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

2. 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.

3. 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.

4. 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.

5. 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
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6. 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.

7. 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.

8. 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.

9. 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

10. 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

11. 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.?

12. 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.

13. 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.