Developing a system to monitor family planning and HIV service integration: results from a pilot test of indicators

Adamchak, Susan E.; Okello, Francis; Kaboré, Inoussa

doi:10.1136/jfprhc-2014-101047

Cited by 5 publications

(7 citation statements)

References 3 publications

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“…Also, the definition only considered one indicator of the process of care and may be too crude a measure to represent all dimensions of integrated FP service delivery. Several other indicators have been proposed to track the integration between FP and HIV services at the health facility level with more depth and breadth [42–44]. In addition to service readiness, these evaluation frameworks also consider demand for services, provider training, knowledge and competence, client reports of service provision, and monitoring and evaluation.…”

Section: Discussionmentioning

confidence: 99%

Availability of integrated family planning services in HIV care and support sites in sub-Saharan Africa: a secondary analysis of national health facility surveys

2019

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Background Integrating family planning (FP) with HIV care and treatment programs is a strategy to expand FP service delivery and prevent unintended pregnancies among women living with HIV. However, little is known about the extent to which FP services are available in health facilities providing HIV services across sub-Saharan Africa. In this study, we assessed the availability of integrated FP services and the associated factors in HIV care and support sites across sub-Saharan Africa. Methods We conducted a secondary analysis of nationally representative facility-level data from Service Availability and Readiness Assessments (SARA) and Service Provision Assessments (SPA) conducted in 10 sub-Saharan African countries between 2012 and 2015. We used six indicators that reflect the structure and process of care essential for FP service delivery in HIV care and support facilities to define the outcome of interest - onsite availability of integrated FP services. Multivariate logistic regression was used to explore facility-level characteristics associated with the outcome. Results Among the 3161 health facilities offering HIV care and support services, most reported also offering FP services at the same location. The availability of three FP methods was higher than the availability of FP guidelines and trained staff. Onsite availability of integrated FP services ranged from 10 to 61%. Results of multivariate logistic regression indicated that the odds of having onsite integrated FP services available was higher in HIV care and support sites that were operated by the government, classified as a tertiary level care facility, and provided services for PMTCT, antenatal care and basic surgery. Conclusions Our findings indicate critical shortcomings in the preparedness of HIV care and support sites to deliver onsite integrated FP services. Renewed efforts are needed to address these supply-side barriers and ensure that integrated FP and HIV services meet the unique needs of HIV clients. Electronic supplementary material The online version of this article (10.1186/s12978-019-0713-x) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Availability of integrated family planning services in HIV care and support sites in sub-Saharan Africa: a secondary analysis of national health facility surveys

2019

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“…Data are not available to guide the initiatives that are urgently needed to strengthen implant services in the country. [8] This is especially pressing given the importance of robust data for directing service delivery in the first years after the introduction of contraceptive methods. [9] Problems with new methods, if not corrected, often lead to withdrawal of methods from national programmes.…”

Section: Discussionmentioning

confidence: 99%

Gaps in monitoring systems for Implanon NXT services in South Africa: An assessment of 12 facilities in two districts

