An integrated sexual and reproductive health package is widely regarded as essential for meeting the needs of both men and women. The practical realities of integration in KwaZulu-Natal, South Africa, were examined from the perspective of both providers and clients. Only minorities of clients received any assessment of reproductive and sexual health needs over and above their main presenting need or problem. The majority would have welcomed such assessments and many were classified as being in need, particularly for advice and services with regard to sexually transmitted infections, including HIV. Most providers were positive about integration, but their ability to practice an active form of integration was limited by inadequate training and time constraints. While training defects can be remedied, the time constraints posed by heavy patient loads are less tractable. More skillful use of booking clerks or the introduction of lay counsellors are also possible solutions.

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JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact support@jstor.org.. Women's Health and Action Research Centre (WHARC) is collaborating with JSTOR to digitize, preserve and extend access to African Journal of Reproductive Health / La Revue Africaine de la Santé Reproductive. ABSTRACTDuring the mid 1990s, high HIV and sexually transmitted disease (STD) prevalence led to calls for the integration of effective services with maternal and child health and family planning (MCH/FP) programs. There are advantages and disadvantages to integration, but little evidence existed to assess the practicalities of implementing this policy. Analysis of policy development for integration was conducted in Ghana, Kenya, South Africa, and Zambia. Semi-structured interviews were conducted with policy-makers at national, provincial and district levels and a survey of facilities was undertaken to identify gaps between policy intent and implementation. Significant advances had been made at the national level to formulate policies to integrate reproductive health and primary health care. However, barriers to implementation included entrenched HIV/STD and MCH/FP vertical programs; diverse demands on district managers and providers, such as on-going institutional reform; and conflicting objectives of international donors. Policy-makers need to address conflicting objectives between the needs for vertical accountability and the reality of providing integrated services. More careful consideration of implementation is required at earlier stages of policy design. Increased consultation with those who are to implement and provide integrated services is recommended. (AfrJ Reprod Health 2001; 5[3]:29-46) RESUME Le r6le des services de la sante maternelle et infantile (SMI) et de la planification familiale dans le con-tr6le du VIH/SIDA: L'integration, est-elle la solution? Au milieu des annees 1990, une haute prevalence du HIV et des maladies sexuellement transmissibles (MST) a conduit aux demandes de l'integration des services efficaces dans des programmes de la planification familiale (SMI/PF). L'integration a ses avantages et ses inconvenients, mais il y avait tris peu d'evidence pour permettre d'evaluer la faisabiliti de la mise en execution de cette politique. L'analyse du developpement de la politique pour l'integration a ete faite au Ghana, au Kenya, en Afrique du Sud et en Zambie. Nous avons eu des entretiens semi-structur6s avec les diecideurs aux niveaux national et provincial ainsi que dans les districts. Nous avons mend une enquite sur les facilites afin d'identifier les ecarts entre l'intention de la politique et sa misc en execution. Sur le plan national, il y a eu de progres importants vers la formulation des politiques visant l'integration de la sant6 reproductive et...