Integration for Impact 2012: Inadequate health workforce a big challenge for integration in Kenya

Dr. Sheila Macharia, senior health advisor at USAID Kenya, has attributed the lack of healthcare personnel as the major challenge in integrating HIV and sexual reproductive health.

Dr. Sheila Macharia, senior health advisor at USAID Kenya, has attributed the lack of healthcare personnel as the major challenge in integrating HIV and sexual reproductive health.

She said Kenya, like many other African countries, has a serious shortage of human resource and this is affecting delivery of SRH and HIV services.

Dr. Macharia said this yesterday during the Integration for Impact conference currently taking place in Nairobi, Kenya.

The health advisor said inadequate healthcare personnel in most health centers in Africa is a major challenge and contributes to burnout among healthcare providers.

Dr. Macharia said: “There are healthcare personnel who attend to more than 80 clients at the health center where integration is happening. This has to change for us to achieve positive results – it is a sad situation.

“If we do not critically address the issue of inadequate healthcare providers in the health sector achieving integration outcomes will be very difficult to attain.”

Dr. Macharia said there is need for leadership on the part of government in coming up with supportive policies that facilitate integration and task shifting. She added that there was need to employ integration strategies with clear coordination and planning processes, which will support the health system and help monitor and evaluate the outcomes to maximize the package of services.

“We need to work on the health infrastructure and improve monitoring of SRH and HIV activities at all levels on implementation,” she said.

Dr Macharia added that integrating HIV and SRH services is not an easy thing and government need to provide policy direction in sustaining health systems. We need to improve on health commodity procurement and supply easy access to SRH and HIV services.

She said the increasing emphasis being given to client centered care has implications on current planning, implementation and financing processes, and change may require policy support and leadership.

“Reproductive health and HIV integration has the potential to improve health outcomes and contribute to the attainment of MDG 6,” said Dr. Macharia.

Dr. Macharia also said there is a growing body of evidence of the slow progress on integration in Sub-Sahara Africa due to differences in policies and strategies. There is need for policies that facilitate integration, enable task shifting at primary health care level in order to reduce the workload of health personnel.

“Health systems need greater attention and innovation in financing…we need to embark on real thinking,” said Dr. Macharia.

The health advisor described as “unfortunate” the situation in which different organisations and institutions access donor funding for the same programs, while others remain deprived of the same resources. She said it is impossible to attain effective integration in such situations.

She added: “There is need to need to harmonise funding if we are to achieve real integration.”

Meanwhile, Dr Michael T Mbizvo, director of the department of reproductive health and research at the World Health Organisation, said integrating SRH and HIV is an urgent matter. He said Africa should be in a hurry to integrate services because people that go for HIV services have sexual reproductive health needs such as family planning and should have access to health commodities, information and care. We should provide the dual needs of HIV and SRH services for women and young girls who are sexually active to help in preventing HIV infection and unintended pregnancy.

Dr Mbizvo said: “We need to jointly address the SRH and HIV needs of women as one way of mutually re-enforcing the health benefit and reduce maternal mortality.”

He added that the 25% of maternal deaths could be prevented by meeting the unmet need of family planning.

Dr Mbizvo said there is need to step up advocacy efforts in order to fill the unmet need gap and make sure women have access to family planning, drugs to eliminate mother-to-child transmission (PMTCT) and keep mothers alive. He cited South Africa and Rwanda as countries with highest number of unintended pregnancies in Africa at 84% and 74% respectively.

Dr Mbizvo said there is need for dedicated funding for sexual reproductive health services and HIV services. He also said there is a need to encourage SRH and HIV integration in a similar way to Zambia, which prioritised increasing access to quality maternal and child health and family planning services integrated with services to prevent STIs including HIV when applying for money from the Global Fund to Fight HIV, Tuberculosis and Malaria.

During his official opening of the conference, Hon Beth W. Mugo, on behalf of the Kenyan Minister of Health, said his government is committed to making reproductive health a national priority not only through the health system but through supportive laws, policies and actions in education. He said these services and information will make it possible for people to be healthy and make informed decisions about their reproductive health.

Hon. Mugo said the public health community can help build cost effective and sustainable national healthcare programmes by avoiding missed opportunities that result from inadequate linkages or integration of reproductive health systems and HIV service provision, particularly at a time when there is great need to increase access to comprehensive, quality, effective, efficient, affordable and sustainable access to reproductive health and HIV services.