Module 4'3: Integration and Partnering

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Module 4.3Integration and Partnering
Basics of Community-Based Family Planning
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Session Objectives

• As a result of this session, participants will
  have
• Described three logical points of integration for
  FP services
• Discussed key steps to address when planning to
  integrate services
• Listed advantages and disadvantages of at least
  three different types of integration
• Described three possible partnerships between
  their program and another to provide quality
  community-based FP services

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What is integration?

• Integration generally means two or more types of
  services previously provided separately are
  offered as a single coordinated and combined
  service.
• Integration may be a means to
• Improve quality of service delivery
• Expand access to services
• Make services affordable or convenient to clients

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When to integrate

• Do you want to reach a wider market by the
  integration?
• Do you want to broaden the services that you are
  currently offering because you feel it will
  benefit your clients?
• Do you want to add more services that are
  profitable in order to cross-subsidize your
  existing services?

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Is the proposed integration realistic?

• Consider the following
• Will the clients who will use the new service be
  the same as or different from the current
  clients?
• Will the current physical resources be adequate
  or will additions be needed?
• Will there be a need for new personnel, or can
  the current staff provide the new services?

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Is the proposed integration realistic? (contd)

• Will the current logistics systems cover the
  needs of the new services, or will new systems be
  required?
• How will the addition of each new service
  contribute to the financial sustainability of
  your program?
• Will this new service provide an opportunity for
  your program to cross-subsidize services in your
  program?

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Steps of integration

• Planning/budgeting
• Plan at the local level
• Make plans flexible
• Internal organization staffing
• Staff roles and responsibilities
• Training
• Supervision
• Logistics and vehicles
• Client services

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Some Sector Areas for FP Integration

• HIV/AIDS Programs
• MNC Programs
• Environment Programs
• RH Programs
• General Primary Health Care Program

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Entry Point to Integration

• Look for overlapping activities between the two
  or more sectors you are wishing to integrate and
  build on those.

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Why Integrate HIV and FP Services
Clients seeking HIV-related services
AND
Clients seeking FP services

• Share common needs and concerns
• are often sexually active and fertile
• are at risk of HIV infection or might be infected
  
• need to know their HIV status
• need access to contraceptives

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Why Integrate HIV and FP Services continued...

• Creates programmatic synergies including
• more attractive to potential clients
• increases access to wider range of services
• helps overcome HIV stigma
• opportunities for follow-up and support for drug
  or method adherence

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When to Integrate FP with HIV Services

• The technical guidelines on FP/HIV integration
  from USAID (USAID 2003)
• In low-level epidemic situations where the HIV
  prevalence has remained below 5 in any at-risk
  sub-populations, and has not reached 1 among
  pregnant women, HIV programming should be
  targeted to those at-risk groups while FP
  services should be prioritized for the general
  population.
• In concentrated epidemic situations where HIV
  prevalence exceeds 5 in at least one of the
  vulnerable sub-populations, FP services should be
  prioritized for the general population while
  FP/HIV integrated services should target the
  at-risk groups.
• In generalized epidemic situations where HIV
  prevalence rates exceed 1 among pregnant women,
  all FP and HIV/AIDS services should be integrated.

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Key Technical Approaches Conducive to FP/HIV
Integration

• ABC programs
• Dual protection
• Integrated services targeted to youth
• FP and PMTCT
• FP and VCT
• FP and ART, care and support
• Policies built on cultural values contributes to
  changing social norms and healthy behaviors
• CB approaches
• Commodities and logistics
• (Source USAID 2003, FP/HIV Integration Technical
  Guidance for USAID Supported Field Programs)

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Birth Spacing

• Birth to pregnancy interval the interval
  between the date of a live birth and the start of
  the subsequent pregnancy
• Healthy timing and spacing of pregnancy
• Delay first pregnancy until 18 years of age
• Couples should wait 2 years after the birth of
  their last baby before trying to conceive
• Wait six months after an abortion or miscarriage
  before trying to conceive.
• (Source ACCESS FP, 2007)

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Facts from Lancet Series on Sexual Reproductive
Health

• Promotion of family planning in countries with
  high birth rates has the potential to
• reduce poverty and hunger,
• potentially avert 32 of maternal deaths
• potentially avert nearly 10 of childhood deaths
• BUT, those who drafted the MDGs in 2000 ignored
  the difficulties posed by sustained rapid
  population growth in many of the worlds poorest
  countries and spurned the goal of universal
  access to reproductive freedom
• (Source ACCESS FP, 2007)

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Lancet Series Maternal Mortality Morbidity

• In the year 2000, family planning could have
  averted
• 90 of abortion related and
• 20 of obstetric related mortality and morbidity
• (Source ACCESS FP, 2007)

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Postpartum Family Planning Facts
Non-lactating women on average the first
ovulation with a chance of conception occurs 45
days after delivery -Campbell Gray 1993.
Breastfeeding women return of menses may be
delayed six months or longer. However, this is
very dependent on breastfeeding practices- and
breastfeeding women can and do get pregnant
before the onset of their next menses. (Source
ACCESS FP, 2007)
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Someone will talk to her after

• Probably notA minority of women their babies
  receive any postpartum/postnatal care
• Nigeria 71- no care
• Kenya 80- no care
• Bangladesh 82-no care
• Haiti 62 -no care
• (Source ACCESS FP, 2007)

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Postpartum/Postnatal Priorities

• HTSP/PPFP

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REDI Counseling Methodology for Integrated FP/RH
Programs

• Rapport-building with client
• Exploration of clients needs, life
• Decision-making with client
• Implementing the decision helping client
  develop action plan
• (source EngenderHealth, Integrated RH Training
  Manual)

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Exercises

• FP/MNC Integration
• Identify key areas for integration
• Follow the steps to integration and outline
  activities necessary to integrate FP
• FP/HIV Integration
• Identify key areas for integration
• Follow the steps to integration and outline
  activities necessary to integrate FP
• 3) Population Health Environment
• Identify key areas for integration
• Follow the steps to integration and outline
  activities necessary to integrate FP
• 4) Postpartum FP Exercise

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Partnerships Key Factors for Effective
Partnerships

• Communication
• Cooperation
• Coordination
• Collaboration

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Possible Partners

• International Public such as UN agencies
• International Private such as NGOs, private
  corporations
• National Governmental Offices
• Community Organizations

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Benefits of Partnerships

• Provides opportunities to be more comprehensive
  in strategies
• Encourages buy-in from the different partners and
  more sustainability
• Encourages scale-up
• Attracts new resources
• Establishes standards and norms for sectors
• Fills service gaps and increases access to
  services

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Conclusion For effective integration and
partnerships

• Managers must always be clear on the goal of the
  effort and monitor progress in terms of meeting
  the goal(s)
• Integration and partnerships have advantages and
  disadvantages
• Integration requires comprehensive planning that
  includes addressing program design, budgeting,
  personnel, training, supervision, logistics,
  monitoring