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Youth Leadership and HIV response in Eastern and Southern Africa
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Youth Leadership and HIV response in Eastern and Southern Africa


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UNAIDS - Youth Leadership and HIV response in Eastern and Southern Africa

UNAIDS - Youth Leadership and HIV response in Eastern and Southern Africa

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  • I will be presenting the story of integration in Tanzania, focusing on milestones since 2007 (where we came from) up to date (where we are now) The next two slides looks at the Situation of the indicators vs the national targets and situation on the policy in 2007
  • Policy analysis conducted in 2008 reveals several policies are mandating integration however these policies were not translated into actions : Operational guidelines lack optimal information on “how to provide” integrated services, Linkages at service delivery are already occurring, but not in a systematic fashion So…….still missing many opportunities Health Sector HIV and AIDS Strategic Plan (“HSHSP-2008-2012) National Guidelines for Clinical Management of HIV and AIDS, NACP (3rd Edition 2008)
  • The policy review gave us direction, and this is when we started walking. In 2008 the stakeholders meeting had the following resolutions:
  • In 2008 the country began to coordinate and move ahead in a strategic and systematic way to address issues at the policy, system and service delivery levels.
  • The next 2-3 slides focus on what has been done/is being done (research/other activities) in Tanzania (2008/11) and how it informs the whole integration efforts as far as different kinds of models of integration is concerned to inform service delivery and policy
  • Not yet reached a ‘tipping point’ – Where things flow/starts rolling themselves and you don’t have to push it
  • Transcript

