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Intégrer la PF / SR dans la programmation VIH: Expériences du Kibera Reach 90 Projet

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 Afrique, 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, se soucier, et traitement (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 est infirmière et responsable de l'établissement au centre de santé Amref Kibera.

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 patientsviral 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 (ASC) for continued health education as well as peer-to-peer education and client support groups. The CHVs cover a total of 1,132 ménages, where they deliver door-to-door education about HIV/TB and FP/RH care. Dans 2019, 547 les femmes et 27 adolescent girls received ART to reduce the risk of mother-to-child-transmission; 6,326 Hommes, 13,905 femmes, 1,178 garçons, et 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, services de planification familiale, and MNCH.

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

en outre, 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 (SMNE) 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. De même, 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. Par conséquent, 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 est infirmière et responsable de l'établissement au centre de santé Amref Kibera.
Sarah Kosgei

Responsable Réseaux et Partenariats, Amref Health Afrique

Sarah est la responsable des réseaux et des partenariats à l'Institute of Capacity Development. Elle a fini 10 années d’expérience dans la direction de programmes multi-pays visant à renforcer la capacité du système de santé pour une santé durable dans l’Est, Central, et Afrique australe. Elle fait également partie du secrétariat du Women in Global Health - Africa Hub domicilié à Amref Health Africa, une section régionale qui fournit une plate-forme pour les discussions et un espace de collaboration pour un leadership transformateur de genre en Afrique. Sarah est également membre de la couverture maladie universelle (UHC) Ressources humaines pour la santé (HRH) sous-comité au Kenya. Elle possède des diplômes en santé publique et une maîtrise exécutive en administration des affaires (Santé globale, Leadership et gestion). Sarah est une ardente défenseure des soins de santé primaires et de l'égalité des sexes en Afrique subsaharienne.

Alex Omari

Officier KM Afrique de l'Est, SUCCÈS DES CONNAISSANCES, Amref Health Afrique

Alex est le spécialiste technique de la planification familiale et de la santé de la reproduction à l’Institut de développement des capacités Amref Health Africa. Il travaille comme agent régional de gestion des connaissances (Afrique de l'Est) pour le projet Knowledge SUCCESS. Alex a fini 8 années d’expérience en santé sexuelle et reproductive des adolescents et des jeunes (AYSRH) conception de programme, la mise en oeuvre, recherche, et plaidoyer. Il est actuellement membre du groupe de travail technique pour le programme AYSRH au ministère de la Santé au Kenya. Alex est un contributeur / écrivain du site Web pour Youth for Change et le coordinateur national sortant du Kenya pour l'International Youth Alliance for Family Planning (IYAFP). Il détient un baccalauréat en sciences (Santé de la population) et poursuit actuellement son Master of Public Health (La santé reproductive).

Diana Mukami

Directeur de l'apprentissage numérique et responsable des programmes, Amref Health Afrique

Diana est directrice de l'apprentissage numérique et responsable des programmes à l'Institut de développement des capacités d'Amref Health Africa. Elle a de l'expérience en planification de projets, conception, développement, la mise en oeuvre, la gestion, et évaluation. Puisque 2005, Diana a été impliquée dans des programmes d'enseignement à distance dans les secteurs public et privé de la santé. Celles-ci ont inclus la mise en œuvre de programmes de formation continue et initiale pour les agents de santé dans des pays comme le Kenya, Ouganda, Tanzanie, Zambie, Malawi, Sénégal, et lesotho, en partenariat avec les Ministères de la Santé, organismes de réglementation, institutions de formation des agents de santé, et organismes de financement. Diana croit que la technologie, utilisé de la bonne manière, contribue de manière significative au développement de ressources humaines réactives pour la santé en Afrique. Diana est diplômée en sciences sociales, un diplôme de troisième cycle en relations internationales, et un certificat post-baccalauréat en conception pédagogique de l'Université Athabasca. En dehors du travail, Diana est une lectrice vorace et a vécu de nombreuses vies à travers les livres. Elle aime aussi voyager dans de nouveaux endroits.

Lydia Kuria

Project Officer, Amref Health Afrique

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, nouveau née, enfant, et la santé des adolescents; prevention of mother-to-child transmission of HIV; la violence sexiste; and pediatric and adolescent HIV prevention, se soucier, et traitement. 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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