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Clients prefer integrated healthcare services

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James Chanje was devastated when he and his newly wed wife tested HIV positive in 2010.

He was not worried about their health only but was also fearful that the couple would pass on the virus to its children resulting in them all dying one after the other.

For James, HIV – the virus that causes Aids – was synonymous with ill health and subsequently death.

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“When some of my wife’s relatives knew about our sero-status, they recommended that our marriage be annulled,” Amon, 31, says. “They accused me of infecting their relative.”

But today, six years down the line, the story is different. James is a proud father of two children.

“Both my children are free from HIV,” he says, grinnig with pride.

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This has been possible because of the integrated HIV and sexual and reproductive health (SRH) service delivery, which was introduced at their health centre. Under the integrated health service delivery, clients seeking HIV or SRH services consult one healthcare provider. They receive the required health care in one room.

“Previously, we used to have specific days of specific service of HIV and SRH, meaning we could only have a Tuesday for family planning and a Thursday for HIV clinic,” says Henry Mayeso, focal person of integration of HIV and SHR services in Dedza.

“So if it’s a Tuesday for family planning, we would expect a lot of women and we could knock off around 6pm because we could not leave them unattended. Nowadays, we are saying these women and other people who are seeking HIV and SRH services should come every day. They would get every service that they need.”

In September 2006, the African Union agreed to implement what is called Maputo plan of action. The plan of action asked member states to ensure that their citizens have universal access to SRH services.

Four years later, the Southern Africa Development Community (Sadc) also recognised the importance of strengthening the linkages between SRH and HIV services, as a key to achieving a 50 percent reduction in new HIV infections by 2015.

This prompted the government of Malawi through the Ministry of Health to pilot a five-year project.

The project commenced in 2011 and has been implemented in Dedza, Mangochi and Nkhata Bay respectively. Five health centres in each of the three districts have been involved in the project.

The rationale for linking HIV with SRH services is that the majority of HIV infections are sexually transmitted or associated with pregnancy, childbirth or breastfeeding and its services should be accessed wholesome, at one point of service.

The European Union (EU) and Swedish International Development Agency (Sida) provided funding for the project. And the Ministry of Health, with technical support from UNFPA and UNAids, organised orientation programmes for healthcare workers at the participating health centres to ensure that all care providers became multi-skilled.

Pilirani Gondwe, a nurse/midwife technician from Nkhata Bay, is one of the healthcare workers who attended the orientation programme. She has been a champion of the programme since its inception at Mzenga Health Centre.

“When a client comes for HIV testing, I do it. If the client comes for familly planning as well, I am able to provide that service. If the client has sexually transmitted infection or is on ARVs [antiretroviral drugs], I also provide those services,” she says.

The number of people seeking voluntary HIV counselling and testing or family planning services was low at the health centres before the integration. Many people were concerned about lack of privacy, a factor that triggers the problem f stigma and discrimination, particularly against clients on HIV treatment.

Chanje experienced this at a health centre in his area before the health centre introduced the integrated service.

“ARVs were provided on a Tuesday [at our health centre] in a room at the end of the clinic. All of us used to queue up outside the room,” he says, adding that a borehole stands a few metres from the room.

“Many people used to come on a Tuesday as if they wanted to draw water. Yet they wanted to see who had come to collect the ARVs. Some outpatients could also come to the ART [antiretroviral therapy] clinic just to see us. This made us feel uncomfortable because sometimes they could laugh at us,” he says.

This forced Chanje and his wife to ask for a transfer out to collect the drugs from a district hospital, situated about 50 kilometres away. However, the decision turned out to be costly for them because they had to spend K2,400 for transport each time they went to collect the drugs. Sometimes they could default on treatment.

In 2013, Chanje heard that the health centre in his area had introduced the integrated HIV/SRH service delivery.

“When they asked me to return to the health centre, I was happy to do so because I knew I would save money and that I would no longer be riduculed,” he says.

“Now I am treated like any other patient. We all queue up together, regardles of the kind of service each one of us is looking for.”

According to Gondwe, the integrated service has helped reduce the workload for care providers among other benefits.

“Now we have time to go for lunch and sometimes we knock off in good time,” she says.

“There is no stigma now. Many people who are coming for ART are not known by other clients,” says Eric Palanjeta, who is in charge at Mtakataka Health Centre in Dedza.

Palanjeta says that the number of people seeking HIV and family planning service keep growing. Clients with sexually transmitted infections, including some adolescent, no longer shy away.

The project has also improved male involvement in sexual and reproductive health issues, particularly in family planning. Many husbands accompany their wives for ante-natal clinic and other SRH services.

Austin Mwafulirwa, who is SRH Coordinator in Nkhata Bay, expresses gratitude to UNFPA and UNAids for the support they have been rendering to Ministry of Health for the project to be a success.

He is hopeful that the project would be extended to other health centres.

“Some of the patients from health centres that are not offering integrated service are transfering to the facilities that have integrated service,” he says.

Indeed, Malawi stands to benefit a lot from this integrated service delivery if all the health facilities could adopt it.

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