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Phase I showed improved service uptake resulting from the integrated services model. This included an increase in the number of individuals and families accessing family planning, HIV and other SRHR services; increased uptake of HIV testing and counselling (HTC) and anti-retroviral treatment (ART) when needed; increased coverage of prevention of mother-to-child transmission (PMTCT), in particular the number of newborns screened for HIV; and an increased number of women and girls screened for cervical cancer.

Results in numbers (indicating change from 2012 to 2013):

  • In Botswana, the number of postnatal care clients accessing both HIV and family planning services increased from 18 per cent to 81 per cent and the number of women seeking family planning services also accessing HIV services increased from 0 per cent to 89 per cent.
  • In Lesotho, the number of clients accessing HIV testing and counselling services (HTC) increased from 3170 in 2012 to 8814 in 2013, and the number of women screened for cervical cancer increased from 629 to 877 for the same period.
  • In Namibia, nurse productivity improved 2.5 times and the length of time patients spent waiting for antenatal care (ANC) was cut in half.
  • In Swaziland, HTC uptake among pregnant women increased from 67 per cent in 2009 to 89 per cent in 2013, and the number of women seeking family planning services who also got tested for HIV increased from 0 per cent (2011) to 20 per cent (2013).

At policy level, the countries have done well in ensuring that integration is placed within their respective health and development plans, policies and strategies. All countries have placed integration in SRHR and HIV policies and developed and/or adapted SoPs on integration. The Linkages project enjoyed a successful collaboration with SADC on developing regional minimum standards on SRHR and HIV integration.

At systems level, oversight structures have been established and are in full operation. There is ongoing development and appraisal of tools to facilitate the work of these structures.

At the level of service delivery, all seven participating countries are involved with different activities to promote more effective project implementation. Facilities/service centres are equipped to provide a range of services.

Low involvement of men and boys was noted as a major challenge in phase I. Hence it is a focus in phase II. The other focus is increased emphasis on engaging communities, which was listed by all countries as the way forward to begin to address these gaps. The gender-based violence component is also to be strengthened; the aim is to include GBV services as part of the minimum package in at least three countries.

In phase I, strong documentation and monitoring and evaluation (M&E) were supported. A compendium with SRH/HIV indicators on outputs, outcomes and impact level was generated. Other examples of a strong evidence base are client satisfaction studies conducted in Botswana, Malawi, Namibia and Swaziland. A Civil Society Partnership Study was carried out and good practices were documented. Project evaluation and cost-efficiency studies are ongoing.  

For further details about the SRHR and HIV Linkages project, contact:
Innocent Modisaotsile
Regional SRH & HIV Advisor