Integrating reproductive health and HIV indicators into the Nigerian health system--building an evidence base for action.

Service Integration

Integrating reproductive health and HIV indicators into the Nigerian health system--building an evidence base for action.

The lack of an integrated monitoring and evaluation system makes it difficult to assess the effectiveness of HIV and family planning service integration. Since 2007, Nigeria integrated family planning and HIV monitoring and evaluation systems. A pre-post survey compared the availability and use of family planning-HIV integration monitoring and evaluation tools six months pre- and 12-months post-integration in 71 health facilities supported by the Global HIV/AIDS Initiative Nigeria (GHAIN). Pre-integration, four facilities (6%) had national family planning registers, 32 (45%) had monthly aggregated family planning data and 33 (46%) reported data up to national level. Post-integration, all (100%) facilities used national family planning register with family planning-HIV integration indicators, and reported data up to national level. Sixty six facilities (93%) had at least one monthly supervisory visit. The average number of family planning clients per facility referred for HIV testing increased from five in the first month to 15 by month 12 post-integration. Leveraging resources of HIV programs improved significantly the monitoring of family planning-HIV services integration.

Editors’ note: In Nigeria, which has the largest population in Africa, a fertility rate of 5.5%, and HIV prevalence of 4.6% in 2008, both family planning and HIV services are usually delivered in specialised, separate service delivery points within primary, secondary, or tertiary facilities. The HIV-family planning integration strategy drew ideas from the well-functioning HIV component of the health management information system. It aimed to increase bi-directional referrals rather than promote ‘one-stop shopping’ integration and to measure change through adding a few indicators to existing data collection mechanisms. The biggest change was in the aggregation and reporting of family planning integration data in 71 public sector facilities from 44% and 46% respectively to 100%, stimulated by training of health care providers and monthly structured supervisory visits funded through the GHAIN initiative. Four key indicators were the number of women referred from HIV clinics for family planning, the number of family planning clients referred for HIV counselling and testing, the number of HIV-positive pregnant women receiving family planning counselling at antenatal care clinics, and the number of family planning clients receiving HIV counselling and testing at family planning clinics. These last two indicators reflect integration rather than referral. Counting and reporting are good starts but to be useful, data must be analysed for decision-making. The next step is to determine whether improved uptake of either HIV testing or family planning occurred when they are offered where women were already being seen.