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Integrating FP/RH into HIV Programming: Experiences from the Kibera Reach 90 Project

The integration of family planning and reproductive health (FP/RH) care with HIV service provision ensures FP information and care are made available to women and couples living with HIV without discrimination. Our partners at Amref Health Africa discuss the challenges of effectively addressing FP needs for vulnerable clients living in informal settlements and slum areas, and offer recommendations for reinforcing FP and HIV integration.

The integration of voluntary family planning and reproductive health (FP/RH) care with HIV service provision ensures FP information and care are made available to women and couples living with HIV without discrimination. In HIV programming, women with HIV or those at high risk of HIV are among the groups that require special consideration because their FP/RH needs are sometimes overlooked. This article provides insights to decision makers and program managers that, like all women, those living with and at risk of acquiring HIV have a right to make their own family planning choices. This is especially critical for the most vulnerable in informal settlements and slum areas like Kibera, where this article draws insights from. This piece discusses challenges to effectively address FP needs for this group and offers recommendations for reinforcing FP and HIV integration especially in slum areas where the workload at the health facility is always high.

The Kibera Reach 90 strategy of service integration (including linking FP/RH counseling with HIV health education and counseling) ensures there are no missed opportunities for clients to receive the care they need.

The Kibera Reach 90 strategy of service integration (including linking FP/RH counseling with HIV health education and counseling) ensures there are no missed opportunities for clients to receive the care they need.

About Kibera Reach 90

Amref Health Africa, in collaboration with the Kenya Ministry of Health with funding from PEPFAR, has been implementing an integrated TB and HIV/AIDS care and treatment project within the informal settlements of Kibera, Nairobi. The project, dubbed Kibera Reach 90, is implemented in nine health facilities throughout the larger Kibera slums. Services provided include adult and pediatric HIV prevention, care, and treatment (including counseling and testing); prevention of mother-to-child transmission (PMTCT); integrated TB/HIV services; and voluntary FP/RH care.

Though the project predominantly focuses on HIV/AIDS and TB services, continuous quality improvement actions in the facilities revealed the need to include FP/RH care as well. It is proven that HIV/FP integration works, and Amref Health Africa supports these facilities to become more efficient in providing comprehensive high-quality care to their clients. This ensures no missed opportunity among couples and women seeking HIV services to access voluntary FP/RH care.

Lydia Kuria is a nurse and facility in-charge at Amref Kibera Health Centre.

Lydia Kuria is a nurse and facility in-charge at Amref Kibera Health Centre.

FP/RH and HIV Integration and Reach

Kibera Reach 90 applies the Kenya Quality Model for Health (KQMH), which integrates evidence-based medicine through wide dissemination of public health and clinical standards and guidelines combined with total quality management and patient partnership. This model strengthens health worker capacity to ensure high-quality service delivery with available resources. Integrating care—including linking FP/RH counseling with HIV health education and counseling—can ensure there are no missed opportunities. Integration also includes the provision of HIV testing at antenatal care visits where FP/RH care is offered.

The project offers direct services to about 12,000 patients receiving antiretroviral therapy (ART), and the facilities monitor patients’ viral load. All couples/partners and women are given FP/RH information and care during their routine clinic checkups. Kibera Reach 90 leverages Community Health Volunteers (CHVs) for continued health education as well as peer-to-peer education and client support groups. The CHVs cover a total of 1,132 households, where they deliver door-to-door education about HIV/TB and FP/RH care. In 2019, 547 women and 27 adolescent girls received ART to reduce the risk of mother-to-child-transmission; 6,326 men, 13,905 women, 1,178 boys, and 2,077 girls were counseled, tested, and received their HIV test results. Additional components of care provided to mothers and girls include counseling on exclusive breastfeeding, PMTCT, and voluntary family planning care.

Kibera Reach 90 also provides mothers with counseling on exclusive breastfeeding, PMTCT, family planning services, and MNCH.

Kibera Reach 90 also provides mothers with counseling on exclusive breastfeeding, PMTCT, family planning care, and MNCH.

Furthermore, Kibera Reach 90 builds the capacity of government facilities by providing human resources support and technical assistance for achieving quality improvement goals. Project activities take place in the primary health facilities, where voluntary FP/RH care is part of the standard package for women accessing care at both outpatient and Maternal, Neonatal and Child Health (MNCH) clinics. Pregnancy intention and family planning screening tools are administered to people living with HIV to increase uptake of voluntary family planning and pre-conception care. This ensures that mothers access specialized services at the model project facilities without queuing with the rest of the facilities’ clients. Where the project is unable to offer FP/RH care as a one-stop shop, project staff makes referrals; upon presentation of the referral slips, the client is served without having to wait in line.

