Integration of Family Planning and HIV Services: A Study of the Health Systems Factors Affecting Integration in Public Health Facilities in Lusaka District in Zambia

Luka Nkhoma; Doreen Chilolo Sitali; Joseph Mumba Zulu

doi:doi:10.11648/j.wjph.20220702.16

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Integration of Family Planning and HIV Services: A Study of the Health Systems Factors Affecting Integration in Public Health Facilities in Lusaka District in Zambia

Luka Nkhoma, Doreen Chilolo Sitali, Joseph Mumba Zulu

Published in World Journal of Public Health (Volume 7, Issue 2)

Received: 11 May 2022 Accepted: 1 June 2022 Published: 16 June 2022

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Abstract

Increased access to contraception by women of child bearing age still remains a global public health challenge. For instance, in 2017, 25% of women who did not intend to get pregnant were not using any form of modern contraceptives. The majority (21%) of the women who were not using modern contraceptives live in Sub-Saharan Africa. We conducted twenty-seven interviews with five policy makers, ten health administrators and twelve Service providers in Lusaka District in Zambia. The interviews were conducted at the Provincial Health Office, Ministry of Health and at three first level hospitals. An interview guide was used to generate data and the data was analyzed using thematic analysis. The factors that were investigated included; leadership and governance, planning, financing for health, service delivery, human resource for health and monitoring and evaluation. Availability of human resource for health and financial support from cooperating partners were identified as enablers to integration of family planning and HIV services. The absence of policy guidance, limited physical space and lack of coordination were recognized as barriers to the integration of family planning and HIV services. In addition, lack of regular training for service providers, lack of donor flexibility on fund utilization and frequent stock-out of long-acting reversible contraceptives were additional barriers to integrating family planning and HIV services. The purpose of this paper is to document the factors which affect integration of family planning and HIV services in public health facilities in Lusaka District in Zambia.

Published in	World Journal of Public Health (Volume 7, Issue 2)
DOI	10.11648/j.wjph.20220702.16
Page(s)	70-78
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Family Planning, HIV Services, Integration, Health Systems, Barriers and Facilitators

