assessment. The document includes specific instruments that can be used to guide interviews and a desk review, but it is up to the assessment team to adapt and modify any of the questions suggested and adapt the tool to the realities at country level.

Structure of the Tool Policy Systems Service Delivery The tool is organised around three sections – policy, systems and service delivery. An overview of each section follows

Policy Instrument What is the level and effectiveness of linkages between SRH and HIV-related policies, national laws, operational plans and guidelines? Political positions, national policies/guidelines Funding/Budgetary support This is the overall question that frames the policy assessment. Questions are organised around two areas: A) Political positions, national policies and guidelines – e.g. Existence of HIV and/or SRH policies; are they addressing SRH needs of PLHIV or key populations?; do they address gender inequalities or HIV related stigma and discrimination? B) Funding and budgetary support – e.g. What are the main sources of funding for HIV and/or SRH; how allocation of funds are distributed among programmes; etc

Systems Instrument Partnerships Planning, management & administration To what extent do systems support effective linkages of SRH and HIV? Partnerships Planning, management & administration Staffing, human resources & capacity Logistics/supplies Laboratory support Monitoring and evaluation This is the overall question for the analysis on systems which include the following sub-sections: a) who are the key partners; what is the role of civil society; how is civil society involved?; b) is there any joint planning of HIV and SRH programmes; is there any collaboration for implementing and managing SRH and HIV?; c) what are the training needs, etc.?

Clinical Service Delivery To what extent are HIV services integrated into SRH services and SRH services integrated into HIV services? A. Provider Interview (i) HIV integrated into SRH (ii) SRH integrated into HIV (iii) Overall perspective on linkages in SRH and HIV services B. Client Exit Interview The overall question at the clinical service delivery level is supported by two key areas: A) Provider interview to assess the type and level of integration that exist on integrated HIV services into SRH and SRH services into existing HIV services. There are also questions on the overall perspective for linking SRH and HIV services; B) The client exit interview includes questions regarding the type of services received during the visit and perceptions about the services received.

Implementation Considerations Estimated timeframe: 3 months Appendix 3. Budget Outline for Estimating Cost Estimated cost: USD 30,000 – 50,000 Appendix 5. List of Selected Possible Next Steps for Utilization of the Assessment Findings The estimated time to conduct this assessment is three months. The cost for conducting the assessment is between US$30,000 and 50,000 depending on the size of the country, local costs, coverage of the assessment, and potential follow up actions. Appendix 3 offers information on the key elements to consider when preparing the budget Appendix 5 presents some suggestions on how to use the findings and the type of actions that may be considered after the assessment.