Conclusion

Since FP/RH integration with other care has proven to be efficient, all programs should adopt it wherever possible. Decision makers and program managers should leverage the established HIV infrastructure to deliver or improve access to comprehensive reproductive health care for those living with or at risk of HIV. Similarly, it is important to use data thoughtfully to avoid commodity stockouts, increase allocation of resources to voluntary FP/RH care, and ensure that the demand for care matches the supply.

Lessons Learned and Challenges Met

Integration is important

One of the greatest lessons of Kibera Reach 90 is that thanks to integration, there has been improved access and utilization of FP/RH services. It has proved to be a sustainable approach that has also strengthened the capacity of health care workers.

Capacity Strengthening for Health Workers

While there are insufficient training opportunities for health care workers to keep abreast of the current knowledge and skills needed to implement FP/RH activities, those who have received additional training have shown great improvement. They make deliberate decisions to integrate services and when this is not possible, they are sure to make referrals.

Strengthen the supply chain

Erratic stockouts of FP commodities has been a challenge. This is due to the fact that supplies are not funded within the current project. Therefore, full integration is dependent on county health services support, which is currently inadequate.

Peer-to-peer education/mobilization works

It is equally important to strengthen the capacity of peer educators and advocates to raise awareness about their clients’ rights and needs for FP/RH services.

Lydia Kuria is a nurse and facility in-charge at Amref Kibera Health Centre.
Sarah Kosgei

Networks and Partnerships Manager

Sarah is the Networks and Partnerships Manager at the Institute of Capacity Development. She has over 10 years’ experience providing leadership to multi-country programs geared towards strengthening the capacity of the health system for sustainable health in Eastern, Central, and Southern Africa. She also part of the Women in Global Health – Africa Hub secretariat domiciled at Amref Health Africa, a Regional Chapter that provides a platform for discussions and a collaborative space for gender-transformative leadership within Africa. Sarah is also a member of the Universal Health Coverage (UHC) Human Resources for Health (HRH) sub-committee in Kenya. She has degrees in Public Health and an Executive Masters in Business Administration (Global Health, Leadership and Management). Sarah is a passionate advocate for primary health care and gender equality in sub-Saharan Africa.

Alex Omari

East Africa KM Officer, Knowledge SUCCESS

Alex is the Technical Family Planning/Reproductive Health Officer at Amref Health Africa’s Institute of Capacity Development. He works as the Regional Knowledge Management Officer (East Africa) for the Knowledge SUCCESS project. Alex has over 8 years’ experience in adolescent and youth sexual and reproductive health (AYSRH) program design, implementation, research, and advocacy. He is currently a Technical Working Group member for the AYSRH program at the Ministry of Health in Kenya. Alex is a website contributor/writer for Youth for Change and the outgoing Kenya Country Coordinator for the International Youth Alliance for Family Planning (IYAFP). He holds a Bachelor of Science (Population Health) and is currently pursuing his Master of Public Health (Reproductive Health).

Diana Mukami

Digital Learning Director and Head of Programmes

Diana is the Digital Learning Director and Head of Programmes at Amref Health Africa’s Institute of Capacity Development. She has experience in project planning, design, development, implementation, management, and evaluation. Since 2005, Diana has been involved in distance education programmes in the public and private health sectors. These have included the implementation of in-service and pre-service training programmes for health workers in countries such as Kenya, Uganda, Tanzania, Zambia, Malawi, Senegal, and Lesotho, in partnership with Ministries of Health, regulatory bodies, health worker training institutions, and funding organisations. Diana believes that technology, used the right way, contributes significantly towards the development of responsive human resources for health in Africa. Diana holds a degree in social sciences, a post-graduate degree in international relations, and a post-baccalaureate certificate in instructional design from Athabasca University. Outside of work, Diana is a voracious reader and has lived many lives through books. She also enjoys traveling to new places.

Lydia Kuria

Project Officer

Lydia is a nurse and works as a Project Officer with Amref Health Africa. She currently provides Technical Support to primary health care facilities located in the Kibera informal settlement in Nairobi. Her technical support covers maternal, newborn, child, and adolescent health; prevention of mother-to-child transmission of HIV; gender-based violence; and pediatric and adolescent HIV prevention, care, and treatment. Prior to this, Lydia worked as a nurse in the MNCH/Maternity and outpatient departments in the Amref Kibera Clinic, where she served as the facility team lead. Lydia enjoys farming and providing mentorship and life skills training to young girls and women. You can reach Lydia at lydia.kuria@amref.org.

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