Sexual and Reproductive Health (SRH) services and HIV programmes are both typically delivered vertically, operating in parallel to national health systems. Such separate service delivery is considered a factor in why the reproductive health needs of women living with HIV remain unmet and, thus, are seen as missed opportunities to link these women to HIV treatment and care programmes.
In South Africa, although SRH and HIV integration was included in policies, it was not fully implemented as there was insufficient guidance on how service provision should be carried out in an integrated manner. This was compounded by a lack of human resources, as well as poor quality of services. Botswana, on the other hand, had made good strides in supporting and strengthening health facilities that provide integrated SRH-HIV services.
Towards a Solution
A South-South Cooperation initiative was conducted to learn lessons and good practices from Botswana on strengthening delivery of comprehensive and integrated SRH and HIV services. This was done through a well-designed learning exchange visit by a South African delegation from the Ministry of Health. The Ministry sought to identify service delivery models that could be implemented to strengthen SRH and HIV integration. The methodology of the learning exchange entailed a policy briefing at the national level and visits to two districts in Botswana. In the district visits, participants learned about the progressive implementation plan of the programme and made four site visits to examine three distinct service delivery models — the “kiosk” (where all services are provided in one room), the “one-stop shop” (where all services are provided in the same room or facility) and the “mall” (where clients are referred to other rooms within the facility). Botswana’s learning programme for its relevant health personnel was also discussed. The visiting delegation observed the involvement of traditional leaders and the community.
In the truest spirit of South-South Cooperation, the learning was not a one-way street. The South Africans also shared with their Botswana hosts the design of their successful programme in addressing the health needs of sex workers. In addition, South Africa shared their “She Conquers” campaign, a programme aimed at providing every adolescent girl and young woman with the resources that they need to lead a healthy, happy and successful life. While observing in one health facility in Botswana that health care workers needed to complete nine registers (data collection tools) in the consultation room, the South Africans shared how they were able to reduce the number of registers to three.
There were benefits to all parties from this initiative. At the advocacy level, the South Africa Ministry of Health was inspired by what they observed and committed to institute service improvements. At the technical level, there were efficiencies gained by simply adopting and contextualizing what was learned instead of starting from scratch. Using the templates gained from Botswana, South Africa launched training programmes for its personnel and developed district implementation plans.
This practice demonstrates how two middle-income countries used the South-South Cooperation modality for mutual gain. It also showed how to design a successful learning visit. An important lesson here is that good preparatory work prior to the learning mission is crucial. Before drafting the concept note and agenda, it is vital to explicitly identify the good practices and what the office is hoping to learn from the intervention. This guides the mission focus, as well as the field visit to specific areas of interest.