Integrated services: Health for all in action
Reproductive, maternal, newborn and child health services are often the first point of entry into the health system for women and children. Integrating communicable disease services into RMNCH can ensure more women and children have access to essential services.
Integrating Health Services
“I am happy today, I get many tests and screenings in today’s visit, these helped in knowing my health status and health of my conceived baby with minimum energy and cost,” says Astede, a 30-year-old pregnant woman, on her antenatal care visit to Telalak Health Centre in Afar, Ethiopia.
Astede is one of the many women who midwife Hana will see during her antenatal clinics at the health centre in Telalak woreda (district) of Afar region, where nearly 87% of the population lives in rural areas and average population density is just 20 people per square kilometre.
Hana has received training from three Amref-implemented programmes which were integrated from March to September 2022 to reach mothers with comprehensive antenatal and infectious disease screening services. She says:
“Astede is one of my clients who follows ANC [antenatal care] and in her visits we provide her with medical check-ups, HIV testing, and screening for malaria and TB and other infections in a single visit in our unit. Now she has been diagnosed positive for malaria and we are treating her in this unit.”
Integrated, patient-centred care and prevention
Last year, three Amref programmes were integrated to provide comprehensive antenatal and infectious disease screening and care services in the Afar region of Ethiopia.
A ViiV Healthcare Positive Action-funded programme to improve the prevention of mother-to-child transmission of HIV (PMTCT) was integrated with a GSK-funded TB & malaria programme focussed on improving the diagnosis and management of these diseases amongst mothers and children.
These two infectious diseases programmes were also integrated with a USAID-funded programme focussed on improving essential maternal and child health services called the Transform: Health in Developing Regions (T-HDR).
Reaching women and children with comprehensive preventive information and care services at their first point of entry into the health system means more effective delivery and more effective coverage for the health issues that affect these vulnerable groups.
Why should we integrate care?
There are close interconnections between the health messaging and services as well as the target groups for HIV, TB and malaria and for reproductive, maternal, newborn and child health (RMNCH). Integrating prevention, care and treatment for these communicable diseases with RMNCH services can greatly enhance services and contribute to improving the health of women and children.
Saving time and cost for mothers
For Astede, having access to all these services in one visit means that she does not have to repeat the long journey to the health centre for each screening, testing or check-up service, which would cost her £8 on average every time.
It also means that she, and other pregnant women, are more likely to attend these antenatal appointments. Overall, there was an increase in eligible women in Afar attending these services from 55-60% pre-integration to 75-80% after integration.
Effective layering of training
The integration of these programmes also allowed more effective layering of health worker training. In the Afar region, 10 health facilities integrated these three programmes.
To be trained in PMTCT, health workers must have an obligatory base in Basic Emergency Obstetric and Neonatal Care (BEMONC). By integrating these programmes and aligning geographically, it meant that health workers already had BEMONC training as standard through one programme and were able to easily take advantage of the additional PMTCT training being offered in the second programme to advance their knowledge and skills.
Sister Hana Birhanu, Health Worker, Metti Health Centre, Gambella
Sister Hana Birhanu (pictured) received training in BEMONC and PMTCT as a result of this integration. NB: In the Gambella region, two programmes were integrated: the ViiV Healthcare Positive Action PMTCT programme and the USAID-funded T-HDR programme.
“I did not have enough knowledge and skills to provide all types of services to antenatal care clients who visit our facilities. I used to refer some clients to other nurses or health centres to ensure they received all services they need. Now things are changed, I have trained on multiple topics including updated BEMONC and PMTCT service provision. Now I can see and manage most cases, I provide HIV counselling and testing to my clients in this unit. These training opportunities have not only reduced clients’ burden but also improved my confidence to provide the demanded services. Now I and my clients are very satisfied.”
Alignment and coordination: operations and technical activities
“The three programmes have been implemented as one programme,” says Mohammed Abrar, Regional Manager, Afar Region, Amref Health Africa Ethiopia.
“We were effective and saved costs in implementing the projects both programmatically and operationally. If projects are implemented independently, all projects may require their own additional costs for project implementation.”
Integrating the three programmes meant operational savings – using the same vehicle, sharing staff and administrative costs, sharing supervisions and programme reviews – as well as technical, by using an integrated maternal health service checklist and a joint action plan to improve coordination. This also saved time for health workers which is important in settings where the health workforce is already stretched through under-resourcing. Mohammed surmises: “Simply we have saved not only the budget but also the energy and expenses of our [programme participants] by availing multiple services in a single unit and visit.”
