Status of Family Planning Status of Family Planning Programs in Countries with Programs in Countries with Severe HIV/AIDS Epidemics:Severe HIV/AIDS Epidemics:

Findings from Kenya and Findings from Kenya and ZambiaZambia

Purpose of the Study Purpose of the Study

To assess FPP in 6 – 8 countries hard hit To assess FPP in 6 – 8 countries hard hit by HIV/AIDS by HIV/AIDS

To understand how FP and HIV/AIDS To understand how FP and HIV/AIDS programs interactprograms interact

To advocate for strengthening FPP in To advocate for strengthening FPP in countries severely affected by AIDS by countries severely affected by AIDS by engaging governments, USAID and other engaging governments, USAID and other donorsdonors

Potential CountriesPotential Countries

• KenyaKenya• ZambiaZambia• Côte d’IvoireCôte d’Ivoire• South AfricaSouth Africa• ZimbabweZimbabwe• UgandaUganda• BotswanaBotswana• LesothoLesotho

MethodologyMethodology

Expert Interviews• Ministry of Health• NACC (or equivalent)• Donors• NGOs• Private Sector• Service Providers• Cooperating agencies/projects

Focus Groups• Providers in antenatal/FP clinics• Clients in antenatal/FP clinics• HIV+ women (drawn from PWA

groups)

Topics• Status of and Need for Family

Planning• Service delivery• Funding• Staffing/personnel issues• Role of NGOs and private sector• Health Sector Reform

Data Collection• Financial data• Survey statistics• Service statistics• Staffing patterns

Country Context – KenyaCountry Context – Kenya

Modern CPR/Unmet Need

0

10

20

30

40

50

60

70

1992 1998

Year

(%)

CPR Unmet Need

3827

36 24

Country Context – KenyaCountry Context – Kenya

Trends in Adult HIV Prevalence (15-49)

0

2

4

6

8

10

12

14

16

Year

Pe

rce

nt

HIV

pre

va

len

ce

Funding Trends: USAID

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

1995 1996 1997 1998 1999 2000 2001

Year

Fun

ding

($0

00)

Population HIV/AIDS Other Health

Political Support – KenyaPolitical Support – Kenya

““FP has fallen off the agenda, maybe because people FP has fallen off the agenda, maybe because people are dying. But it was never in govt. agenda are dying. But it was never in govt. agenda anyway….As it is now – it is a donor driven program anyway….As it is now – it is a donor driven program with donors supplying the necessary contraceptives.”with donors supplying the necessary contraceptives.”

““There is some element of political support though at There is some element of political support though at times FPP is politicized by thinking and saying that it times FPP is politicized by thinking and saying that it is a way of reducing voting power of certain people.”is a way of reducing voting power of certain people.”

““Was very strong in the 1970s but has waned over the Was very strong in the 1970s but has waned over the years and has taken a nosedive in the 1990s and into years and has taken a nosedive in the 1990s and into the 21the 21stst century.” century.”

Programmatic Changes - Programmatic Changes - KenyaKenya

• Traditional FP NGOs turning attention to Traditional FP NGOs turning attention to HIV/AIDSHIV/AIDS

• HIV/AIDS NGOs not incorporating FP into HIV/AIDS NGOs not incorporating FP into their mandatetheir mandate

• Integration not adequateIntegration not adequate

Perceived Need for FPPerceived Need for FP

• ““This may be the time when we need FP the This may be the time when we need FP the most ..including providing information on the most ..including providing information on the benefits of FP and promotion of condoms.”benefits of FP and promotion of condoms.”

• ““As far as I am concerned, the need for FP is As far as I am concerned, the need for FP is demonstrated by the consumption of demonstrated by the consumption of contraceptives. So long as there is consumption, contraceptives. So long as there is consumption, there is need… In any case the first step to there is need… In any case the first step to PMTCT programs starts with preventing the PMTCT programs starts with preventing the mother from getting pregnant.”mother from getting pregnant.”

