Integrating reproductive health: myth and ideology.

ABSTRACT

PIP: This paper provides a historical comparison between the health systems in Ghana, Kenya and Zambia and South Africa, to examine progress on integration of HIV/STD services since 1994. Findings gathered from the study conducted during 1997-98 revealed that the primary health care in Ghana, Kenya and Zambia has been used mainly by women and children and that integration has meant adding new activities to these services. For the vertical program which support these services, integration implies enhanced collaboration rather than merged responsibility. This compromise between comprehensive rhetoric and selective reality has resulted in little change to existing structures and processes; problems with integration have been exacerbated by the activities of external donors. By comparison, in South Africa integration has been achieved through political commitment to primary health care rather than expanding vertical programs (top-down management systems).