A key component of TIP is to strengthen the capacity of local and national CSOs to identify and take advantage of advocacy opportunities for advancing RH/HIV integration within policies and structures of the Global Fund, the U.S. government, and their national governments. As part of their work in TIP, civil society partners in Ethiopia, Kenya, Nigeria, Tanzania, and Zambia have done a landscape analysis of RH/HIV integration within their respective countries. Partners are using the assessments to develop communication materials for advocacy with key stakeholders to advance RH/HIV integration at the national level. Partners found that despite different national contexts in their respective countries, they share several similar challenges and opportunities.

Partners’ assessments revealed that while the benefits of integration are recognized by governments, CSOs, donors and technical agencies, the policy environments in each country vary in the strength of their support. Kenya, for example, has developed a specific national strategy on RH/HIV integration strategy while in other countries references to integration are buried within various strategies on HIV or FP/RH.

For all the countries, the main entry point for RH/HIV integration has been the delivery of PMTCT services within the antenatal care clinic (ANC) settings. However, there are successful integration pilots going on specifically to integrate FP into HIV services. For example, even though there is no overarching policy on RH/HIV Integration in Zambia, efforts exist to integrate RH/HIV services at service delivery levels particularly voluntary counseling and testing and STI testing sites.

Despite movement to increase integrated services within each of the countries, these TIP partners’ assessments found that many challenges remain at both the policy and delivery levels. Lack of coordination between National AIDS Councils and Reproductive Health Units are of ongoing concern as is the lack of capacity to deliver services because of untrained health staff, parallel reporting, weak referral systems and poor facility infrastructure. A lack of integrated donor funding was also cited as a problem by CSO partners.

Fortunately, the assessments also identified several upcoming opportunities for advocacy on these issues. A number of these countries are reviewing and or developing key national RH- and HIV-related policies, strategies and implementation frameworks, and many of the TIP partner CSOs are participating in these policy reviews and/or development. For example, the Zambian government is developing its National Health Strategic Plan for 2011-2015 and Kenya is reviewing/revising its 3rd National AIDS Strategic Plan (KNASP-III).

Partners are also linking their national level integration work to advocate within influential global institutions. The development of proposals for Global Fund Round 11, the PEPFAR Country Operation Plans (COPs), partnership frameworks and GHI Country Strategies also provide opportunities to advance RH/HIV integration. In Tanzania, the Country Coordinating Mechanism meeting endorsed the inclusion of integration into Round 11 proposal development. In addition to other TIP countries, Zambia’s PEPFAR/GHI team is also championing FP integration and the one-stop-shop model within the partnership framework.