References

[1]	Atun, De Jongh, T., Secci. V. F, Adeyi. O and Ohiri. K, (2009); Integration of targeted health interventions into health systems: a conceptual framework for analysis, Oxford University Press, doi: 10.1095/heapol/czp055. Accessed on 17/02/2022.
[2]	Close. M. A, Barden-O’Fallon and Mejia c., (2019); Quality of family planning services in HIV integrated and non-integrated health facilities in Malawi and Tanzania, Reproductive Health 16, 58 (2019). https://doi.org/10.1186/s12978-019-0712-y
[3]	Dejene, H., Abera, M., and Tedele, A., (2021); Unmet need for family planning and associated factors among married women attending ante-retroviral treatment clinics in Dire Dawa City, Eastern Ethiopia, PloSOne 16 (4): e0250297. https://doi.org/10.1371/journal.pone.0250297
[4]	Dereje, B. D., and Mmusi-Phetoe, R, (2021); Integration of family planning services with HIV treatment for women of reproductive age attending ART Clinic in Oromia Regional state, Ethiopia, Reprod Health 18, 102 (2021). https://doi.org/10.1186/s12978-021-01157-0
[5]	Edietah, E., Njotang, P. N, Ajong. A. B., Essi, M. J, Yakum, M. N, and Mbu, E. R, (2018); Contraceptive use and determinants of unmet need for family planning: A Cross-Sectional Survey in the North West Region, Cameroon, BMC Women’s Health 18, Article number 171 (2018).
[6]	Feyissa. T. R, Harris. M. L, Melka. A. S. S, and Loxton. D, (2019); Unintended Pregnancy in Women Living with HIV in Sub-Saharan Africa: A Systematic Review and Meta-analysis, PMID: 30467712 DOI: 10.1007/s10461-018-2346-4.
[7]	Grant-Maidment, T., Kranzer, K., and Ferrand, R., (2022); The effect of integration of family planning into HIV services on Contraceptive Use Among Women Accessing HIV services in Low and Middle Income Countries: A systematic review, Frontiers in global women’s health, 3, 837358. https://doi.org/10.3389/fgwh.2022.837358
[8]	Hawkins, L., Gerrtz, A. M., Badubi, O., Sickboy, O., Mussa, A., Maotwe, T., Whittaker, P. G., Shcreiber, C. A., Ramagola-Masire, D., and Marroni, C., (2020); Integration of family planning services into health care for HIV positive women in Botswana, International Journal for Gynecology and Obstretics, https://doi.org/10.1002/ijgo.13464
[9]	Jacobstein. R, Curtis. C, Spieler. J and Rodloff. S, (2013); Meeting the need for modern contraceptives: effective solutions to a pressing global challenge, International Journal of Gynecology and Obstetrics, USA. IJG-07556.
[10]	Kanyangarara. M, Sakyi. K and Laar. A, (2019); Availability of Integrated family planning services in HIV Care and support sites in Sub-Saharan Africa: a secondary analysis of national health facility surveys, Reproductive Health Journal 16, 60 (2019). https://doi.org/10.1186/s12978-019-0713-x
[11]	Kefale. B, Adane. B, Damtie. Y, Aretaynie. M, Yalew. M, Andargie. A, and Addisu. E, (2021); Unmet need for family planning among reproductive-age women living with HIV in Ethiopia: a systematic review and meta-analysis, PLOSONE Journal. https://doi.org/10.1371/journal.pone.0255566
[12]	Nabirye, J., Matovu, J. K. B., Bwanika, J. B., Makumbi, F., and Wanyenze, R., (2020); Missed opportunities for family planning counselling among HIV positive women receiving HIV care in Uganda, BMC Women’s Health, 20, 91 (2020). https://doi.org/10.1186/s12905-00942-6
[13]	Narasimhan. M, Yeh, P. T, Haberlen. S, Warren. C. E. E, and Kennedy. C. E. E, (2019); Integration of HIV testing services into family planning services: a systematic review, Reproductive Health Journal 16, 61 (2019). Https:doi.org/10.1186/s12978-019-0714-9
[14]	Maharaj, P. and Cleland. J, (2005); Integration of Sexual and reproductive health services in Kwazulu Natal, South Africa, Health Policy and Planning Journal, Volume 20, Issue 5, Pages 310-318, https://doi.org/10.1093/heapol/CZ1038. Accessed on 31/01/2022.
