Minimum service package for FGS Integration in SRHR programmes

© Frontline AIDS/Denis Mwangi/2023

Key information

  • Organisation: Frontline AIDS
  • Country: Multi-country: applicable to all schistosomiasis-endemic countries
  • Region: Global
  • Stage of innovation: Stage 2: Proof of concept developed
  • Start date: 01/03/2023
  • Type of innovation: Conceptual innovation: new ways of looking at problems, challenging assumptions, or both
  • Funders: Children’s Investment Fund Foundation (CIFF)

Summary of intervention

Female genital schistosomiasis (FGS) affects an estimated 56 million women and girls in sub-Saharan Africa. Untreated, FGS can result in anaemia and serious sexual and reproductive health (SRH) complications such as ectopic pregnancy, low birth weight, miscarriage and infertility. FGS can increase risk of human papilloma virus — a precursor to cervical cancer — and triples the risk of HIV. Symptoms are similar to STIs, often leading to misdiagnosis resulting in stigma and gender-based violence. Although one of the most common SRH issues in sub-Saharan Africa, FGS remains misunderstood, under-researched and under-diagnosed. Evidence shows an integrated approach is necessary to tackle FGS and its consequences for SRH and HIV, however, there has been a lack of guidance on integrating FGS within sexual and reproductive health and rights services and programmes.

Frontline AIDS developed the first minimum service package (MSP) for integrating FGS and SRHR services. It includes three main service areas: health literacy; screening and diagnosis; treatment and care, and a cross-cutting area — social inclusion and equity. It outlines activities for FGS-SRHR integration across services delivery points at community, primary health care, and secondary and tertiary health care levels.

The MSP was developed with an underlying assumption that all staff implementing the MSP are trained on FGS, applicable to their cadre and outlines the ethical need to ensure that praziquantel — a medication used to treat parasitic worm infections such as schistosomiasis — is available in all levels of facilities for treatment and prevention. The MSP also directs users to applicable clinical and diagnostic information, guidelines and training competencies for staff.

learnings

The MSP was developed using a participatory approach, with contributions from 35 experts from the SRH, HIV, NTD, FGS, WASH and cervical cancer sectors across various countries. The participatory process included in depth literature reviews and the identification of a foundational framework for the integration of FGS and SRHR interventions. The foundational framework laid the ground for the identification of the integration points and activities across the four areas of the MSP.

Challenges included the short timeline of approximately 2–3 months to complete the development of the MSP, which was particularly demanding given the extensive consultation required. The MSP also relies on a certain number of assumptions that must be met to successfully implement the integrated activities. These assumptions include that health workers and community health workers will be trained on FGS and that praziquantel will be available in health facilities, which is currently not the case in most countries.

Virtual workshops allowed a thorough consultation of experts across different countries and regions.

next steps

This global MSP is now ready to be contextualised and tested in different countries. As part of the FGS integration project, health workers and community health workers in nine sites across Homa Bay, Kilifi and Kwale counties in Kenya will now be trained on the MSP. Following training, the integration of FGS within SRHR as per the MSP will be piloted in the nine project sites. The feasibility, acceptability and cost of this will be assessed and results from this study will inform adaptations to the MSP.

sustainability

A peer review journal article was developed on the MSP, and Frontline AIDS will continue advocating for the MSP to be contextualised to other countries with endemicity of urogenital schistosomiasis.

To enable other endemic countries to use the MSP, it will be translated into French and Portuguese and made available online.

 

Tags


Health SystemsHealth workersHIV preventionPeer educatorsPolicy makersSexual and reproductive health and rights (SRHR)