"Integrated services are a proactive approach to addressing clients’ broader reproductive health needs, so your providers have the opportunity to prevent a problem that without integrated services would have been treated only after it occurred. And it is also an opportunity to treat a problem early in the etiology of the problem that without integrated services would have been treated after it interfered with the client’s quality of life."
-Heidi Reynolds [Listen to this interview]
Integrating family planning with related health services offers many potential benefits.
Integration of services can help programs to:
- Offer clients greater convenience
- Reach a broader audience
- Provide a greater range of services
- Reach beneficiary groups not always seen at family planning clinics such as men, youth, and unmarried women
- Address unmet need for contraception
- Make services more cost-effective
- Expand access to services.
Q. What types of services can be integrated? Which combinations work best together?
A. Family planning services can be integrated with related health services. Many combinations of services exist, but some of the most common include integration of family planning with Maternal and Child Health (MCH) services, HIV/AIDS or STIs. Integration of family planning with HIV interventions, for example, provides an opportunity to prevent both unintended pregnancies and HIV infection and to provide family planning counseling for those who want to have a baby. Family planning can be integrated into several types of HIV services: [INFO Report on Integrating FP and HIV/AIDS Services]
PMTCT services: Preventing unintended pregnancies among women with HIV will reduce the number of infants with HIV infections. Pregnant women usually have the desire to delay future pregnancies. Therefore, PMTCT services are an ideal place for providers to counsel women on postpartum contraceptive options. Family Health International carried out a cost-effectiveness analysis that showed that in terms of reducing mother-to-child transmission, any investment in family planning as part of PMTCT would be more effective than providing nevirapine alone. [Global Health Technical Briefs on Integration]
VCT services: When contraceptives were offered during VCT in Kenya, the program discovered that over a quarter of the VCT clients were interested in avoiding pregnancy but were not currently using a family planning method. [Integrating Family Planning into VCT Services]
Care and Treatment, including ARV services and home based care: Often women taking antiretroviral (ARV) medication have increased need for family planning services. A wide range of contraceptive options is safe and should be available for women with HIV, including those on ARVs.
" When we go to do an HIV/AIDS intervention (like a drama group or street theatre), we always systematically integrate messages on family planning. That's an easy way to leverage an existing resource and communicate on two crucial elements of sexual and reproductive health."
-Claire Stokes, Program Manager, PSI [Watch the interview]
Q. Who benefits from integrated services?
A. Housing multiple services at one location can increase efficiency and convenience for clients, providers, and programs. For example, integrated services offer clients the convenience of access to multiple services in one location, saving time and money that they would have spent on visiting separate facilities. For providers, integrated services reduce duplication of services and allow them to address the health of their clients in a more holistic way. Integration can also translate into better cooperation at higher levels. This consolidation of supervisors can streamline reporting processes for providers. For programs, integration can save funds that might have to be spent in renting separate facilities. [Potential Benefits and Challenges of Integration
Q. Should every program integrate services?
A. Integrated services may not suit all programs. Before integrating services, programs should assess feasibility and staff capacity. For example, integrating services may require providers to take on new roles and develop new skills as well as to increase their workload. Programs should consider the capacity of providers and avoid overloading staff. USAID recommends that programs follow three basic integration principles: [Opportunities and Pitfalls in Family Planning]
1. Both of the interventions being integrated must be effective.
2. The interventions should share target audiences and a field of operation (e.g., within clinical services, mass media behavior change communication, or high-level policy-making).
3. Integrating the interventions should create synergies that enhance the impact of both.
Because integrating services all at once can be challenging, programs may want to consider small steps toward integration.
Case Study
Integrating Family Planning into MCH Services
In Russia, the Women and Infants’ Health (WIN) project helped government-supported health facilities to integrate family planning into maternal and infant health programs. The program began by establishing policies and creating a shared vision. They planned for success by creating a monitoring and evaluation system. Then they provided evidence-based family planning training. Linkages between family planning and maternal and child health were stressed. In addition, the program designed behavior change communication materials and planned for scale-up. The program continues to remain open to innovation and improvement. Results include increased access to client-centered counseling and a decrease in unplanned pregnancies.
DELIVER, 2007
Each of the 10 elements was chosen based on online survey results and was discussed in an online forum hosted by the Implementing Best Practices (IBP) Knowledge Gateway. Read more about the survey, forum and results in the Forum Synopsis. Learn more about IBP Knowledge Gateway, and join their Initiative here.
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