    • 1. Integrating HIV and SRH Services: Tanzania’s ProgressBy Dr. Subilaga K. Kaganda (TACAIDS) & Dr. Deborah Kajoka(MOHSW)HIV CAPACITY BUILDING PARTNERS’S SUMMIT,Johannesburg, RSA20th March 2013
    • 2.  Introduction Overview of HIV/SRH integration Opportunities for Integration through PMTCT & other HIV services Examples: Integration efforts in Tanzania Challenges Future Directions
    • 3. Tanzania National statistics, targets, Statistics, 2010 &2012 • Population : 44.9 Million • CPR: 20% (modern method) • Unmet Need: 22% • High fertility rates 5.7 • MMR: 454/100,000 • HIV: 5.7% (6.6% women, 4.6% men) 2007/08 THMIS • HIV (pregnant women): 6.9% National Targets, 2007 • Increase CPR to 60% by 2015 • Reduce MMR to 193 by 2015 • At least 80% of women living with HIV and attending PMTCT receiveSources: TDHS 2010; THMIS 2007/08; ANC sententinel FP by 20154
    • 4. Kagera 7.7% 3.4% 5.6% Mara Mwanza Arusha National Average: 5.7% 7.4% 1.6% Kili. Shinyanga 1.8% Manyara 1.9% 12% Kigoma 1.5% Tanga 6.4% 2.7% Pemba 0.3% Tabora Singida 3.3% 4.8% Dodoma Unguja 0.8%% 4.9% Moro- Dar- 9.3% Rukwa Iringa goro 6.7% Pwani 9.2% 15.7% 7.0-15.7% Mbeya 5.1% Lindi 3.8% 3.1-6.9%Percent of women 5.9% 3.6% Mtwara 0.3-3.0%and men age 15-49 Ruvumawho are HIV-positive 2007-08 THMIS: NBS, TACAIDS, and Macro International, Inc.
    • 5. Age2007-08 THMIS- NBS, TACAIDS, and Macro International
    • 6. Percent HIV-positivewomen andmen 15-24 2007-08 THMIS- NBS, TACAIDS, and Macro International
    • 7.  Integrating Reproductive Health, HIV and AIDS policies, programs, and services has been considered essential for meeting International and National goals and targets (MDG 4,5 & 6 and MKUKUTA) Tanzania developed the National Road Map Strategy (2008 – 2015) to accelerate the reduction of maternal, newborn and child deaths in Tanzania. The MOHSW has also reviewed National HIV and RCH Policy Guidelines and strategies to lay down frameworks for integration of RH and HIV services. Initial focus has been on integrating FP into various HIV services such as FP into PMTC, FP into VCT and FP into CTC. Development of National Operations Guidelines for Integrating MNCH & HIV National Multisectoral Strategic Framework III (2013-17) has highlighted the importance of integration
    • 8.  At the lower level of facilities such as dispensary and health centers, services like PMTCT, SRHs are provided under one roof and in dispensary it may be carried out by the same provider At regional and district levels (Regional & Council Health Management Teams) At national level RCH section and NACP are two separate institutions under one directorate (Preventive)
    • 9. Policy, 2007 Policy review in 2007 : Several HIV and FP policies mandate integration (initial focus was on FP/HIV integration) • HIV Policies: FP recognized as a core intervention for PMTCT; FP services to be offered to HIV clients • Comprehensive STI case management /FP • Focused Antenatal Care (FANC)-ANC/Syphilis/Malaria • Integrated Logistic system- HIV/FP commodities, Condoms • FP Policies: Universal access to HIV testing Gap: • Minimal integrated service delivery (passive) • Policy not translated into practice ; lack of “how to” guidance  Leading to missed opportunities
    • 10. Processes… Stakeholders consultation meeting (2008) - key recommendations: • The two MoHSW arms (NACP & RCHS) agreeing that integration has a mutual benefit to each of their program • To Formulate the FP HIV Technical Working Group- DONE • To have evidence based programming- on going • To develop the National Strategic Framework for integration- DONE
    • 11. A processes…Since 2008, Tanzania has  Ensured an enabling policy environment  Continued to do Evidence based programming - conduct research to inform policy and service delivery (on going)  Continued strengthening health system to deliver effective integrated SRH & HIV services
    • 12. Enabling policy environment In 2009, the FPHIV TWG (Technical Working Group) was established, co chaired by the NACP and RCHS unit of the MoHSW (secretariat – partner rotation). Advocacy strengthened Outcomes  Integration one of the MoHSW priority  Structural adjustment – PMTCT was reallocated from NACP to RCHs to enhance integration  Increase donor attention/support  Resource mobilization- Tanzania National Coordinating Mechanism (TNCM) endorsed inclusion of FP in the GF round 10 proposal  Just finalized National Operational Guidelines for Integrating MNCH & HIV (2012)  ASRH and HIV integration on going through provision of YFS (youth friendly services- slow scale up)
    • 13. Evidence based programming - conductresearch to inform policy & service delivery  Focusing on generating local evidence on feasible and effective service delivery models Counseling & Testing PMTCT HBC FP/MCH Care & Treatmen t
    • 14. Evidence based programming - Conduct research to inform policy and service deliveryResearch Status (policy and practice)Global FP/HIV • Inform improvement in the HMISIndicatorpilot, 2010 • Provided information on where we are with integration;Rapid • Showed existing linkages between SRH & HIV within Tanzanians policy, systems & services;Assessment, • Identified gaps in the policy and programmatic environment2009 • Results greatly informed advocacy effortsSite specific • SRH/HIV linkages seen in national RH and HIV policies & plans butassessments integration guidelines not present • At Facility level – HCWs supportive of integration but human resources and technical capacity remains a challenge
    • 15. Evidence based programming - conduct research to inform policy & service deliveryResearch/project Status (policy and practice)FP CTC studies • Policy decision to scale up2 studies looking at 2 different • Modality decided: Provision of condoms, pills,modalities; 2009/10 injectables and implants at the CTC and referrals for other long acting and permanent methodsFP VCT study • Piloting the intervention, VCT service providers to provide pills and condomsFP-HBC Project • Community HBC provides FP counseling; non clinical FP methods and referrals for long acting and permanent2 groups (HBC & FP methodsand HBC & FP counseling) methodsFP-PMTCT Project • Modalities of FP integration into ANC(PMTCT), PNC and HIV/STI units assessed in 12 health facilities
    • 16. FP into CTC: through facilitated referrals in Morogoro and Iringa regions by FHI and through training of HCW in Pwani by ICAP. EFPAF- TaboraFP in PMTCT: Training of HCW in Manyara and Iringa- Engenderhealth FP into facility and community PMTCT in Morogoro- JHPIEGO; EGPAF-Tabora (+cervical cancer screening)PITC and FP in the framework of MNCH services in Mwanza, Mara, Kigoma, Shinyanga, and Arusha by IntraHealth and Iringa, Tabora, Dodoma, Singida, Tanga, Mtwara, Manyara and Kilimanjaro by UHAI/JHPIEGOFP in Home Based Care Programme by Path finder International In Arusha, Kilimanjaro and Dar es salaamFP and VCT By AMREF and Marie StopesSRH in HIV& AIDS : Lindi,Tanga, Mbeya& Mtwara by GIZ
    • 17. Challenges Limitations in scaling up  due to vertical funding streams- District planning process – skewed to HIV compared to SRH programming – limited linkages  Operational guidelines have just been finalized and yet to be disseminated  Integration not comprehensive enough Moving forward within the overburdened system  Human resource shortage  Coverage of trained providers in integrated service delivery are not adequately trained.  Inadequate funding for basic supplies and commodities
    • 18. Lessons learned Policy  Maintaining advocacy at all levels  Importance of demonstrating mutual benefits of integration in both HIV and SRH programs.  Political commitment is critical  FPHIV TWG is vital in moving and sustain the SRH/HIV integration agenda Health Systems & Service delivery  It takes evidence to inform country to scale up  Different service delivery models-One size doesn’t fit all
    • 19. Future directions  Policy  Enhancing advocacy efforts • Increase donors willingness to fund integration issues at country level • MoHSW and Partners ready to adopt and scale up models • Strengthen joint planning and implementation between SRH and HIV&AIDS at all levels  Ensure conducive operational policies to effectively provide integrated services (NMSF III, Reviewed National HIV & AIDS Policy, Health sector RCH & HIV guidelines)  Health System/ service delivery  Adopt studies findings into policy  Scale up integrated service delivery models nationwide  Finalize and put operational guidelines in use.  Expand use of community based volunteers for FP/HIV /MNCH services
    • 20.  delivered by Community Health Workers (CHW) approved by the Ministry of Health and Social Welfare at household level or health post and shall be predominantly promotional in nature. These services can also be preventive and curative in nature:Family planning, HIV Testing and Counseling, Maternal and Child Health, Post Rape Care, Tuberculosis, Cervical, breast, and prostate cancer screening Preventive messages shall include:Benefits of knowing one’s HIV status, Safer sex practices (i.e. abstinence, being faithful, Correct and consistent use of condoms,) Early initiation and exclusive breast feeding, Healthy timing and spacing of births) and Use of insecticide- treated nets (ITN).
    • 21. CHW also will provide services at community level: • Contraceptive pills • Male and female Condoms • Informational materials • Referrals
    • 22.  Improved access to and uptake of key HIV and MNCH services. Better access of PLHIV to MNCH 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 resources and better utilization of Human Resources Enhanced programme effectiveness and efficiency Better understanding and protection of individuals’ rights Mutually reinforcing complementarities in legal and policy frameworks