Improving the implementation of family planning through integration with HIV services is vital to reduce maternal and child morbidity and mortality that has been a concern especially in developing countries like Ethiopia (UNFPA 2016). The aim of this study was to develop a strategic plan that could facilitate the implementation of an integrated family planning and HIV services at the public health centre level. The researcher utilized an explanatory sequential mixed method design with quantitative data collected in the first phase and qualitative data collected in the second phase. Data were collected from 403 clients in face-to-face structured interviews and from 305 service providers by means of a self-administered questionnaire. Descriptive analysis was applied to describe the findings of the study. Significance testing between variables was computed by odds ratio, p-value and 95% confidence interval. Bivariate and multi-variate logistic regressions were used for the analysis. In Phase 1, awareness of family planning methods, male involvement, marital status, client satisfaction, family income, waiting time, training, awareness of policies/guideline and transport availability were statistically significant challenges identified by clients and service providers. The client and service provider respondents identified previous use of family planning, men’s involvement, client satisfaction, availability of behavioural change communication materials, accessibility, budget, infrastructure and medical resources as opportunities. In phase 2, the researcher utilized the nominal group technique (NGT) to collect qualitative data from programme officers. Twenty-four programme officers from 10 sub city health offices, city and national level participated in two nominal groups, consisting of 12 participants each. Multiple group analysis was used to analyse the data from the nominal groups. The five strategies ranked as the most important were leadership and management; capacity building; implementation of policies and guidelines; advocacy/awareness, and infrastructure. The findings in phase 1 and phase 2 formed the basis for the development of a strategic plan using the process planning model. The strategic plan was developed and validated with the active participation and involvement of programme officers. The plan is intended to be implemented by service providers and programme officers to facilitate the implementation of integrated family planning and HIV services at the public health centre level. / Health Studies / D. Litt et. Phil. (Health Studies)

The purpose of this study was to explore the level of integration of health promotion and disease prevention services with the curative care provided at hospitals and health centres in Addis Ababa, and to propose recommendations that could improve such an integrated health service. A quantitative approach, using an exploratory and descriptive design was applied at 22 public health facilities in Addis Ababa followed by the Delphi technique to reach consensus on ways to improve the integration of health promotion, preventive and curative care. An integrated health service (IHS) framework was used as the conceptual framework upon which the study was based. Multistage sampling involving stratified simple random sampling was applied to select hospitals and health centres while a systematic sampling technique was used to sample patients from the outpatient and inpatient medical departments. Data was collected by means of two questionnaires from patients and health service managers, respectively, following which two Delphi rounds with experts resulted in agreement on a contextually accepted integrated framework. The findings revealed that promotive and preventive services for chronic diseases were not optimally integrated in the routine health care services of the health facilities. Most health facilities lacked skilled health professionals, adequate medication and equipment to provide a comprehensive integrated service. The study emphasized the need for health service providers to undergo a paradigm shift and additional training in order to provide a comprehensive, patient-centred, integrated health service instead of only treating patients’ complaints. To assist this approach, the study affirmed the Integrated Health Service (IHS) framework as a tool which comprehensively demonstrates the cause, effect and progression of chronic diseases and the appropriate interventions which health professionals can apply in managing diseases or their risk factors. Recommendations for effective, integrated promotive and preventive health care, included the development of guidelines, protocols and policy documents for cultivating a healthy lifestyle, adopting effective disease prevention approaches, re-designing medical school curriculums, and staffing health facilities with trained and specialized staff, capacitating health facilities with the necessary equipment, medication and supplies that would enable the provision of an integrated health care service. / Health Studies / D. Litt. et Phil. (Health Studies)

Introduction: HIV referral and linkage system in many countries in general and in Ethiopia in particular was poorly characterised by low linkage rate. The purpose of this study was to analyses factors associated with poor referral and linkage system and develop strategies to improve the system. Methods: A sequential mixed method approach using exploratory descriptive study design was employed. The study was conducted in Addis Ababa, Ethiopia and it was conducted in two phases. Phase I involved data collection and analysis as evidence for the development of strategies while phase II was the development of strategies. For phase I, data were collected in steps 1 and 2 using individual interviews and focus group discussions respectively. The study participants were programme owners and partners who were supporting facilities during the data collection period in step 1 and health care providers in step 2. A total of 4 individual interviews and 3 FGDs were conducted with purposively selected participants. Data were analysed using computer assisted software called OpenCode version 4.2. Results: The findings revealed five themes namely, issues of referral and linkage practice, ensuring linkage through communication, issues of health care, issues of health care system and issues of partnerships and Health Bureau. Many gaps that affected the referral system were identified and in phase II, nine strategies were developed to strengthen the referral and linkage system. Conclusion:The results of this study highlighted weaknesses in the referral and linkage system of the HIV positive clients from counselling and testing services to chronic care and proposed strategies to strengthen those weaknesses. Measures to operationalise those strategies are also proposed. The successful implementation of the proposed strategies depends on the support of the ministry of health and regional bureau in terms of resources and the readiness of the health care providers to adhere to the proposed measures. Intervention research is needed to test the effectiveness of the proposed strategies. / Health Studies / D. Litt. et Phil. (Health Studies)