Caribbean Regional Strategic Framework

Integration

Integration refers to rationalising health sector and social development resources, systems and processes in order to improve impact, efficiency and sustainability. In many countries, HIV services have been delivered through vertical or stand-alone programmes with parallel human resource, procurement and service delivery systems. There have been advantages and disadvantages to this approach. Strong central management structures have successfully mobilised significant external funding, and have delivered services effectively. In some instances, external funding earmarked for HIV has been used strategically to benefit the wider health system and to strengthen the capacity of civil society partners. In others, investment in HIV programmes has reduced the resources available for other health and social development programmes.

As donor funds for HIV diminish, there is widespread agreement on the need to improve efficiency in order to sustain quality HIV services. Many countries have made significant progress towards this by integrating HIV and other health platforms to reduce costs, improve planning and resource allocation and maximise return on investments. Weaknesses or gaps in the national health systems can hinder these efforts, however, and shared needs in this area can benefit from regional support. Immediate challenges include maintaining strong, central HIV programme leadership and ensuring that innovations developed by HIV programmes — including in the areas of outreach, social marketing, multisectoral and civil society partnerships, human rights promotion, stigma reduction and training — are adapted by chronic disease and other programmes. Outside of the health sector, the challenge is for countries to capitalise on investments already made in support of other development priorities. Integration with social development efforts will broaden the focus of the HIV response from individual risk behaviours to the social and structural factors that influence the health of populations. Improving the conditions in which people live will reduce health disparities, sustain and accelerate progress towards elimination. This requires a proactive and deliberate process of collaboration with the planning, education, labour, social security, culture, youth and community development sectors playing more meaningful roles in changing social and gender norms.

Strategic objective 5.1: Integrate HIV into national health systems.

Expected results:

1. National capabilities are strengthened to move towards more integrated service delivery.
2. Targeted technical support is provided to strengthen national health systems in the areas of:
   1. Leadership and governance: Legislation, policies and guidelines are in place for the integration and decentralisation of HIV and STI services in primary health care and SRH programmes, depending on the national context.
   2. Financing: National health accounts are developed.
   3. Service delivery: Countries are supported to transition from vertical services to integrated prevention, care, treatment and support.
   4. Human resources for health: National human resources for health (HRH) policies and plans covering training, retention, tracking and quality improvement are formulated and activated, including strategies for task-shifting.
   5. Medical products and technology: Laboratory services are continuously improved. Supply chain management and pharmacovigilance are strengthened.
   6. Strategic information: Comprehensive M&E plans are operationalised; health information systems are developed; and surveillance systems, research capacity and information sharing are strengthened.

Strategic objective 5.2: Integrate HIV into social and economic development efforts.

Expected results:

1. Priorities are identified for addressing social determinants of health and HIV, and strategies are developed to guide partnerships, research, and policy interventions for innovative and long-term action to address these.
2. Collaboration with non-health partners is strengthened to mobilise multisectoral action, including at the community level, to achieve health goals.
3. Social protection programmes, including economic interventions, are implemented to mitigate the impact of HIV in communities.