Integrated Services Necessary
Ranges of services are presently provided in compartmentalised ways, organised by ‘specialisation’ into departments between which clients are transferred. Clients may meet with an initial nurse or counsellor in a consulting or examination room. HIV counselling and HIV testing take place in a separate section of the facility, staffed by different nurses. Family Planning is a separate department. TB-screening is a separate department. Each area may have its own queue or waiting area.
Given that “visibility equals vulnerability”, and the realities of a busy, congested, high-traffic facility, this is a less than ideal design for an integrated service, especially one that is intended to be KP-sensitive. Amongst other effects:
It increases wait-time and through-time in the facility.
It increases the level of visibility and exposure for key populations to staff and other service-users; there is a higher chance of a KP-client leaving midway through the visit, or avoiding seeking services entirely.
It requires a client to repeat a history several times, depending on how many service providers he or she is required to see.
Improving integration is a technical, systems and culture issue, and one of practical design. It requires a different way of thinking about how health workers are trained, how the health system operates within the environment of the facility, and how the physical layout of the clinic is organised to facilitate smooth and efficient movement of clients from entry to exit. It presents a programming opportunity for modelling thoughtful design of a KP-friendly health facility.