Country Experiences

© 2004 Arturo Sanabria, Courtesy of PhotoshareA growing number of countries are integrating family planning and HIV (FP/HIV) services. The pace and stage of these efforts vary by country, and few programs have been rigorously evaluated. Nevertheless, promising practices and useful lessons from these experiences can help guide the integration of FP/HIV services. The Country Experiences section of the Family Planning and HIV Services Integration Toolkit contains reports, case studies, and other materials on countries’ experiences with FP/HIV integration. 

FP/HIV integration is a particularly valuable approach in countries with both high HIV prevalence and high levels of unmet need for family planning. Many of the experiences described in this section stem from countries that share these characteristics. For example, according to the Population Reference Bureau, both Lesotho and Uganda are among the 10 countries with the highest HIV prevalence in the world. These two countries are also among the 10 countries with the highest levels of unmet need for family planning in rural areas. Both countries are working on integrated approaches, including:

  • Postpartum family planning for prevention of mother-to-child transmission of HIV
  • Integrating family planning and antiretroviral therapy services
  • Examining how HIV status affects fertility desires and implementing FP/HIV programs that effectively address related needs

The experiences of these and other countries, which have a great need for integration but also face great implementation challenges, yield rich information on good practices and key reasons for success. From these experiences, programmers, policy makers, and providers can also learn from interventions whose elements appeared to be sound but whose results were of limited value.

Click on the links below to browse program experiences from the following countries:

Multi-country         Ethiopia         Haiti         India         Kenya         Lesotho         Nigeria        

Rwanda         South Africa         Tanzania         Uganda         Zimbabwe

Do you have a comment about this section or would you like to suggest a new resource? Please share your feedback by emailing us at toolkits@k4health.org or posting on our discussion board.

Multi-country

    Making the case for integration: Tides Foundation's Africa family planning and HIV integration fund
    2010 | Tides Foundation | 52 pp
    This report serves as a piece in a growing body of information about FP/HIV integration in Sub-Saharan Africa. The following pages contain a summary of current research, an evaluation of difficult challenges and real solutions, in-depth profiles of organizations working on the frontlines, and insights from experts representing government and philanthropy. Together, these elements contribute to a base on which to build a more robust model of care, treatment, and prevention.  
    [read more >]
    Study of family planning and HIV integrated services in five countries: Final report
    2010 | FHI | 54 pp; 2 pp
    This study was undertaken to provide a “snapshot” of early integration efforts, in order to provide the U.S. Agency for International Development (USAID) and national programs with information needed to improve integrated services. Three models of integrated HIV and FP services were included in this study: family planning in counseling and HIV testing (FP-CT), family planning in HIV care and treatment services (FP-C&Tx), and HIV services (particularly counseling and testing) into family planning (HIV-FP).  
    [read more >]
    Supporting the Integration of Family Planning and HIV Services
    2009 | Population Reference Bureau (PRB) | 6 pp
    English
    This policy brief highlights why service integration makes political and program sense, and describes the lessons learned from successful integration strategies in Ethiopia, Kenya, Lesotho, and Uganda. This brief also urges policymakers and program managers to make integrated services routinely and widely available.
    [read more >]
    Family Health Research: Integrating Services
    2007 | FHI | 8 pp
    English
     The theme of this issue of Family Health Research, a quarterly newsletter, is integration of family planning and HIV services. Integration experiences in Kenya, Uganda, South Africa, and Zimbabwe are featured.
    [read more >]

Ethiopia

    Integrating Family Planning and HIV Services
    2011 | USAID's AIDSTAR-One Case Study Series | 16 pp
    English
    In regions of high fertility and HIV prevalence, integration of family planning and HIV services has emerged as a promising strategy to prevent transmission of HIV, particularly from mother to child. This case study explores different models of integration and how they have been realized in Kenya and Ethiopia, two pioneers in family planning and HIV service integration.
    [read more >]
    Providing family planning in Ethiopian voluntary HIV counseling and testing facilities: client, counselor and facility-level considerations
    2009 | AIDS | 23(Suppl 1):S105-S11
    English
    Governments and donors encourage the integration of family planning into voluntary HIV counseling and testing (VCT) services. Researchers aimed to determine whether VCT counselors could feasibly offer family planning and whether clients would accept such services. Clients demonstrated lower than expected immediate need for contraception, but, despite the relatively low risk this population had for unwanted pregnancy, family planning counseling in VCT increased from 2 to 41% for women and from 3 to 29% for men  (P<0.01). Approximately, 6% of clients received contraceptive methods.
    [read more >]