[15]	Martinez-Garcia. M and Hernandez-Lemus, (2013); Health Systems as complex systems, American Journal of operations Research, http://dx.doi.org/10.4236/ajor.2013.31A011. Accessed on 10/02/2022.
[16]	McGinn, E. K., and Irani. L. (2019); Provider-Initiated Family planning with HIV services in Malawi: Did Policy Make It into practice? Global Health: Science and Practice December, 2019, 7 (4): 540-550. https://doi.org/10.9745/GHSP-D-19-00192
[17]	Mekonnen. D. A. and Roets, (2020); Integrating HIV and family planning services: The Pros and Cons, Doi: 10.2147/HIV.S281997, PMCID: PMC7733375 Accessed on 18/01/2022.
[18]	Memon. Z. A, Reale. S, Ahmed. W, Spencer R, Lashari TH, Bhutta Z, and Soltani H, (2022); Effects of integrating family planning with maternal, Newborn and Child health services on uptake of Voluntary Modern Contraceptive methods in rural Pakistan: Protocol for a Quasi-experimental study, JMIR Res Protoc 2022; 11 (3): e35291. Doi: 10.2196/35291.
[19]	Mutisya. R, Wambua. J, Nyachae. P, Kamau. M, Karnad. S. R, and Kambue. M, (2019); Strengthening Integration of family planning with HIV and other services: Experience from three Kenyan Cities, Reproductive Health 16, Article number 62 (2019).
[20]	Steinfeld, R. L., Newmann, S. J., Onono, M., Cohen, C. R., Bukusi, E. A., and Grossman. D., (2013); Overcoming Barriers in family planning through integration: perspectives of HIV-positive men in Nyenza Province, Kenya, PubMed. gov. Doi: 10.1155/2013/861983.
[21]	Shade, S. B, Kevany. S, Onono. M, Ochieng. G, Steinfeld. R. L, Grossman, Newmann. S. J, Blat. C, Bukusi. E. A, and Cohen. C. R, (2013); Cost, Cost-efficiency and Cost-effectiveness of integrated family planning and HIV services, Europe PMC, AIDS (London, England), 01 Oct 2013, 27 Suppl: S87-92. Doi: 10.1097/qad.0000000000000038 PMID: 24088688.
[22]	Teklu, Belina. S, Chemir. F, Tessema. M, and Yismaw. W, (2021); Unintended Pregnancy and Associated Factors Among HIV Positive Women in Ilu Aba Bora Zone, South- Western Ethiopia: A Facility- Based Cross-Sectional Study, https://doi.org/10.2147/HIV.S288373. Volume 2021.13.
[23]	UNFPA (2010), The right to contraceptive information and services for women and adolescents, Briefing paper, Centre for Reproductive Rights, 2010.
[24]	Wall, Kristin. M, Kilembe, William, Inambao, Mubiana, Hoagland, Alexandra, Skarkey, Tyronza, Malama, Kalonde, Vwalika, Bellington, Parker, Rachael, Sarkar, Suprya, Hunter, Ken, Streeb, Gordon, Mazarire, Christine, Tichacek, Amanda, Susan and Allen, (2020); Cost-effectiveness of integrated HIV prevention and family planning services for Zambian coulples, AIDS Journal, Volume 34-Issue 11, p 1633-1642. Doi: 10.1097/QAD.0000000000002584.
[25]	World Health Organization, (2010); Integrated Health Services-What and Why, Technical Brief No. 1, 2008.
[26]	Yam, E. A., Kahabuka, C., Mbita, G., Winani, K., Apicella, L., Casalini, C., and Mbuguni, K., (2020); Safer contraception for female sex workers living with HIV in Dar es Salaam, Tanzania: Cross-sectional analysis of needs and opportunities in integrated family planning/HIV services, PLOS ONE, https://doi.org/10.1371/journal.pone.0235739
[27]	Zewdie. Z, Yitayal. M, Kebede. Y and Gebeyehu. A, (2020); Status of family planning integration to HIV care in Amhara Regional State, Ethiopia, BMC Pregnancy and Childbirth Journal, 20, 145 (2020). https://doi.org/10.1186/s12884-020-2838-x
[28]	Zulu. M. J, Goicolea. I, Kinsman. J, Sandoy. F. I, Blystad. A, Mulubwa. C, Makasa. C. M, Michelo. C, Musonda. P and Hurtig. K. A, (2018); Community based interventions for strengthening adolescent sexual reproductive health and rights: how can they be integrated and sustained? A realist evaluation protocol from Zambia, Reproductive Health 15, Pages 1-8, Article no: 145 (2018). Accessed on: 31/01/2022.

