Integration of Reproductive Health Services
Integration; this is defined as an approach in which health care providers use opportunities to engage clients in addressing broader health & social needs than those promoting health encounters.
- It‘s a phenomenon or 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.
- This is the process of providing a variety of Reproductive Health services by either one or more competent service providers within one facility on a daily basis.
In order to maximize use of resources, Sexual Reproductive Health Services (SRHS) should be provided as an integrated health care package that is convenient to clients and service providers. Clients should be able to receive/access various SRHS during one visit at a given static or outreach health units.
Integration provides anticipatory assessment, plan and evaluates services relevant to the clients‘ desires, needs and/ or risks.
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.
Factors that can promote Integration of Sexual 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 staffs and recruiting more skilled staffs 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 centers, 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 behaviors and make them aware of the available services.
Reasons for Integration of Reproductive Health Services
- To make various services available at the same time
- To help reach the community who may not be able to access distant RHS
- To make people with specific reproductive related problems assisted and those with complicated cases referred for specialized attention.
- To create awareness and improve on community contact.
Benefits of integration
- For clients:
- ✔ Convenient and time saving.
- ✔ Confidentiality is respected because information is shared with one provider.
- ✔ The service is perceived to be complete because all clients‘ reproductive health needs are addressed at the same time.
- ✔ Improve client provider relations.
- ✔ Increase client satisfaction.
- Providers:
- ✔ Better distribution and more effective sharing of duties.
- ✔ Resources accessible to every provider.
- ✔ Increased client confidence in the providers.
- ✔ Work load spread out over all service hours.
- Service:
- ✔ Increase accessibility and availability of services.
- ✔ Complete-improves quality of care.
- ✔ 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.
Principles for integration of Reproductive Health Services
- Build on existing opportunities for integration
- ✔ Assess the existing health services offered at the clinic particularly Reproductive Health services.
- ✔ Type, age of clients being served and client load.
- ✔ Identify the strengths and limitations of the services offered and modes of offering the services.
- 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.
- Reorganize services:
- ✔ Create space and ensure smooth client flow in order to:
– Serve clients on first come first served basis
– Prioritize the very ill clients who need immediate care
– Avoid clients to queue twice
– Avoid unnecessary delays
- ✔ The waiting areas should include:
– Reading materials on RH issues
– Television and radio to help clients be educated as they are waiting and to reduce on 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
- 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 Centre
- ✔ Work with community leaders to reach the community
- ✔ Liaise with community health workers to spread the news and refer clients for services
- ✔ Link up with peer educators and providers
Note. Counselling and IEC (Information, education and communication (IEC)) form the backbone of all reproductive health services
Modes of Reproductive Health service delivery
- 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
- Static clinics:
All the above plus,
- – Adolescent health
- – Male friendly Reproductive Health services
- – Infertility
- – Screening of RH cancers example 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 example. for HIV and postpartum mothers
- Social marketing
- – Health promotion and education
- – Provision of family planning services
- – Provision of medical supplies example. Mama kits, insecticide treated nets and anti-malarial.
Disadvantages of Integration
- 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.