The Basket Indicator – Strengthen HIV integration
Whether the provision of core HIV and SRH services is integrated at the delivery point.
The delivery of one or more services from different HIV baskets and the delivery of one or more services from different SRH baskets at the service delivery point is an indication of the extent of the integration. The international community recognizes that key development goals will not be achieved without ensuring expanded and ready access to HIV and SRH services. Given the overlaps and connections between these two types of services and the ability to improve access to each of them by integrating HIV and SRH within service delivery points, it is useful to assess the extent of this service integration. A better understanding of the extent of HIV and SRH integration will contribute to ongoing efforts to strengthen and improve integration as well as the quality and availability of integrated services.
The simplest approach is to designate the numerator as the number of sound/proven service delivery points that provide services from one or more HIV basket and from one or more SRH basket. Sound/proven service delivery points are those points that report sufficient information on their services to assess their standing as a credible provider of HIV and/or SRH services.
Other options for the numerator include but are not limited to:
- The number of sound/proven service delivery points that provide services in each of the six baskets included in the questionnaire. Using this numerator would highlight delivery points with the highest degree of integration between HIV and SRH services.
- The numbers of sound/proven service delivery points that provide a specific HIV-related service (e.g. ART) and also provide one or more SRH service from one or more SRH basket. Using this numerator would focus attention on specific relationships between HIV and SRH services that could provide useful information for improving HIV and SRH integration.
- The numbers of sound/proven service delivery points that provide a specific SRH service (e.g. ANC) and also provide one or more HIV service from one or more HIV basket. As mentioned above, using this numerator would focus attention on specific relationships between HIV and SRH services that could provide useful information for improving linkages.
- The number of sound/proven service delivery points that provide services from at least two HIV baskets and two SRH baskets to a specific population group (e.g. female sex workers).
In every case, the denominator would be the number of sound/proven service delivery points included in the relevant sample. (If population group is being factored into the denominator, it would be possible to limit the denominator to service delivery points that provide services to the specified population(s).)
Numerator / Denominator
A representative sample of HIV and/or SRH service delivery points in the selected survey area (e.g. national, province, district, urban, rural) should be identified to complete the questionnaire. The questionnaire should be sent to participating service delivery points. One or more knowledgeable and authorized representative from the participating service delivery points should complete and submit the questionnaire.
Geographic location: Rural, Urban
The primary strength of this indicator is its ability to collect a significant amount of data on HIV and SRH service delivery using a simple and straightforward questionnaire. The reported data can be used in multiple ways to assess integration between SRH and HIV services at the level of the service delivery point.
Given the currently low level of integration between HIV and SRH services, this indicator may provide limited information on the breadth and depth of linkages. However, over the long term, as integration between HIV and SRH services become more common, the indicator will be increasingly useful for assessing linkages generally and integration between individual services more specifically.
One potential weakness of the indicator is the inclusion of STI screening, diagnosis and treatment as an HIV service as well as an SRH service. The delivery of STI services can and should vary based on the context and the population. For example, STI services available at a delivery point may not be sensitive to the specific circumstances facing people living with HIV. Similarly, not all delivery points providing STI services are capable of dealing with key populations, such as female sex workers or men who have sex with men. As a result, the reported data may show integration in STI services that are not necessarily practical, desirable and/or effective.
There is a parallel concern about condom provision, which also appears under HIV and SRH services. Including condom provision under both types of services flags the overlapping use of condoms for disease and pregnancy prevention. In general, service delivery points focused on HIV-related services distribute condoms to prevent the spread of HIV, not to prevent pregnancy. To simply count condom distribution by service delivery points as an SRH service could provide misleading data on the integration between HIV and SRH services.
Sexual & reproductive health and HIV linkages: evidence review and recommendations at http://www.who.int/reproductivehealth/publications/linkages/hiv_2009/en/
Rapid Assessment Tool for Sexual and Reproductive Health and Linkages at http://srhhivlinkages.org/wp-content/uploads/2013/04/rapidassessmenttool...