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APA Style

Luka Nkhoma, Doreen Chilolo Sitali, Joseph Mumba Zulu. (2022). Integration of Family Planning and HIV Services: A Study of the Health Systems Factors Affecting Integration in Public Health Facilities in Lusaka District in Zambia. World Journal of Public Health, 7(2), 70-78. https://doi.org/10.11648/j.wjph.20220702.16

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ACS Style

Luka Nkhoma; Doreen Chilolo Sitali; Joseph Mumba Zulu. Integration of Family Planning and HIV Services: A Study of the Health Systems Factors Affecting Integration in Public Health Facilities in Lusaka District in Zambia. World J. Public Health 2022, 7(2), 70-78. doi: 10.11648/j.wjph.20220702.16

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AMA Style

Luka Nkhoma, Doreen Chilolo Sitali, Joseph Mumba Zulu. Integration of Family Planning and HIV Services: A Study of the Health Systems Factors Affecting Integration in Public Health Facilities in Lusaka District in Zambia. World J Public Health. 2022;7(2):70-78. doi: 10.11648/j.wjph.20220702.16

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@article{10.11648/j.wjph.20220702.16,
  author = {Luka Nkhoma and Doreen Chilolo Sitali and Joseph Mumba Zulu},
  title = {Integration of Family Planning and HIV Services: A Study of the Health Systems Factors Affecting Integration in Public Health Facilities in Lusaka District in Zambia},
  journal = {World Journal of Public Health},
  volume = {7},
  number = {2},
  pages = {70-78},
  doi = {10.11648/j.wjph.20220702.16},
  url = {https://doi.org/10.11648/j.wjph.20220702.16},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.wjph.20220702.16},
  abstract = {Increased access to contraception by women of child bearing age still remains a global public health challenge. For instance, in 2017, 25% of women who did not intend to get pregnant were not using any form of modern contraceptives. The majority (21%) of the women who were not using modern contraceptives live in Sub-Saharan Africa. We conducted twenty-seven interviews with five policy makers, ten health administrators and twelve Service providers in Lusaka District in Zambia. The interviews were conducted at the Provincial Health Office, Ministry of Health and at three first level hospitals. An interview guide was used to generate data and the data was analyzed using thematic analysis. The factors that were investigated included; leadership and governance, planning, financing for health, service delivery, human resource for health and monitoring and evaluation. Availability of human resource for health and financial support from cooperating partners were identified as enablers to integration of family planning and HIV services. The absence of policy guidance, limited physical space and lack of coordination were recognized as barriers to the integration of family planning and HIV services. In addition, lack of regular training for service providers, lack of donor flexibility on fund utilization and frequent stock-out of long-acting reversible contraceptives were additional barriers to integrating family planning and HIV services. The purpose of this paper is to document the factors which affect integration of family planning and HIV services in public health facilities in Lusaka District in Zambia.},
 year = {2022}
}

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TY  - JOUR
T1  - Integration of Family Planning and HIV Services: A Study of the Health Systems Factors Affecting Integration in Public Health Facilities in Lusaka District in Zambia
AU  - Luka Nkhoma
AU  - Doreen Chilolo Sitali
AU  - Joseph Mumba Zulu
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DO  - 10.11648/j.wjph.20220702.16
T2  - World Journal of Public Health
JF  - World Journal of Public Health
JO  - World Journal of Public Health
SP  - 70
EP  - 78
PB  - Science Publishing Group
SN  - 2637-6059
UR  - https://doi.org/10.11648/j.wjph.20220702.16
AB  - Increased access to contraception by women of child bearing age still remains a global public health challenge. For instance, in 2017, 25% of women who did not intend to get pregnant were not using any form of modern contraceptives. The majority (21%) of the women who were not using modern contraceptives live in Sub-Saharan Africa. We conducted twenty-seven interviews with five policy makers, ten health administrators and twelve Service providers in Lusaka District in Zambia. The interviews were conducted at the Provincial Health Office, Ministry of Health and at three first level hospitals. An interview guide was used to generate data and the data was analyzed using thematic analysis. The factors that were investigated included; leadership and governance, planning, financing for health, service delivery, human resource for health and monitoring and evaluation. Availability of human resource for health and financial support from cooperating partners were identified as enablers to integration of family planning and HIV services. The absence of policy guidance, limited physical space and lack of coordination were recognized as barriers to the integration of family planning and HIV services. In addition, lack of regular training for service providers, lack of donor flexibility on fund utilization and frequent stock-out of long-acting reversible contraceptives were additional barriers to integrating family planning and HIV services. The purpose of this paper is to document the factors which affect integration of family planning and HIV services in public health facilities in Lusaka District in Zambia.
VL  - 7
IS  - 2
ER  -

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Author Information

Luka Nkhoma

Institute of Distance Education, University of Zambia, Lusaka, Zambia
Doreen Chilolo Sitali

School of Public Health, University of Zambia, Lusaka, Zambia
Joseph Mumba Zulu

Institute of Distance Education, University of Zambia, Lusaka, Zambia

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APA Style

Luka Nkhoma, Doreen Chilolo Sitali, Joseph Mumba Zulu. (2022). Integration of Family Planning and HIV Services: A Study of the Health Systems Factors Affecting Integration in Public Health Facilities in Lusaka District in Zambia. World Journal of Public Health, 7(2), 70-78. https://doi.org/10.11648/j.wjph.20220702.16

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ACS Style

Luka Nkhoma; Doreen Chilolo Sitali; Joseph Mumba Zulu. Integration of Family Planning and HIV Services: A Study of the Health Systems Factors Affecting Integration in Public Health Facilities in Lusaka District in Zambia. World J. Public Health 2022, 7(2), 70-78. doi: 10.11648/j.wjph.20220702.16

