HEALTH POLICY Family Planning and HIV Integration in : A Policy and Systems-level Analysis PROJECT

Introduction Policy Analysis Stakeholder Interviews

■■ In 2014, USAID requested that the Health Policy ■■ Nineteen government documents were reviewed and ■■ Semi-structured interviews were conducted with representatives of the HIV, reproductive health Project undertake an assessment of the status and summarized: five on HIV/AIDS, eight on FP/sexual and (RH), and health management information system (HMIS) departments of the Ministry of Health Malawi has a high unmet need for family planning extent of FP-HIV integration in Malawi. reproductive health (SRH), and eight general health (MOH). Interviews were also conducted with representatives of the National AIDS Commission, policies, strategies, and guidelines. donors, implementing partners, civil society organizations, medical training and licensing (FP), and grapples with high HIV prevalence. institutions, and Central Medical Stores. ■■ This included three different components: ■■ This policy analysis found that all RH and HIV policies, ■■ A policy analysis to determine the level of FP-HIV strategies, and guidelines discussed integration of FP/SRH ■■ Interviews focused on understanding institutional relationships at the national and decentralized integration that appears in government policy and HIV services to some degree. levels, and how integrated services were provided at the facility level, with a special focus on documents, and explore the extent to which the integration of routine monitoring, training of providers, and addressing the special needs of policies outline and address the integration of ■■ There was much discussion on the need to integrate FP adolescents and youth. services. services into HIV services, for example through antiretroviral Poster prepared by: UNMET NEED FOR HIV PREVALENCE therapy (ART) clinics. ■■ Stakeholders agreed that communication and collaboration between HIV and RH departments of CONTRACEPTION FOR AMONG ADULTS ■■ Discussions with national- and district-level the MOH can be strengthened during policy development, implementation, and monitoring. AGES 15–49 stakeholders to ascertain the policy and program WOMEN AGES 15–49* ■■ Information on how these policies should be monitored in a Laili Irani environment for integration and how policies are harmonized manner is lacking. ■■ Various health systems-related challenges impede integration. These include being implemented on the ground. *Rounded to the nearest whole Only slightly lower than the 12% Pierre Dindi number reported in 2004 ■■ Lack of training among healthcare workers to provide integrated services MDHS, 2010 ■■ A mixed-method descriptive case study ■■ An implementation and monitoring plan is needed to documenting the type and quality of FP and HIV consolidate individual plans and efforts for integration noted in the policy documents; roles and responsibilities of ■■ Segregated services at the facility level across various clinics and days of the week Erin McGinn Integrating FP and HIV services is seen as a integrated services across various categories of health facilities. individual entities should be highlighted. promising practice to address unmet need for ■■ FP and HIV commodities being transported, stored, and accessed through different systems Olive Mtema contraception as well as reduce HIV transmission. ■■ Further collaboration and monitoring across HIV and RH departments will ensure stronger implementation of ■■ Separate registers and monitoring tools for FP and HIV services integration activities. ■■ Better planning, reporting, and use of data will ensure improved collaboration.

■■ Analysis is ongoing and more results will be shared in September 2015. Facility Surveys

■■ Data were collected from 41 facilities across the nine ■■ In addition, nine mystery clients were deployed to 20 Categories of facilities randomly selected districts: , Mzimba North facilities to get a better understanding of how services are and South in the Northern Region; Lilongwe, Mchinji, and disseminated and integrated. Government Hospitals Health Center/Post CHAM Mission Hospitals/Health Centers Dedza in the Central Region; and Mangochi, Mulanje, and District Name of Facility District Name of Facility District Name of Facility Blantyre in the Southern Region. ■■ Three focus group discussions were held with HIV-positive Rural Hospital Mpherembe Health Centre Mabiri Health Centre clients participating in HIV support groups. Nkhata-Bay Mzimba South ■■ A range of healthcare facility types were included to Nkhata-Bay District Hospital Mzimba North Engucwini Health Post Katete Community Hospital understand the feasibility of recommending different Monkey-Bay Community Hospital Thunduwike Health Centre Nkhoma Mission Hospital ■■ Data entry was completed in July 2015 and analysis is Mangochi Dedza integration models for the different types of facilities, ranging ongoing. Results will be available in September 2015. Hospital Mzimba South Manyamula Health Centre Bembeke Health Centre from large, high-volume sites (rural or urban hospitals) where Mchinji Hospital Lighthouse Clinic Lumbira Health Centre HIV and FP services may be offered by different providers in Blantyre different spaces (vertical services) but on the same grounds, ■■ The findings from this study will be useful for RHD, HIV Dedza Hospital Lilongwe Lumbadzi Health Centre Mlambe Mission Hospital to small sites (dispensary/clinic) staffed by one or two Department, USAID and other donors, and service delivery Mulanje Hospital Malingunde Health Centre Mulanje Mulanje Mission Hospital providers, which clients may frequent for a variety of primary projects/organizations to identify ways to improve Mzimba North Mzuzu Central Hospital Nkanda Health Centre integration of FP and HIV services. healthcare needs. Blantyre Queen Elizabeth Central Hospital Kochilira Health Centre Michinji Kapanga Health Centre ■■ In each facility, several data collection methods were Nkhwazi Health Centre employed, such as a facility audit, a quantitative survey Integrated Health Services Dedza Golomoti Health Centre with the hospital facility in-charge, three health service CONTACT US providers, and ten clients attending ART clinics. District Name of Facility Blantyre Madziabango Health Centre Mpamba Health Centre Mimosa Health Centre Health Policy Project Mzenga Health Centre Mulanje Lujeri Health Centre Nkhata-Bay 1331 Pennsylvania Avenue, NW Kande Health Centre Chisitu Health Centre References Nkhata-Bay BLM Asaalam Clinic Suite 600 1. MSH. 2010. Community-Based Family Planning and HIV & AIDS Services in Malawi: A Study of Integration of Family Planning and HIV and AIDS Services in Malawi. Lilongwe, Malawi: Management Sciences for Health. Ntakataka Health Centre Mangochi Namwera Health Centre Washington, DC 20004 2. FHI360. 2010. Integrating Family Planning into HIV Programs: Evidence-Based Practices. Durham, NC: FHI360. Dedza 3. Ministry of Health, UNAIDS, EU, UNFPA. 2013. “Measuring integration of SRH, HIV and Rights in Malawi.” PPT presented at 3rd RPSC meeting, 23 September. Lobi Health Centre Phirilongwe Health Centre www.healthpolicyproject.com 4. National Statistical Office (NSO) and ICF Macro. 2011.Malawi Demographic and Health Survey 2010. Zomba, Malawi, and Calverton, Maryland, USA: NSO and ICF Macro. email: [email protected] 5. IPPF, UNFPA, WHO, UNAIDS. Rapid Assessment on SRH-HIV Linkages in Malawi. 2011. Blantyre, Malawi: IPPF, UNFPA, WHO, UNAIDS.

Tel: +1.202.775.9680 The Health Policy Project is a five-year cooperative agreement funded by the U.S. Agency for International Development under Agreement No. AID-OAA-A-10-00067, beginning September 30, 2010. The project’s HIV activities are supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). HPP is implemented by Futures Fax: +1.202.775.9684 Group, in collaboration with Plan International USA, Avenir Health (formerly Futures Institute), Partners in Population and Development, Africa Regional Office (PPD ARO), HEALTH Population Reference Bureau (PRB), RTI International, and the White Ribbon Alliance for Safe Motherhood (WRA). POLICY The information provided in this document is not official U.S. Government information and does not necessarily represent the views or positions of the U.S. Agency for PROJECT International Development.