Integrating SRH, HIV services

Call her Joyce Chirwa to protect the identity of her  granddaughter who is living with HIV. It takes the 59-year-old about 20 minutes to walk to Liuzi Health Centre where the girl , aged15, can get antiretroviral treatment.

The Standard Seven girl, diagnosed with HIV three years ago, suspects she was infected by her mother at birth.

Chirwa was born and raised in this community. She has known the  health centre from the start.

“Since Kasakaniza started, this health facility has transformed when it comes to accessing health services,” she says.

Previously, Chirwa had to move from one room to another to get different health services.

Now, she gets everything she wants in one room—from one service provider.

Kasakaniza, a Chichewa term describing integration of HIV and Sexual Reproductive Health (SRH) services, helps her granddaughter get ART services without stigma and discrimination.

“No one knows what she is getting when both of us get into the room to meet the health worker. This is a complete transformation compared to what we knew before at this facility” she explains.

Chirwa earns her living through sewing and selling clothes in her community. This is how she supports her grandchildren.

Integration unpacked

The integration of health services at Liuzi started in 2011.

UNFPA Malawi supported Nkhata Bay District Health Office which selected five health centres—Liuzi, Maula, Mzenga, Mpamba and Kachere—to start providing integrated SRH/HIV services.

Some health workers, who were trained in integration of services at Liuzi, have been transferred to other facilities.

However, those remaining still provide the services in an integrated manner.

This has ensured continuity of the practice which has improved access to health services associated with stigma.

Thokozani Steven Chaguza, a nurse-midwife technician, has been working at Liuzi for the past seven years.

He says a lot has changed since 2012 when he was trained in providing SRH/HIV integrated services.

Now patients have more opportunities and a friendly environment to access different services at a single point of contact with a service provider.

“This wasn’t happening before,” he says “The initiative has narrowed the gap between clinicians and nurses as both of them can offer similar services; save for a few cases that might require specialised nursing or clinical care and referral.”

At the start, health workers constantly briefed patients that the facility now offers integrated services.

This also happened in the community. Soon patients started to see the benefits.

“This has lessened the time we spend to get services at the facility. We can get any services on any day, in the past, health workers allocated a specific day for a service, especially ART” says Chirwa.

The benefits of integration have spilled over as people who live over 50 kilometres from Liuzi travel to the health centre, attracted by integrated services which their nearest health facilities  do not offer.

Eight health centres in Nkhata Bay offer integrated services—the new ones being Chisala, Bula and Usisya.

This means more than 50 percent of health facilities in the lakeshore district provide SRH/HIV integrated services.

“We have seen an improved relationship among health workers as they share tasks equally through an integrated daily roster, thereby reducing their workload,” says Austin Mwafulirwa, who coordinates the project in Nkhata Bay.

He also says most facilities that offer integrated services do not have many patients to attend to in the afternoon.

There are no lengthy queues because most clients are assisted in good time in the morning.

The national picture

UNFPA has coordinated the SRH/HIV integration project since 2011.

The European Union bankrolled the project until 2014 and Swedish International Development Cooperation Agency (Sida) started supporting the project in 2013.

The initiative targeted Mangochi, Dedza and Nkhata Bay with five facilities in each district.

“We have seen significant progress. Some districts like Mangochi and Nkhata Bay have scaled up the services from the initial five to eight,” says Thandiwe Mijoya, the national coordinator for SRH/HIV linkages project at UNFPA Malawi.

To strengthen the scope of the project, adolescents and the youth, including key populations, have become the primary beneficiaries of the SRH/HIV integrated services.

UNFPA also supported the development of the National Strategy for SRH/HIV Integration to ensure further institutionalisation, scale up and sustainability of this life-changing approach.n