The opportunities to integrate health services to better address the client’s needs – especially women – is a key piece of the Obama administration’s Global Health Initiative (GHI). I went to Kenya in November to look for lessons for GHI from another US program -- the PEPFAR-USAID program called the AIDS, Population, Health and Integrated Assistance Project (known as APHIA II; the next phase, APHIA Plus, will begin in 2011). APHIA II has shown that integration of HIV/AIDS and family planning can be an important component of HIV services for women, and that PEPFAR funds can be used effectively in an integrated setting to promote access to HIV services as well as broader health outcomes for women and children.
In Kenya’s Western Province, APHIA II -- a consortium of U.S. NGO partners led by PATH and including EGPAF, JHPIEGO, and World Vision -- is using the maternal child health clinic as the entry point for women and their babies to receive a range of health services, including: antenatal and postnatal care; prevention of mother-to-child transmission (PMTCT) programs; HIV counseling, testing and treatment; early infant diagnosis; childhood vaccinations; TB screening; malaria services; cervical cancer screening; and family planning methods. By providing these services within the MCH clinic, as opposed to the HIV/AIDS clinic, the program seeks to create a more conducive and less stigmatizing environment for women to access appropriate HIV, reproductive health, and child health services for themselves and their babies. While the MCH model still faces many challenges, especially regarding adequate training for health care workers, which is further complicated by staff shortages and high turnover, it is showing important results.
In one such site, the women have formed a PMTCT support group, with “mentor mothers” providing information and support to other women about HIV, PMTCT, family planning, and other social issues they confront. The women I spoke to found the integration of services to be extremely helpful. As one new mother put it: “It’s easier to get all your services in the same place. They understand your history better, and they follow up on your baby. They guide you well.”
These women are supposed to be transferred to the regular HIV/AIDS clinic once their babies reach 18 months. Do you think that will work?