et al. 2017

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Background. Implanon NXT, a long-acting subdermal contraceptive implant, was introduced in South Africa (SA) in early 2014 as part of an expanded contraceptive method mix. After initial high levels of uptake, reports emerged of frequent early removals and declines in use. Monitoring of progress and challenges in implant service delivery could identify aspects of the programme that require strengthening. Objectives. To assess data management and record keeping within implant services at primary care facilities. Methods. We developed a checklist to assess the tools used for monitoring implant services and data reporting to district offices. The checklist was piloted in seven facilities. An additional six high-volume and six low-volume implant insertion clinics in the City of Johannesburg (CoJ), Gauteng Province, and the Dr Kenneth Kaunda District, North West Province, were selected for assessment. Results. All 12 facilities completed a Daily Head Count Register, which tallied the number of clients attending the clinic, but not information about implant use. A more detailed Tick Register recorded services that clinic attendees received, with nine documenting number of implant insertions and six implant removals. A more specific tool, an Insertion Checklist, collected data on insertion procedures and client characteristics, but was only used in CoJ (five of six facilities). Other registers, which were developed de novo by staff at individual facilities, captured more detailed information about insertions and removals, including reasons. Five of six low-volume insertion facilities used these registers, but only three of six high-volume facilities. No facilities used the form specifically developed by the National Department of Health for implant pharmacovigilance. Nine of 12 clinics reported data on numbers of insertions to the district office, six reported removals and none provided data on reasons for removals. Conclusion. For data to inform effective decision-making and quality improvement in implant services in SA, standardised reporting guidelines and data collection tools are needed, reinforced by staff training and quality assessment of data collection. Staff often took the initiative to fill gaps in reporting systems. Current systems are unable to accurately monitor uptake or discontinuation, or identify aspects of services requiring strengthening. Lack of pharmacovigilance data is especially concerning. Deficiencies noted in these monitoring systems may be common to family planning services more broadly, which warrants investigation.

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“…Most often, indicators for two or more services were developed specifically for the study and measured the extent to which those services were delivered jointly. The two most common indicators were variations on (1) testing, screening, or counseling a patient with one condition for the other condition or service need [ 32 – 46 ]; and (2) availability of services on the same day, whether via joint treatment by the same provider or in the same visit by different providers [ 38 , 40 , 41 , 46 – 58 ].…”

Section: Resultsmentioning

confidence: 99%

“…Other indicators included variations on (3) internal and external referral practices [ 32 , 41 , 42 , 47 ]; (4) common treatment or counseling spaces [ 41 , 47 , 50 ]; (5) availability or receipt of commodities, equipment, and or medications for two or more conditions [ 38 , 44 , 49 , 50 , 52 , 59 ]; and (6) provider knowledge on two or more services [ 35 , 39 , 52 , 55 , 60 ].…”

Section: Resultsmentioning

confidence: 99%

Integration measurement and its applications in low- and middle-income country health systems: a scoping review

Neill,

Zia,

Ashraf

et al. 2023

BMC Public Health

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Background Despite growing interest in and commitment to integration, or integrated care, the concept is ill-defined and the resulting evidence base fragmented, particularly in low- and middle-income countries (LMICs). Underlying this challenge is a lack of coherent approaches to measure the extent of integration and how this influences desired outcomes. The aim of this scoping review is to identify measurement approaches for integration in LMICs and map them for future use. Methods Arksey and O’Malley’s framework for scoping reviews was followed. We conducted a systematic search of peer-reviewed literature measuring integration in LMICs across three databases and screened identified papers by predetermined inclusion and exclusion criteria. A modified version of the Rainbow Model for Integrated Care guided charting and analysis of the data. Results We included 99 studies. Studies were concentrated in the Africa region and most frequently focused on the integration of HIV care with other services. A range of definitions and methods were identified, with no single approach for the measurement of integration dominating the literature. Measurement of clinical integration was the most common, with indicators focused on measuring receipt of two or more services provided at a single point of time. Organizational and professional integration indicators were focused on inter- and intra-organizational communication, collaboration, coordination, and continuity of care, while functional integration measured common information systems or patient records. Gaps were identified in measuring systems and normative integration. Few tools were validated or publicly available for future use. Conclusion We identified a wide range of recent approaches used to measure integration in LMICs. Our findings underscore continued challenges with lack of conceptual cohesion and fragmentation which limits how integration is understood in practice.

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Developing a system to monitor family planning and HIV service integration: results from a pilot test of indicators

Cited by 5 publications

References 3 publications

Availability of integrated family planning services in HIV care and support sites in sub-Saharan Africa: a secondary analysis of national health facility surveys

Availability of integrated family planning services in HIV care and support sites in sub-Saharan Africa: a secondary analysis of national health facility surveys

Gaps in monitoring systems for Implanon NXT services in South Africa: An assessment of 12 facilities in two districts

Integration measurement and its applications in low- and middle-income country health systems: a scoping review

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