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BMC Health Services Research

, 12:48

First Online: 27 February 2012Received: 25 December 2011Accepted: 27 February 2012DOI: 10.1186-1472-6963-12-48

Cite this article as: Smit, J.A., Church, K., Milford, C. et al. BMC Health Serv Res 2012 12: 48. doi:10.1186-1472-6963-12-48


BackgroundIntegration of sexual and reproductive health SRH and HIV services is a policy priority, both globally and in South Africa. Recent studies examining SRH-HIV integration in South Africa have focused primarily on the SRH needs of HIV patients, and less on the policy and service-delivery environment in which these programs operate. To fill this gap we undertook a qualitative study to elicit the views of key informants on policy-and service-level challenges and opportunities for improving integrated SRH and HIV care in South Africa. This study comprised formative research for the development of an integrated service delivery model in KwaZulu-Natal KZN Province.

MethodsSemi-structured in-depth interviews were conducted with 21 expert key informants from the South African Department of Health, and local and international NGOs and universities. Thematic codes were generated from a subset of the transcripts, and these were modified, refined and organized during coding and analysis.

ResultsWhile there was consensus among key informants on the need for more integrated systems of SRH and HIV care in South Africa, a range of inter-related systems factors at policy and service-delivery levels were identified as challenges to delivering integrated care. At the policy level these included vertical programming, lack of policy guidance on integrated care, under-funding of SRH, program territorialism, and weak referral systems; at the service level, factors included high client load, staff shortages and insufficient training and skills in SRH, resistance to change, and inadequate monitoring systems related to integration. Informants had varying views on the best way to achieve integration: while some favored a one-stop shop approach, others preferred retaining sub-specialisms while strengthening referral systems. The introduction of task-shifting policies and decentralization of HIV treatment to primary care provide opportunities for integrating services.

ConclusionNow that HIV treatment programs have been scaled up, actions are needed at both policy and service-delivery levels to develop an integrated approach to the provision of SRH and HIV services in South Africa. Concurrent national policies to deliver HIV treatment within a primary care context can be used to promote more integrated approaches.

KeywordsHIV Family planning Reproductive health Sexual health Integrated delivery of healthcare South Africa AbbreviationsARVAnti-retroviral

DoHDepartment of Health South Africa

FPFamily planning

HCTHIV counseling and testing

ICPDInternational Conference on Population and Development

KIIsKey informant interviews

KZNKwaZulu-Natal Province

MCHMaternal and child health

NGONon-governmental organization

PHCPrimary health care

PLWHAPeople living with HIV-AIDS

PMTCTPrevention of mother-to-child transmission of HIV

SRHSexual and reproductive health

STISexually transmitted infection.

Electronic supplementary materialThe online version of this article doi:10.1186-1472-6963-12-48 contains supplementary material, which is available to authorized users.

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Autor: Jennifer A Smit - Kathryn Church - Cecilia Milford - Abigail D Harrison - Mags E Beksinska


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