Integrating Reproductive Health and Family Planning Into HIV Care in African Urban Slums

Healthcare needs are growing rapidly in Africa urban slums. Rapid urbanization and the growth of slums have put immense pressure on systems that barely function. Despite proximity to health facilities, the attitudes of health workers have traditionally barred many women and children from accessing health services. Increasingly, attention and resources have been directed toward addressing HIV while reproductive health (RH) and other health issues have become overshadowed. To address these concerns, JHPIEGO has instituted a comprehensive care (CC) program in the slums of Nairobi to address the reproductive health challenges faced by health clinics and the communities they serve. As part of this effort, JHPIEGO has begun addressing all aspects of HIV including pediatric HIV, adherence treatment, voluntary counseling and testing (VCT), and at the request of the communities, JHPIEGO is now working to improve RH, family planning, focused antenatal care (FANC), safe motherhood issues and nutrition. By employing the Process Quality Improvement (PQI) process - a non-proscriptive self assessment that enables health providers and communities to identify gaps in needs, and to plan to fill those gaps - providers and communities are drawn together to identify challenges and work together to meet the reproductive health needs of the slum communities by integrating reproductive health care into HIV care. This effort has resulted in: 1) Clinic staff identified their needs through PQI. Specific needs identified include: supportive supervision, free medical camps, training for home-based care, improving services for their clients and patients, nutrition and herbal workshops, community urban gardening, and community mapping of services. 2) Healthcare staffs were trained in ART, counseling & testing, infection prevention and control, FANC, and pediatric HIV 3) Improved quality of healthcare (according to community focused group discussions and exit interviews) 4) Created community maps, and a community directory of all CC services 5) Community empowered (e.g. community now makes its own maps of all services; made a community garden; repaired and painted health facilities) 6) Greater respect for community by clinic staff and vice-versa (community now talks of “our clinic”) 7) Increased demand for services (by more than 50% in some instances) 8) Service providers more knowledgeable in managing cases in the clinics