Integrating reproductive health and HIV indicators into the Nigerian health system--building an evidence base for action.

The lack of integrated M&E system makes it difficult to assess the effectiveness of HIV and family planning (FP) service integration. Since 2007, Nigeria integrated FP and HIV M&E systems. A pre-post survey compared the availability and use of FP-HIV integration M&E tools six months pre- and 12-months post-integration in 71 health facilities supported by the Global HIV/AIDS Initiative Nigeria (GHAIN). Pre-integration, four facilities (6%) had national FP registers, 32 (45%) had monthly aggregated FP data and 33 (46%) reported data up to national level. Post-integration, all (100%) facilities used national FP register with FP-HIV integration indicators, and reported data up to national level. Sixty six facilities (93%) had at least one monthly supervisory visit. Average number of FP clients per facility referred for HIV testing increased from five in the first month to 15 by month 12 post-integration. Leveraging resources of HIV programs improved significantly the monitoring of FP-HIV services integration.

The use of routine monitoring and evaluation systems to assess a referral model of family planning and HIV service integration in Nigeria.

OBJECTIVE: To measure changes in service utilization of a model integrating family planning with HIV counselling and testing (HCT), antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT) in the Nigerian public health facilities. DESIGN: It is a retrospective survey of attendance and family planning commodity uptake in 71 health facilities in Nigeria that analyzes the preintegration and postintegration periods between March 2007 and January 2009. METHODS: A prepost retrospective comparison of mean attendance at family planning clinics and couple-years of protection (CYP) compared 6 months preintegration with 9 months postintegration period. An analysis of service ratios was conducted, relating completed referrals at family planning clinics to service utilization at the referring HIV clinics. RESULTS: Mean attendance at family planning clinics increased significantly from 67.6 in preintegration to 87.0 in postintegration. The mean CYP increased significantly from 32.3 preintegration to 38.2 postintegration. Service ratio of referrals from each of the HIV clinics was low but increased in the postintegration period by 4, 34 and 42 per 1000 clients from HCT, ART and PMTCT clinics, respectively. Service ratios were higher in primary healthcare settings than in secondary or tertiary hospitals. Attendance by men at family planning clinics was significantly higher among clients referred from HIV clinics. CONCLUSION: Family planning-HIV integration using the referral model improved family planning service utilization by clients accessing HIV services, but further improvement is possible. Male utilization of family planning services also improved. The government of Nigeria should review the family planning user fee policy and scale up the integration in primary healthcare facilities.