The Obama administration's Global Health Initiative (GHI), announced in May 2009 as a six-year, $63-billion program, has put a strong emphasis on integration of health services, building largely on the work of PEPFAR (the President's Emergency Plan for AIDS Relief). As implementation of GHI is moving ahead and country strategies are being developed, this is an important moment to bring forward lessons learned from the experience of integration in the U.S. government's health and development programs. A key example involves U.S. health programs in Kenya over the past five years, notably the APHIA program (the AIDS, Population and Health Integrated Assistance program), which developed an integrated program based on the PEPFAR platform. This paper finds that the APHIA programs in Kenya hold some important lessons that should help inform GHI implementation. Since Kenya has been designated one of eight GHI-Plus countries, the emphasis on program integration in those U.S. government programs is especially relevant.
This paper, which is based on interviews conducted in Kenya in November 2010, as well as with policymakers and implementing partners in Washington, D.C., shows that the APHIA experience illustrates that integration across health sectors is feasible and effective, and that more focused evaluation of the impact of integrated programs would help Kenya and other GHI-Plus country teams and national governments as they develop their strategies. The maternal and child health (MCH) model in Kenya's Western province is emerging as an innovative example of the benefits of providing women with a comprehensive set of MCH, family planning, reproductive health, and HIV/AIDS services in an integrated setting. Moving forward, the paper identifies key areas to watch as the GHI program in Kenya is implemented, including: how the GHI principle on women, girls, and gender equality will be implemented; how the social determinants of health will be addressed, and how linkages will be made beyond the health sector; how integration of services will be prioritized and measured; and how GHI's emphasis on greater U.S. government coordination will be realized.
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