Integration of sexual and reproductive health services in the provision of primary health care in the Arab States: status and a way forward

Abstract

Different approaches are used for integration of sexual and reproductive health (SRH) services at the primary health care (PHC) level, aiming at providing comprehensive services leaving no one behind. This paper aims to assess gaps in the delivery of SRH in PHC services, identifying challenges and proposing action towards universal health coverage in Arab countries. The United Nations Population Fund, Arab States Regional Office (UNFPA/ASRO), in partnership with Middle East and North Africa Health Policy Forum (HPF), launched an assessment of integration of SRH into PHC in 11 Arab countries in 2017-2018. Desk reviews were conducted, using published program reports and national statistics. Data from country reports were compiled to present a regional assessment, challenges and recommendations. SRH services are partially integrated in PHC. Family planning is part of PHC in all countries except Libya, where only counselling is provided. Only Morocco, Tunisia and Oman provide comprehensive HIV services at PHC level. Jordan, Libya and Saudi Arabia rely mainly on referral to other facilities, while most of the integrated family planning or HIV services in Sudan, Morocco and Oman are provided within the same facilities. Action is required at the policy, organisational and operational levels. Prioritisation of services can guide the development of essential packages of SRH care. Developing the skills of the PHC workforce in SRH services and the adoption of the family medicine/general practice model can ensure proper allocation of resources. A presented regional integration framework needs further efforts for addressing the actions entailed.

Exploring Providers’ Perception Towards Provision of Sexual and Reproductive Health Services for Unmarried Adolescents in Gamo Zone, Southern Ethiopia: A Phenomenological Study

“…2–4 Evidence shows that making SRH services available, accessible, appropriate, and adequate in addressing the SRH needs of adolescents plays an important role in averting sexual and reproductive health problems. 1 , 5–7 …”

“…[2][3][4] Evidence shows that making SRH services available, accessible, appropriate, and adequate in addressing the SRH needs of adolescents plays an important role in averting sexual and reproductive health problems. 1,[5][6][7] Despite the global and national commitments to adolescents' SRH needs, the provision of the service remains highly inadequate, especially in low-and middle-income countries (LMICs). 8 In SSA countries, the utilization of SRH services by adolescents is very minimal.…”

“Imagining the world anew”: a transformative, rights-based agenda for UHC and SRHR in 2021 and beyond

“…Kabakian-Khasholian et al describe how, despite a diverse mix of political systems and the impediment of political unrest, the governments of the 11 Arab countries that are considered are making efforts in terms of the integration of SRH services within primary health care systems. 25 Owino et al highlight Kenya's experience in the roll out of UHC via an SRHR lens, concluding thatdespite prior optimismthe UHC process under the present government in Kenya falls short in this respect. 26 Future perspectives: "righting" the power imbalances in UHC spaces…”

Sexual and reproductive health self-care interventions in the Eastern Mediterranean Region: findings from a cross-sectional values and preferences survey to inform WHO normative guidance on self-care interventions

“…Access to, and availability of, SRH services has increased in the Eastern Mediterranean Region (EMR) in the past decade [ 4 ]. For instance, access to and use of contraception is on the rise, and sexually transmitted infection (STI) voluntary counselling and testing programmes are reported in Lebanon, Algeria, Morocco, Jordan, and the Islamic Republic of Iran [ 5 , 6 ]. The Islamic Republic of Iran and Morocco have HIV self-testing policies in place, and Afghanistan, Libya, Somalia, and Sudan have policies in development [ 7 , 8 ].…”

“…These intersecting forms of HIV and SRH stigma may be amplified for young persons [ 15 ]. While postnatal care, family planning, and breast cancer screening are available at the primary health care level [ 6 ], these services are developed for married women and may exclude young people due to stigma surrounding nonmarital sex [ 5 ]. Stigma surrounding SRH and sexual activity signal the salience of self-care strategies to advance SRH in the EMR.…”