VCT counselor from Marie Stopes Kenya talking to clinic patients about HIV/AIDS testing and family planning options. (Amanda Cary/PHR)
In our last blog post, we explored how service integration is critical for protecting and promoting the health of women and turning the tide on the feminization of the AIDS epidemic. However, there are other, profound benefits to integrating HIV/AIDS and family planning services. For the right to health to be realized, health systems must be be available, accessible, acceptable and of good quality. Service integration is one strategy that can be employed to build health systems responsive to this framework. Even with limited resources such as infrastructure, health workers, supplies and financing, service integration can have a deep impact on human rights.
Take, for example, the success at the small health dispensary in Kenya’s Eastern Province. On a bright, hot Tuesday morning, an outreach team from Marie Stopes Kenya (MSK) has come to provide a full range of family planning services. MSK is known across the country, and when the outreach team arrives, women come from the surrounding areas to speak with health workers, learn and make decisions about their family planning options. When rural women and men are actively seeking information and counseling, MSK takes the opportunity to provide them with the option of testing for HIV.
Access to health services in Kenya is a major challenge, as it is for many other countries. Service integration is one way to eliminate simple barriers, such as time-consuming and costly travel. 80% of the Kenyan population lives in rural areas. Integrated services help to reach those who are the most vulnerable, leveling the playing field when it comes to accessing quality health services. According to Cyprian Awiti, Country Director of MSK,
The end product is the poor woman, who cannot travel a long time, or several times, to come to the facility. [With integrated services] people can access services at one visit, at one place and under one roof.
There are, however, other barriers to health services access. Structural inequalities and stigma prevent people from seeking out health services. It may be hard to imagine methods of overcoming these barriers, but when we see service integration in action, possibilities become clearer.
As the day wears on at the health dispensary, the lines seem to slowly dwindle. Women who have received information, counseling and family planning services spread out across the lawn in front of the facility, or say their goodbyes and walk out of the dispensary gate. The nurse with the MSK outreach team who is administering VCT stands in the doorway of the private counseling room and asks if there are any others who would wish to be tested. The women sit quietly, momentarily pausing in their low conversation. With no reply, the nurse turns around and begins to pack up his supplies.
And then a small woman quietly slips in and shuts the door.
This is the reality in Kenya, as in many other countries. For rural women, for poor women, for women who are sick it is not easy to find the time, or the money, or the means to get to a health facility. It is not easy to overcome the many barriers to get tested for HIV and AIDS, including the fear of stigma and discrimination. And when they do—when that door opens—we must work to make sure that the health system takes advantage of the opportunity, and lets just one more slip in.
Integrating services is an approach that protects and promotes women’s rights and fosters the development of a rights-based health system.
Read here to find out how integration promotes the right to health by contributing to better availability, accessibility, acceptability and quality of health services.