Abstract
BackgroundThere are few rigorous studies evaluating the benefits of vertical versus integrated delivery of healthcare services, and limited published studies describing conceptual models of integration at service-delivery level in public healthcare facilities. This article seeks to fill this gap, by describing the development of a district-based model for integrating sexual and reproductive health (SRH) and HIV services in KwaZulu-Natal, South Africa.MethodsBaseline data were collected from seven urban public healthcare facilities through client and provider interviews, and a facility inventory was completed to assess current service integration practices. Feedback sessions were held with health providers from participating facilities to share data collected and explore appropriate integration scenarios. A conceptual model of potential service integration was then designed, and subsequently implemented and evaluated in the research sites.ResultsKey principles of the model included a focus on health system strengthening and strong community input and involvement. The model was designed primarily to support the integration of family planning into HIV services, and included measures to improve client and commodity monitoring; capacity building through training and mentorship; and a ‘health navigation’ strategy to strengthen referrals within and between public healthcare facilities. Endline evaluation data were collected in the same facilities following implementation of the model.ConclusionsThis manuscript demonstrates the utility of the conceptual model. It shows that service integration can be accomplished in a phased manner with support of community and healthcare providers. In addition, local context must be taken into account and the components of the model should be flexible to suit the needs of the health system.
Highlights
There are few rigorous studies evaluating the benefits of vertical versus integrated delivery of healthcare services, and limited published studies describing conceptual models of integration at service-delivery level in public healthcare facilities
We describe the development of a district-based model for integrating sexual and reproductive health (SRH) and HIV services in KwaZulu-Natal, South Africa
Feedback sessions were held with healthcare providers from participating facilities to explore possible scenarios for integrating services that could work in their settings
Summary
There are few rigorous studies evaluating the benefits of vertical versus integrated delivery of healthcare services, and limited published studies describing conceptual models of integration at service-delivery level in public healthcare facilities. South Africa is a country where service integration in the fields of HIV and SRH is critically important It has one of the largest populations of PLHIV globally, with a national HIV prevalence of almost 18% (in adults aged 15–49 years), in 2017 [7, 8]. While providing ART on this scale is challenging for the health system, and numbers on treatment still fall short of the UNAIDS 90–90-90 targets [8], remarkable success has been achieved in initiating clients on treatment. This initiation of treatment is affected by clients’ ability to reach health services and, once there, to negotiate a complex range of visits and medical tests. Clients accessing SRH services in health facilities are known to be at high risk of HIV acquisition, and need to be offered integrated HIV services [1, 9]
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