INTRODUCTION TO
(RH ) KUNDA
JFS
@LMMU
INTRODUCTION
This unit covers the definition and components of
RH, Reproductive Health Policy, and the
Principles of IRH
Introduction cnt’d
The session will be interactive, and will be
more interesting with your full participation
Objectives
At the end of this Unit, you should be able to;
[Link] RH and IRH
[Link] the components of IRH
[Link] the Reproductive
Health Policy
[Link] the Principles of RH
DEFINITION OF TERMS
Reproductive Health (RH)
Reproductive Health is a state of complete
physical, mental and social wellbeing and not
merely the absence of reproductive disease
or infirmity
Definition of terms cnt’d
Integrated Reproductive Health
(IRH):
This is a comprehensive approach to Reproductive
Health in a response to expanding needs arising
from; increased demand for family planning, greater
awareness of maternal and neonatal mortality and
morbidity, and a growing burden of reproductive ill
health (MoH, 2003)
Components of IRH
The components of IRH include:
1. Reproductive health information
To expand/ increase reproductive health
information and service provision so that all
individuals and couples will be able to achieve
their reproductive intentions while upholding
their reproductive rights
Components of IRH
Reproductive health information
To strengthen the concept of Integrated
Reproductive Health through advocacy and
IEC so as to ensure sustainability of Integrated
Reproductive Health programs
Components of IRH
2. Safe motherhood
To ensure the provision of quality
Integrated Safe Motherhood Services
which are accessible, acceptable and free at
all levels of the health care system
Components of IRH
3. Family planning
To ensure that procurement of family
planning commodities are made on a
sustainable basis
To ensure that provision is made for
production and distribution of IEC
Components of IRH
4. Maternalnutrition
To ensure that the nutritional status of
women and adolescent girls in
particular, is improved to prevent health
problems
[Link] health and development
To empower adolescents/youth by
equipping them with life skills,
including assertiveness, self esteem,
value clarification and decision making
in order to achieve a positive life
attitude Adolescent health and
development
Components of IRH
To increase accessibility and availability of
affordable Youth Friendly Health Services
to adolescents/youth at all levels of the
health care system
6. STIS/HIV/AIDS
[Link] strengthen the prevention and effective
management of
STI/HIV/AIDS
Components of IRH
[Link] reduce the rapid spread of HIV/AIDS
7. Abortion
To strengthen the quality and availability of
Post Abortion Care (PAC) and counseling
services within the context of Integrated
Reproductive Health
7. Infertility
Components of IRH
1. To ensure the provision of appropriate services for
overcoming infertility barriers to the achievement of
reproductive intentions
8. Health service delivery
To ensure the provision of quality reproductive health
services at all levels of the health care system
Components of IRH
Other reproductive health issues
To strengthen diagnosis and management
of all related reproductive health cancers
at all levels of health care system (cancer
of the cervix, breast and prostate)
To ensure that there is a preventive and
curative programme for women after
menopause
Components of IRH
To prevent harmful traditional practices,
such as female genital mutilation, unsafe
male circumcision
IRH POLICY
The reproductive health policy was
formulated by the Ministry of Health to
provide guidelines to different sectors
involved in the implementation of
reproductive health programs
IRH Policy cnt’d
The policy is set to respond to the country's
prevailing reproductive health situation in order to
improve the standard of living and quality of life for
Zambians
The Reproductive Health Policy(RHP) provides
guidelines to different sectors involved in the
implementation of reproductive health programmes
IRH Policy cnt’d
The policy commits itself to addressing the
reproductive health needs of individuals and
families, as well as supporting their physical,
mental, emotional and social development
throughout their life cycle
The policy also commits itself to the concept of
Reproductive Health which encompasses
Safe Motherhood and includes:
IRH Policy cnt’d
Safe Abortion care
Family Planning:
Adolescent Health
STD/HIV/AIDS
Gender issues throughout the life of individuals,
within the context of population and sustainable
development,
and reduction of poverty
IRH Policy cnt’d
Additionally, the policy is committed to advocating
for a multi-sectoral approach to reproductive
health by involving:
Other Government Ministries
Non-Governmental Organization
IRH Policy cnt’d
Politicians
Policy makers
Senior managers
The Community
Church organizations and other concerned bodies
and users of services
Other commitments for IRHP include:
IRH Policy cnt’d
Creating an enabling environment for the provision of
reproductive Health services by;
effective management
training supervision
essential logistic supplies
infrastructure
referral system
Other commitments for IRHP include:
IRH Policy cnt’d
Guaranteeing that all public and private health facilities
will provide the essential Reproductive Health services to
all in consistent with the level of experience and training
of service providers
Providing Reproductive Health information and services to
all regardless of age, gender, and marital or socio-
economic status
IRH P cnt’d
Other commitments for IRHP include:
Taking into account the religious, social and
cultural factors in the provision of sexual and
reproductive health information and services in
the various communities and groups of people
Other commitments for IRHP include:
