2014 Partners' Forum
30 JUNE - 1 JULY | Sandton Convention Centre, Johannesburg, South Africa
Session 3C: Integrating services for HIV/AIDS and RMNCH to promote equitable access to quality care for women and children
The session “Integrating services for HIV/AIDS and RMNCH to promote equitable access to quality care for women and children” was attended by government representatives, technical experts, civil society, and development partners passionate about improving access and quality of HIV/AIDS and RMNCH services through integration. The session was moderated by well-known South African journalist Iman Rapetti.
Florence Ngobeni-Allen, a citizen of Johannesburg, women’s health counselor, and ambassador for the Elisabeth Glaser pediatric AIDS foundation, spoke first and movingly. She told her personal story of how she became aware of her status eighteen years ago, when there was no access to antiretroviral medications, how her husband and young daughter passed away from HIV, and how, because of this experience, she became a counselor at the hospital for other women with similar challenges. She has since started antiretroviral treatment, remarried, and given birth to two children who are free from HIV, and has not had any complications from HIV since her diagnosis. She said “It is easy to talk about integration, but for a typical woman in the township it is not easy…It sounds easy, but let’s listen to the women and men out there. Let’s listen to them, and make sure their voices are heard.” She went on to give examples of the importance of integrating different health services in an accessible location and described how women may not be able to access care or may stop attending clinics because they have to go to so many different places for different types of care, such as family planning, child immunizations, and HIV services.
A moving video from the Elizabeth Glaser pediatric AIDS foundation stressed the point that for the 700 children who are infected with HIV each day, half will die without treatment by age 2, and today 66% of children with HIV do not receive counseling and testing. Services are not always available to them, as access is much better for adults. For those who are tested, the medicines are not always easy to take, as they may taste bitter or be difficult to swallow. The film ended with a call for improvement these many HIV services for care and prevention of pediatric HIV.
The next speaker was Dr. Liz Mason, former Director of the Department for Maternal, Newborn, and Child health at the WHO. Dr. Mason spoke of how South Africa was the first country to look at the integration of HIV care with IMNCI. She pointed to the “Double Dividend” identified recently in a UNICEF and WHO report, which highlights the gains made through integration and efforts to deliver on the dual goals of promoting child survival and access to pediatric HIV services. While speaking of missed opportunities she highlighted the need for integrating services such as HIV testing and treatment, immunizations, and antenatal care visits.
His Excellency the Honourable Aaron Motsoaledi, Minister of Health for the Republic of South Africa, began his intervention by stating that whenever you hear a speaker like Florence, you want to run out right away to the nearest health facility, but since there are over 4,000 in South Africa, you must choose carefully where to start. He posed the question, “Where should South Africa be by 2030? A whole generation of 20-year-olds who are HIV/AIDS free.” He then spoke of the many successes South Africa has had recently. For example, 68% of children with HIV in South Africa are on treatment, which is more than double the figure for the continent. 80% of children of HIV positive mothers are tested for HIV at 6 weeks, and 93% of pregnant women are on PMTCT or ARVs. He admitted that not everything was smooth and detailed many of the additional efforts his government is pursuing, including a proposed doubling of community health workers, and better integration of RMNCH and HIV services so that any day a woman arrives at the clinic she can receive treatment.
Katie Taylor, Deputy Assistant Administrator at USAID spoke about recent successes of public-private partnerships in promoting integration in health delivery. USAID, working in conjunction with the governments of Norway, Zambia and Uganda, Merck, and non-profit actors such as the American College of Obstetricians and Gynecologists on the “Saving Mothers, Giving Life” program helped to build up integrated RMNCH services at the community level. In the districts where they worked, maternal mortality declined 30% in Uganda and 35% in Zambia. They are now looking to expand the model, and make it more readily available, adoptable, and unbranded.
Nekeisha Lewis, from Jamaica and “Women Deliver” spoke about important details to consider when integrating sexual and reproductive health (SRH) services with those for all adolescents, including those living with HIV. She said “If we are to discuss integration, young women in particular are wondering what SRH service integration will look like for certain sub-constituencies. The sub-constituencies she noted were the unemployed poor women who cannot pay for transportation, the working woman who does not have the luxury of having an understanding boss who can let her take a half day off and the adolescent. She urged for haste and need to look at missed opportunities, and concluded by pointing out that these gains cannot be sustained for woman without some investment in education. She concluded that since healthcare facilities are a great place to capture as many women of reproductive age as possible, it is a wonderful opportunity for multiple stakeholders to make synergistic multisector impact.
Dr. Simangele Mthethwa, from the Ministry of Health in Swaziland, spoke of their experience integrating SRH with HIV/AIDS care at five centers of excellence as a part of the UNAIDS and UNFPA SRH/HIV Linkages project which is active in seven countries. The Ministry of Health in Swaziland is now working to expand SRH/HIV integration to the rest of the country. She also detailed their successful mentoring program, where health facilities work with mentors from the health ministry to monitor the data in real time. Using real time data monitoring and the support provided by the mentoring program, they have increased the percent of women who need are on antiretroviral treatment to 84%. She ended with remarks that integrating family planning services with care for HIV-positive women remains a challenge.
Respondents from the floor included Professor Sheila Tlou, UNAIDS Regional Support Team Director and former Minister of Health from Botswana. Prof Tlou spoke of the need to apply investment thinking to inform strategic planning and implementation. She also spoke of the importance of the role and involvement of civil society. Dr. Marijke Wijnroks, Chief of Staff of the Global Fund, spoke of the value of investing in MNCH and of the positive outcomes for HIV and RMNCH. She also spoke of the New Funding Model and highlighted the MNCH Info Note available on the Global Fund website.
Other respondents asked about including men in the promotion of PMNCH, of reaching the poorest of the poor, and engagement of youth. The panel gave encouraging answers to these questions, and the moderator closed by observing that while the concept of integration is complex to get right, there are clear examples of those who are the path to doing so, and that we must be still further motivated to make this happen for more women and their families.