Summary
  • This report also in French.

(September 2009) The rationale for integrating family planning/reproductive health (FP/RH) and HIV services, especially in high HIV prevalence settings, has long been apparent: Sexually active individuals are at risk of both unintended pregnancies and HIV. The integration of these two sets of services share the key intended health outcomes of prevention of new HIV infections and prevention of unintended pregnancies. Years of experience in reproductive health settings demonstrate that individuals make greater use of services if they are easy to access. Visits to a health facility represent costs to clients and health systems, and making the most of these visits can have enormous benefits in the uptake of services and efficient program operations.

One of the biggest challenges to integrating FP and HIV services is generating the political will to bring together programs that have been physically, financially, and managerially separate. When policymakers understand the savings and benefits of integrating FP and HIV services, they are more likely to support it.

This policy brief highlights why service integration makes political and program sense, and describes the lessons learned from successful integration strategies in Ethiopia, Kenya, Lesotho, and Uganda. This brief also urges policymakers and program managers to make integrated services routinely and widely available.

Studies Demonstrate Financial Benefits of FP/HIV Integration

  • A multiple-country study found that at the country level, the minimum cost savings to be realized from averting unintended HIV-positive births through adding FP services ranged from $26,000 in Vietnam to $2.2 million in South Africa. These variations reflect different levels of HIV prevalence and the scope of unmet need for FP.
  • A costing study in India, in which separate RH and HIV counseling and testing services were integrated, demonstrated that providing integrated services also produced a small net profit (program revenues exceeded program costs. The provision of services increased and financial sustainability improved.
  • In the high-prevalence environment of South Africa, a study found that when providers have the time to offer the additional services, it is more cost-effective to integrate HIV counseling and testing services within existing FP centers than to set up stand-alone centers.

Benefits of Integrating FP/HIV Services for Programs and Clients

  • Maximized productive use of scarce resources.
  • Enhanced ability to prevent new HIV infections, especially among infants and youth.
  • Improved access to and better-quality HIV/FP/RH services tailored to meet the needs of people living with HIV.
  • Greater support for dual protection against unintended pregnancy and disease.
  • Reduced stigma and discrimination.
  • Better coverage of key populations and areas of high HIV prevalence.
  • Reduced care-seeking burden for individuals.
  • Enhanced community involvement and participation.