“Nowadays we communicate...” What providers think about Integrating HIV and reproductive health services in Kenya and Swaziland

Background Despite widespread integration of HIV and SRH services, little attempt has been made to understand the impact on front-line providers delivering these services. This study aimed to explore providers' experiences of integrated HIV /SRH service delivery. Methods In-depth interviews were conducted with 56 frontline providers of integrated HIV-SRH services at MCH/FP units of public facilities in Kenya and Swaziland. Data were coded using Nvivo 8 and analysed using thematic analysis. Results Providers expected that integration would increase their workload but improve their capacity to offer quality services. In practice, most providers reported delivering services in a combination of provider-level (provider gives several services to a client in one room) and unit-level integration (clients move between rooms/providers, but in the same part of the facility e.g. MCH unit). Experiences of actual integration were mixed. Many said it had increased their workload but they found ways to cope – through better team-working and load-sharing. Providers valued skills enhancement, more variety and challenge in their work and better job satisfaction through increased client-satisfaction. However, they felt that their salaries were poor, they faced increased occupational stress through increased workload/waiting times, less quality time with clients. Conclusions The success of integration depends on those delivering services. Most staff are supportive of integration but formal support mechanisms are needed to help providers cope with high stress and workloads. Lessons can be learned from providers reporting good teamwork to cope with increased workload. Long waiting times while problematic may be resolved by reorganizaton of care.