Funding and Staffing TrendsFunding and Staffing Trends

• Donor funding increasing for HIV/AIDS Donor funding increasing for HIV/AIDS

• Funding for FP is either stagnating or Funding for FP is either stagnating or decliningdeclining

• Staff shortages due to AIDS deaths and Staff shortages due to AIDS deaths and overseas recruitment overseas recruitment

• Low staff morale is very lowLow staff morale is very low– Worker overloadWorker overload

– Lack of protection against HIV/AIDSLack of protection against HIV/AIDS

Country Context – ZambiaCountry Context – Zambia

Modern CPR/Unmet Need

05

1015202530354045

1992 1996

Year

(%)

CPR Unmet Need

149

31 27

Country Context – ZambiaCountry Context – Zambia

Trends in Adult HIV Prevalence (15-49)

16

17

17

18

18

19

19

20

20

21

1992 1993 1994 1995 1996 1997 1998 1999 2000

Year

Pe

rce

nt

HIV

pre

va

len

ce

Funding Trends: All Donors

0

10000

20000

30000

40000

50000

60000

1997 1998 1999 2000 2001 2002

Year

Fu

nd

ing

Am

ou

nt

($0

00

)

FP HIV/AIDS

• Number of policy documents existNumber of policy documents exist

• FP integrated into RHFP integrated into RH

• FP not approached multisectorallyFP not approached multisectorally

• No explicit shift from FP although perception that No explicit shift from FP although perception that GOZ’s emphasis is on HIV/AIDS GOZ’s emphasis is on HIV/AIDS

• Strong national FP strategy with components of Strong national FP strategy with components of HIV/AIDS HIV/AIDS

• HIV/AIDS strategy weak on FPHIV/AIDS strategy weak on FP

Political Support – ZambiaPolitical Support – Zambia

Programmatic Changes – Programmatic Changes – ZambiaZambia• Most NGOs and GOZ respondents satisfied with Most NGOs and GOZ respondents satisfied with

FP achievementsFP achievements

• FP integrated into RHFP integrated into RH

• CBD and employer-based programs established CBD and employer-based programs established

• Donors dissatisfied with FP results Donors dissatisfied with FP results

• Persisting barriers Persisting barriers

– spousal consentspousal consent

– lack of FP training institutions lack of FP training institutions

– Some methods limited to a few urban centersSome methods limited to a few urban centers

– Stockouts are commonStockouts are common

Need for Family Planning – Need for Family Planning – ZambiaZambia

• FP enhances quality of lifeFP enhances quality of life

• All respondents reiterated need for FP All respondents reiterated need for FP servicesservices

• Need is more critical because of Need is more critical because of HIV/AIDS, poverty and poor health status HIV/AIDS, poverty and poor health status of the familyof the family

Staffing Trends – ZambiaStaffing Trends – Zambia

• Acute staff shortagesAcute staff shortages– AIDS deathsAIDS deaths– Voluntary Separation Program Voluntary Separation Program – Deployment of staff to HIV/AIDS programsDeployment of staff to HIV/AIDS programs– Brain drainBrain drain

• Lack of trained staff in FP especially in the private Lack of trained staff in FP especially in the private sectorsector

• Low staff morale Low staff morale – poor protectionpoor protection– chronic illness and absenteeism chronic illness and absenteeism – increased workloadincreased workload

Funding – ZambiaFunding – Zambia

• Uncertain impact on funding for FP Uncertain impact on funding for FP

• Contraceptive security remains a major Contraceptive security remains a major issueissue

• Resources for HIV/AIDS programs have Resources for HIV/AIDS programs have definitely increaseddefinitely increased

• Efforts to secure funding for HIV/AIDS Efforts to secure funding for HIV/AIDS through SWAp but not for FPthrough SWAp but not for FP

Role of NGOs and Private Sector – Role of NGOs and Private Sector – ZambiaZambia

• Focus of NGOs has changed primarily due to Focus of NGOs has changed primarily due to fundingfunding

• New NGOs focusing on HIV/AIDSNew NGOs focusing on HIV/AIDS

• CARE Zambia discontinued its community FP CARE Zambia discontinued its community FP programs due to lack of fundsprograms due to lack of funds

• PPAZ did not receive funding from GOZ for their PPAZ did not receive funding from GOZ for their CBD activitiesCBD activities

• PPAZ lost USAID funding due to GAG rule PPAZ lost USAID funding due to GAG rule

Summary and ConclusionsSummary and Conclusions

• Strong recognition of continued need for FPStrong recognition of continued need for FP

• Emphasis shifting to HIV/AIDS Emphasis shifting to HIV/AIDS

– Government, donors and NGOsGovernment, donors and NGOs

• Resource for FP may be decliningResource for FP may be declining

• Definite impact on staff availabilityDefinite impact on staff availability

• Integration of HIV/AIDS services into RH/FP more common than integration of FP into HIV/AIDS programs

• National AIDS Control Program and MOH are not working closely

• Skepticism concerning the impact of health sector reform

Recommendations so farRecommendations so far

• Advocacy efforts aimed at governments, donors and NGOs

• Further research on impact of HIV/AIDS on staffing

• Operational policies emphasizing the integration of FP services into HIV/AIDS programs