20th International AIDS Conference - Melbourne, Australia


THPE394 - Poster Exhibition

Toward greater sustainability in Jamaica: national-level integration of family planning and HIV programming to create a new agency for sexual health

C.D. Carr1, K. Harvey2, K. McClure3

1Futures Group, Health Policy Project, Washington DC, United States, 2Ministry of Health, Kingston, Jamaica, 3Health Policy Project/Futures Group Consultant, Kingston, Jamaica

Background: Classified as an upper-middle-income country in 2010, Jamaica is reorganizing its HIV response to heighten efficiency and sustainability. A key challenge involves sustaining the program given declining external assistance and a government in fiscal crisis. Facing this challenge, the Jamaican Ministry of Health has integrated elements of its HIV program into its family planning program to create a new Ministry of Health (MOH) agency for sexual health.
Description: In undertaking this reform, the MOH found a dearth of guidance about national-level integration. Thus, the MOH collaborated with the USAID- and PEPFAR-funded Health Policy Project to assess lessons to date in Jamaica and map next steps. The 2013 assessment entailed desk review and interviews with 18 stakeholders from government, civil society, and donor agencies. This assessment covered integration initiation in 2010 through implementation in 2013. As of 2014, the agency officially exists; efforts are underway to address governance, policy, communications, and other issues identified by the assessment.
Lessons learned:
  • Integration proved different than a merger. It resulted in a new organization warranting a new strategy.
  • Both government and donor champions were necessary to propel a process requiring ongoing time, attention, and funds.
  • Planning and implementing an evidence-informed process took three years. Experts were needed to advise on legal, governance, organizational, and other issues.
  • Major stakeholder concerns included maintaining mechanisms for civil society participation, focus on key populations, and balance between HIV and family planning priorities.
  • Integration elicited stakeholder optimism and fears. Assessment and communications are critical for addressing concerns.
  • Change management and communications are key for addressing potential integration “stalling points”: reducing staff and addressing HIV-FP program differences and asymmetries.
  • Leadership of the new agency requires a “bridge-builder” with grounding in HIV and family planning.

Conclusions/Next steps: Jamaica''s integration experience may be useful to other countries seeking more sustainable HIV-FP programming models. While integration has strengthened institutional sustainability, evidence is still needed to demonstrate cost-savings, efficiencies, and outcomes. The MOH will continue to assess results. Next steps for the new agency include service-level integration. Progress in this area has been uneven, partly due to perceived gaps in decision-making authority.

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