Wonders of integrated health care

James was devastated when he and his wife tested HIV positive in 2010.

The newlyweds feared that they would pass the virus to their children.

For them, HIV, the virus that causes Aids, was synonymous with sickliness and death.

“When some of my wife’s relatives knew about our sero-status, they wanted us to separate,” says James, 31. “They accused me of infecting their relative.”

But six years on, James is a proud father of two.

“Both my children are free from HIV,” he says with pride.

He commends integrated HIV and sexual and reproductive health service delivery at their health centre.

Under the integrated system, clients seeking HIV or sexual and reproductive health services (SRH) consult one healthcare provider and receive required services in one room.

“Previously, we used to have specific days for separate services. We could only have a Tuesday for family planning and a Thursday for HIV clinic,” says Henry Mayeso, focal person of integration of HIV and sexual and reproductive health services in Dedza District.

Complete package

On Tuesdays, health workers used to knock off after 6pm as health centres were inundated by women seeking family planning.

“Nowadays, these women and other people seeking HIV and SRH services come every day and get any service they need,” Mayeso says.

In 2006, the African Union (AU) adopted the Maputo Plan of Action which requires member States, including Malawi, to ensure their citizens have universal access to sexual and reproductive health services.

Four years later, the Southern Africa Development Community (Sadc) recognised the importance of strengthening linkages between SRH and HIV services to half new HIV infections by 2015.

This prompted government of Malawi to pilot a five-year project.

Since 2011, the Ministry of Health has implemented the project in Dedza, Mangochi and Nkhata Bay.

Five health centres in each of the districts have been involved in the initiative funded by the European Union (EU) and Swedish International Development Agency (Sida).

The justification is that most HIV infections are sexually transmitted or associated with pregnancy, childbirth or breast feeding and associated services should be accessed at one point of service.

The ministry, with support from UNFPA and UNAids, trained healthcare workers from targeted health centres to make them multi-skilled.

Nurse-midwife technician Pilirani Gondwe, who attended the orientation programme, has been championing integrated service provision since its inception at Mzenga Health Centre in Nkhata Bay.

“When clients come for HIV testing, I do it. When they come for family planning as well, I provide the service. So do I when  the client has sexually transmitted infection or is on ARVs,” she says.

The number of people seeking HIV counselling and testing or family planning services at the health centres was low before the integration.

According to Gondwe, many people were worried about lack of privacy, which triggers stigma and discrimination, particularly against clients on HIV treatment.

James experienced this at a health centre in his area before the services were integrated.

He explains: “ARVs were being provided in a room at the end of the clinic. All of us used to queue outside the room located a few metres from a borehole.

“Many people used to come on a Tuesday as if they wanted to draw water. Yet they wanted to see who had come to collect the ARVs.  Some out-patients could also come to the ART clinic just to see us. Sometimes, they could laugh at us. This made us uncomfortable.”

This pushed James and his wife to stop collecting the drugs at the nearest health centre in preference for a district hospital, situated about 50km away.

The transfer proved costly as they had to spend K2 400 for transport each time they went to collect the drugs.

Sometimes, they could default on treatment.

In 2013 James heard that the health centre in his area had introduced the integrated HIV/SRH service delivery.

“When they asked me to return to the health centre, I was happy to do so because I knew I would save money. Now I am treated like any other patient. We all queue up together regardless of the services we are looking for,” he says.

“We have less work”

According to Gondwe, the integrated service has also helped reduce the workload.

“Now we have time to go for lunch and sometimes we knock off in good time,” she says.

Besides reducing stigma and ensuring people on ART are not detected by onlookers, the number of people seeking HIV and family planning service keeps growing.

“Clients with STIs, including adolescents, no longer shy away,” says Eric Palanjeta, who is in charge of Mtakataka Health Centre in Dedza.

The project has also improved male involvement in SRH issues, particularly family planning. Many husbands accompany their wives for ante-natal clinics.

Nkhata Bay district SRH coordinator Austin Mwafulirwa thanks UNFPA and UNAids for supporting the Ministry of Health to make the project a success.

He wants the project to be extended to unreached health centres.

“Some patients from health centres that are not offering integrated services are transferring to the facilities that have been reached,” Mwafulirwa says.

Indeed Malawi stands to benefit a lot from this integrated service delivery if all the health facilities could adopt it. n