Haiti

India

Kenya

Lesotho

    Extending prevention of mother-to-child transmission through postpartum family planning in Lesotho
    2008 | Population Council and Frontiers in Reproductive Health | 46 pp
    The Lesotho Ministry of Health and Social Welfare (MOHSW), with technical support from the Frontiers in Reproductive Health Program (FRONTIERS) of Population Council and funding from PEPFAR/RHAP/USAID, carried out an operations research project to strengthen the existing postpartum care services.  This study has a specific focus on strengthening linkages with existing PMTCT follow up services and family planning services during the postpartum period by changing the number, timing and content of postpartum consultations that a woman and her newborn should receive.  Researchers foun
    [read more >]

Nigeria

Rwanda

    Preventing Mother-to-Child HIV Transmission through Family Planning in Maternal and Child Health Services: Kenya, Rwanda, and South Africa
    2010 | FHI | 2 pp
    Study findings show unmet need for family planning among HIV-positive women and low provider readiness to provide family planning in maternal and child health services. Intention to use family planning is high but not accompanied by use in many clients. Those clients using methods primarily rely on condoms and injectables. Providers lack training in family planning, particularly in counseling HIV-positive women, and have misconceptions about appropriate methods for women with HIV.
    [read more >]
    Pregnancy desires, and contraceptive knowledge and use among prevention of mother-to-child transmission clients in Rwanda
    2009 | AIDS | S19-S26
    English
    The objective of this study was to understand pregnancy intentions and contraception knowledge and use among HIV-positive and negative women in the national prevention of mother-to-child transmission (PMTCT) program in Rwanda. HIV-positive women were less likely to report wanting additional children than HIV-negative women, and although a majority of women reported discussing family planning with a health worker during their last pregnancy, modern family planning use remained low in both groups.
    [read more >]
    Global Fund in Rwanda agrees to finance contraceptives: Policy update
    2008 | John Snow [JSI], DELIVER | 2 pp
    In Rwanda, integration of family planning and HIV services is a national priority. In a significant step for both contraceptive security and HIV prevention in Rwanda, local Global Fund stakeholders have decided to fund contraceptives by providing a three-year commitment worth more than US$2.4 million from Round 7 Funds. Global Fund financing has been used in the past to finance condoms in a number of countries, but Rwanda is believed to be the first country to fund contraceptives as part of its efforts to fight HIV and AIDS.    
    [read more >]

South Africa

Tanzania

Uganda

    Integrating Family Planning and Antiretroviral Therapy Services in Uganda
    2010 | FHI | 2 pp
    Among the findings in this case study of an integration project in Uganda are that careful preparation and systems strengthening are critical to the success of the integration; community participation generates support and demand for the new service; and continued assessment of the facility’s capacity and service delivery will guide improvement efforts and service expansion.
    [read more >]
    Addressing the Family Planning Needs of People Living with HIV and AIDS through Integration of Family Planning Services at an ART Center in Uganda
    2009 | The ACQUIRE Project/EngenderHealth | 11 pp
    Developed for the International Conference on Family Planning: Research and Best Practices, which took place in November 2009, Kampala, Uganda, this presentation looked at a project to provide family planning (FP)-integrated HIV services for people living with HIV (PLHIV) in Mbale, Uganda. Included are the following: a discussion of an approach to integrating FP and HIV services, the range of levels of FP integration, and examples of interventions to strengthen service delivery systems in coordination with demand creation and advocacy activities.
    [read more >]
    Fertility desires and infection with the HIV: Results from a survey in rural Uganda
    2009 | AIDS | 9 pp
    English
    The objective of this study was to determine how a positive HIV diagnosis influences fertility desires and reproductive decisions for women and men living in western Uganda. HIV-positive individuals in the Kabarole region have a much greater desire to stop childbearing than their HIV-negative counterparts. The barriers to utilizing family planning services, as evidenced through the very low use of highly effective contraceptive methods, have to be jointly addressed by HIV/AIDS care/prevention and family planning programs.  
    [read more >]

Zimbabwe