Health Systems Integration of Sexual and Reproductive Health Programmes for HIV Discordant Couples: The Case of Rwanda

A large proportion of new HIV transmissions on the African continent occur between long-term cohabiting HIV discordant couples. These couples have specific sexual and reproductive health (SRH) needs that often go unmet. In some contexts, SRH services are offered through vertical programmes that are not integrated with the primary health care (PHC) system. These vertical programmes, however, can lead to the undermining of health systems as a result of service fragmentation, and the preferential funding from external donors which can draw highly trained staff away from the public health care system. At the 1994 International Conference on Population and Development, there was a call for greater integration of SRH programmes into the PHC system to help ensure access and equity. Despite a history of conflict, Rwanda, through innovative service delivery mechanisms, such as performance-based financing and task shifting, has managed to integrate SRH services for HIV discordant couples into its PHC system. The purpose of this paper is to describe the steps the Rwandan government took to achieve SRH integration and distill the lessons that can be garnered from this achievement that may be valuable for other jurisdictions working towards integrated primary health care initiatives.