Harubu is an HIV-positive woman living in Bagamoyo, Tanzania. She receives her antiretroviral treatment from an HIV/AIDS care and treatment center with assistance from a home-based care provider. Like millions of women around the world, Harubu also needs access to contraceptives, so that she can protect herself from unwanted pregnancy. But the health worker who provides her HIV medication can’t help her. Instead, Harubu must miss work and travel miles to a separate clinic in order to access family planning services.

Harubu’s story shows that not everyone in Tanzania is able to access integrated reproductive health and HIV programs.  In many areas women living with HIV face barriers to accessing comprehensive health services.

A home health care worker provides a woman with her HIV medication. In many parts of Tanzania, women living with HIV face barriers to accessing contraception.

A home health care worker provides a woman with her HIV medication outside of Dar es Salaam, Tanzania. Many women living with HIV there face barriers to accessing contraception.

Recently I had the opportunity to travel to Tanzania to see international family planning programs supported by U.S. foreign assistance in action.  I spent five days in Dar es Salaam, Zanzibar and Bagamoyo, a rural town two hours outside of Dar es Salaam, visiting hospitals, learning from peer educators and talking to women – some of whom benefit from truly accessible family planning services and others who are forced to travel miles just to get services they need and want.

In Bagamoyo, I met with a group of women like Harubu, who are receiving their HIV treatment with the assistance of Yassini, a home-based care provider. Yassini helped the women form a support group for women living with HIV. But Just like Harubu, these women can only receive antiretroviral treatment from their HIV/AIDS care and treatment center.  For other health services, including information, counseling and provision of contraceptives, these women have to travel to a separate clinic.

The women often have to take time off from work and family to travel to the separate clinics.  With help from Yassini, women in the support group started a small business selling tea, which makes it easier for them to coordinate work schedules and travel to different health facilities. In addition to traveling added kilometers to a second health facility, the lack of integrated services also poses challenges in finding a trusted health care provider. When the women I met in Bagamoyo developed a good relationship with a health care provider for their HIV treatment, this provider could not meet all of their health care needs.  To receive other reproductive health services meant visiting another facility, meeting another provider, possibly disclosing their status to a new person with no guarantee this new provider would be accepting or supportive.

When directly asked “Would you like to be able to get reproductive health and HIV services in one place?” the women unanimously responded, “Yes!”

In the Temeke district of Dar es Salaam, I was able to see firsthand what this integrated clinic could look like. While the Mbagala Health Center was more crowded than any I’ve ever seen in the US, women and men had access to a full range of services from family planning, to a maternity ward to HIV counseling and testing.  Across the courtyard from the main health center was the HIV care and treatment clinic where people could also access reproductive health services, testing and treatment for other sexually transmitted infections, and support for victims of gender-based violence.

The integrated reproductive health and HIV programs at Mbagala Health Center increase women’s access to information and services that help to reduce unintended pregnancy, maternal mortality and mother-to-child transition of HIV.  It allows women to get everything they need at one time, in one convenient place, so they don’t have to miss work or find someone to care for their children in order to travel to yet another clinic. This, in turn, increases their productivity and income.  While it’s great to see that women living in Dar es Salaam have access to integrated programs, all women deserve the best and most complete care.