Integration of RH services

Integrated reproductive health service delivery is a way of providing complementary reproductive health services that suit the client’s needs with the least inconvenience, promoting quality care, acceptance, continuity, and client confidence.

Ideally, it means meeting all the reproductive health needs of a client during a visit, potentially by different service providers.

It can also be defined as a process where several services are made available to clients or groups of people so that people who need specific RHS can access them within their vicinity, for instance family planning with safe motherhood, Cancer of the cervix screening.

When an integration approach is applied in RHS the goal is to provide more than one service other than unique needs of the clients. Integrated services may be provided by one facility where the client gets all of his/her health needs met during one encounter.

Depending on the service capacity, integrated services will be offered at the same facility or location during the same operating hours. Services may be by the same provider in one visit or the provider of one services may actively encourage the client to consider using another recommended services during that same visit available within the same facility or if the needed services are beyond the capacity of the facility or the skills of the attending provider then appropriate referral should be effected.

However, for integration to be effective in the latter future an effective referral system must be in place to provide accessible, timely and affordable coordinated care.

• Education and information: This can be provided in more than one reproductive component in a session, helping clients understand the links between reproductive health components and reinforcing behaviour change.
• Counselling : All components need the counselling aspect, and while counselling clients on, for example, Family Planning, involve STI and HIV prevention.
• History taking : The client’s entire reproductive history is obtained to get a clear diagnosis and proper treatment.
• Physical examination : This can address more than one reproductive health need.
• Client management: Based on findings from the client’s history and physical examination, the client is managed for any reproductive health need identified.

1. Build on existing opportunities for integration:

• Assess the existing health services offered at the clinic, particularly Reproductive Health services.
• Identify the type, age of clients being served, and client load.
• Identify the strengths and limitations of the services offered and modes of offering the services.

2. Involve other stakeholders:

• Hold meetings with supervisors, colleagues, as well as health unit management committees to:
• Review personnel tasks and make a list for each cadre.
• Draw a work plan and re-allocate services according to providers’ training and interest.

3. Reorganize services:

• Create space and ensure smooth client flow to:
• Serve clients on a first-come, first-served basis.
• Prioritize very ill clients who need immediate care.
• Avoid clients having to queue twice.
• Avoid unnecessary delays.
• Waiting areas should include:
• Reading materials on RH issues.
• Television and radio to help clients be educated as they wait and reduce boredom.
• Health talks by providers and peers.
• Counseling/consultation rooms should:
• Ensure privacy and confidentiality.
• Be well-equipped with supplies.
• Minimize referrals.
• Include recreation space/room to allow:
• Group discussion.
• Peer education.
• Indoor games, especially for adolescent-friendly services.

4. Orient the community to create demand for services through:

• Client recruitment activities.
• Identifying and offering services to young persons who come for other services.
• Putting up notices in public places about services offered at the health center.
• Working with community leaders to reach the community.
• Liaising with community health workers to spread the news and refer clients for services.
• Linking up with peer educators and providers.

Note : Counseling and IEC (Information, Education, and Communication) form the backbone of all reproductive health services.

Several factors can help in the smooth running of Reproductive Health Services in an integral manner. It includes the following;

• Capacity building (training) . This involves improving the ability of the already existing staff and recruiting more skilled staff to counter balance work load.
• Improving infrastructures . The government and her partners in development should improve on transport and communication networks as well as upgrading and improving on her health centres, referral systems in a view to improve on clients‘ turn up and accessibility.
• Increasing the range of commodities and sustaining availability . This can be achieved by making constant and timely supply of Reproductive Health Services items to the overwhelming number of clients.
• Constant and timely integrated supervision, monitoring and evaluation to ascertain RHS successes.
• Facilitating effective referral across services . This will help to address and help clients who need specialized care to be treated within the shortest time possible.
• Community sensitization about the existence of integrated services in a bid to improve on the health care seeking behaviours and make them aware of the available services.

To the client

• Upholds the client’s rights to information, confidentiality, comfort, and continuity.
• Saves time and is convenient.
• Addresses all the client’s RH needs.
• Helps the client identify RH risks and needs.
• Improves access to reproductive health services and client-provider relations.
• Increases client satisfaction.
• Effective because many services are obtained in one visit.
• Improves financial sustainability.
• Leads to improved health and service delivery outcomes.
• Women with unmet needs for family planning can access services.
• Reduces mother-to-child transmission of HIV.
• Access to ARVs.

To the provider

• Enhances the competences of health workers.
• Makes resources accessible to every provider.
• Increases the client’s confidence in the provider.
• Proper distribution of duties is better and makes sharing them more efficient.
• Adequate number of human resources available.
• Training of staff for quality care service delivery.
• Encourages research.
• Achievement of gender equality.

To the Service:

Integration is good for service provision because it makes services

• Acceptable to the clients.
• Complete- improves quality of care, Increases accessibility and availability of services.
• Available and accessible ― ONE STOP SHOP
• User- friendly.
• Efficient, effective and quick.
• Meet various clients‘ reproductive needs at the same time.
• Reduces missed opportunities.
• Maximizes utilization of the available resources, example; equipment, staff time.
• Increases client satisfaction.
• Improves clients‘ provider relation.

• Increased costs; the client may need to pay for more than one service at a time.
• A visit takes more time/Long waiting and turnaround time.
• Shortage of human resources.
• Shortage of ARV drugs and other medicines.
• It increases workload especially where the number of staff is limited.
• Tiresomeness since service providers have to spend great time serving clients.
• It‘s costly especially where financial support is very poor.
• It‘s very difficult to perform the outreach integration especially where geographical barriers, impassable roads e.t.c.

1. Community outreaches:

• Health promotion and education.
• Immunization.
• Antenatal.
• Family planning.
• STI and HIV/AIDS screening and management.
• Malaria prevention and treatment.
• Treatment of minor ailments.
• Deworming.

2. Static clinics:

• All the above plus:
• Adolescent health.
• Male-friendly Reproductive Health services.
• Infertility.
• Screening of RH cancers (e.g., cancer of cervix, breast, prostate, and testicles).

3. Community-based services:

• Distribution of contraceptives and condoms.
• Distribution of iron and folic acid, distribution of anti-malarial.
• Delivery services and referral.
• Home-based care (e.g., for HIV and postpartum mothers).

4. Social marketing:

• Health promotion and education.
• Provision of family planning services.
• Provision of medical supplies (e.g., Mama kits, insecticide-treated nets, and anti-malarial).

DETERMINANTS OF RHS CONSUMPTION

• Availability of services.
• Accessibility.
• Advocacy by the media.

• Poor physical accessibility.
• Poor/little attention to clients by HCWs/Negative HCW attitudes.
• Long queues at the health facility.
• High cost of services.
• Socio-discrimination.
• Long distances from home to the health facility.
• Poor quality care to clients.

Every client seeking RHS has the right to the following:

• Information : To learn the benefits and availability of RHS.
• Access : To obtain services regardless of sex, color, mental status, or location.
• Choice : To decide freely to receive RHS.
• Safety : To be able to receive safe and effective health services.
• Privacy : To have a private environment during all steps of service delivery.
• Confidentiality : To be assured that no personal information will be breached.
• Dignity : To be treated with courtesy, consideration, and attentiveness.
• Comfort : To feel comfortable when receiving RH.
• Continuity : To receive RHS for as long as needed.
• Opinion : To express views on the services and receive respect for those views.