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AMA Style

Luka Nkhoma, Doreen Chilolo Sitali, Joseph Mumba Zulu. Integration of Family Planning and HIV Services: A Study of the Health Systems Factors Affecting Integration in Public Health Facilities in Lusaka District in Zambia. World J Public Health. 2022;7(2):70-78. doi: 10.11648/j.wjph.20220702.16

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@article{10.11648/j.wjph.20220702.16,
  author = {Luka Nkhoma and Doreen Chilolo Sitali and Joseph Mumba Zulu},
  title = {Integration of Family Planning and HIV Services: A Study of the Health Systems Factors Affecting Integration in Public Health Facilities in Lusaka District in Zambia},
  journal = {World Journal of Public Health},
  volume = {7},
  number = {2},
  pages = {70-78},
  doi = {10.11648/j.wjph.20220702.16},
  url = {https://doi.org/10.11648/j.wjph.20220702.16},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.wjph.20220702.16},
  abstract = {Increased access to contraception by women of child bearing age still remains a global public health challenge. For instance, in 2017, 25% of women who did not intend to get pregnant were not using any form of modern contraceptives. The majority (21%) of the women who were not using modern contraceptives live in Sub-Saharan Africa. We conducted twenty-seven interviews with five policy makers, ten health administrators and twelve Service providers in Lusaka District in Zambia. The interviews were conducted at the Provincial Health Office, Ministry of Health and at three first level hospitals. An interview guide was used to generate data and the data was analyzed using thematic analysis. The factors that were investigated included; leadership and governance, planning, financing for health, service delivery, human resource for health and monitoring and evaluation. Availability of human resource for health and financial support from cooperating partners were identified as enablers to integration of family planning and HIV services. The absence of policy guidance, limited physical space and lack of coordination were recognized as barriers to the integration of family planning and HIV services. In addition, lack of regular training for service providers, lack of donor flexibility on fund utilization and frequent stock-out of long-acting reversible contraceptives were additional barriers to integrating family planning and HIV services. The purpose of this paper is to document the factors which affect integration of family planning and HIV services in public health facilities in Lusaka District in Zambia.},
 year = {2022}
}

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TY  - JOUR
T1  - Integration of Family Planning and HIV Services: A Study of the Health Systems Factors Affecting Integration in Public Health Facilities in Lusaka District in Zambia
AU  - Luka Nkhoma
AU  - Doreen Chilolo Sitali
AU  - Joseph Mumba Zulu
Y1  - 2022/06/16
PY  - 2022
N1  - https://doi.org/10.11648/j.wjph.20220702.16
DO  - 10.11648/j.wjph.20220702.16
T2  - World Journal of Public Health
JF  - World Journal of Public Health
JO  - World Journal of Public Health
SP  - 70
EP  - 78
PB  - Science Publishing Group
SN  - 2637-6059
UR  - https://doi.org/10.11648/j.wjph.20220702.16
AB  - Increased access to contraception by women of child bearing age still remains a global public health challenge. For instance, in 2017, 25% of women who did not intend to get pregnant were not using any form of modern contraceptives. The majority (21%) of the women who were not using modern contraceptives live in Sub-Saharan Africa. We conducted twenty-seven interviews with five policy makers, ten health administrators and twelve Service providers in Lusaka District in Zambia. The interviews were conducted at the Provincial Health Office, Ministry of Health and at three first level hospitals. An interview guide was used to generate data and the data was analyzed using thematic analysis. The factors that were investigated included; leadership and governance, planning, financing for health, service delivery, human resource for health and monitoring and evaluation. Availability of human resource for health and financial support from cooperating partners were identified as enablers to integration of family planning and HIV services. The absence of policy guidance, limited physical space and lack of coordination were recognized as barriers to the integration of family planning and HIV services. In addition, lack of regular training for service providers, lack of donor flexibility on fund utilization and frequent stock-out of long-acting reversible contraceptives were additional barriers to integrating family planning and HIV services. The purpose of this paper is to document the factors which affect integration of family planning and HIV services in public health facilities in Lusaka District in Zambia.
VL  - 7
IS  - 2
ER  -

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