Protecting the rights of the clients in the
course of obtaining appropriate medical
information and services and ensuring
maximum confidentiality and privacy
Other commitments for IRHP include:
Strengthening existing pre-service, in service and
post graduate training on reproductive Health, and
ensuring regular updates according to staff
performance and establishing appropriate
IRH Policy cnt’d
infrastructure to meet the service provision
requirements
IRH Policy cnt’d
Other commitments for IRHP include:
Involving traditional practitioners/healers in the
promotion of safe practices for all aspects of
sexual and reproductive health (MoH, 2000)
Conclusion
We have come to the end of our discussion on the
IRH Policy
We saw how committed the policy on the concept
of RH like Safe Motherhood that encompasses
IRH Policy cnt’d
Safe Abortion care, Family Planning, Adolescent
Health, STD/HIV/AIDS and Gender issues in
individual’s lives
Conclusion cnt’d
We looked at other commitments of the IRHP like
creating an enabling environment for the
provision of reproductive Health services by
effective management, training, supervision,
IRH Policy cnt’d
essential logistic supplies, infrastructure
development quality and reliable referral
system
PRINCIPLES OF IRH
PRINCIPLES OF IRH
Integrated Reproductive Health has
12 principles which are as follows:-
1. Community Participation
Community participation is essential at all
stages to ensure acceptability,
appropriateness and sustainability of RH
programmes
It is necessary for empowering the community,
particularly women, to have greater control over
their lives and over the services that are provided
to them
It is through community participation that
essential information will be gathered to direct
the planning of services
Such information includes:
Identification of the training needs of care
providers
Selection of appropriate sites to avoid
stigmatisation of users. Analysis of the
appropriate level of privacy and
confidentiality required by local customs,
cultures or beliefs
Decisions on whether primarily female staff must be
used; and recognition of birthing preferences
Failure to obtain such information may have a
negative impact on the use of services, for example, if
family members are excluded from a birth when they
have an important cultural role to play at such times
It is important that both men and women be
involved in many aspects of the RH programme
to promote responsible and caring attitudes and
behaviour for the benefit of all
Although men may be poorly informed about RH
matters, they are often the decision makers
Health providers need to be aware of the
roles and decision-making process within the
family so they can provide services effectively
and in the best interests of the whole family.
2. Quality of Care
Quality RH services require that
organisations, programmes and providers use
appropriate technologies and have trained staff
There is also need to respect clients’ rights to
informed consent by providing adequate
information and counselling,
RH Care providers must ensure accessible services,
privacy,
confidentiality, and continuity of care
These aspects of quality of care are also guiding
principles of medical ethics in the protection of
human rights
3. Appropriate Technologies and Skills
Appropriate technologies must be selected
according to universal standards
Providers must be adequately trained,
equipped and supervised
Appropriate supplies must be available, clean and when
necessary should be sterile
All invasive procedures must involve Infection Prevention (IP)
and proper use of drugs should be upheld
4. Accessibility
Primary Health Care (PHC) services must be available within a
reasonable distance for all patients (at least within 5Km
radius)
A referral network, including transportation
of clients to higher level facilities should be
attached to PHC services
Patients’ access to services should not be
dependent on social or cultural backgrounds
nor on age, marital status, parity, number of
male children, sexual orientation,
Patients should not be required to accept one service in
order to gain access to another type of service
partner or parental consent
5. Informed Consent
A patient has the right to know, before any procedure
is performed, what the procedure involves as well as its
expected benefits, possible risks, duration of
treatment, and cost to the patient or her/his family
This information must be presented to the
patient in a language that s/he can
understand
Informed consent means that the patient not
only has choices, but also can make an
informed decision among various options
To make such a decision, the patient must know her/his
condition and have ample opportunity to ask questions
and receive answers from a knowledgeable provider
6. Privacy
Visual and auditory privacy must be maintained during all
phases of patient care, that is, from presentation
through diagnosis, testing, treatment, and counselling
Examination tables should face away from
doors and windows so that a woman will not
risk exposure during examination, particularly
during pelvic examination
Windows should be covered, and partitions
placed between
examination areas
Others within the health facility should not be able to
overhear the interaction between the patient and
health provider
7. Confidentiality
All information regarding the patient, her/his history,
treatment, condition, circumstances, and prognosis
is discussed only between the patient, the provider
and supervisors
No staff member should share patient information
with anyone who is not directly involved in the
patient’s care without the patient’s permission
(shared confidentiality)
Medical records should be stored in a locked room
or file cabinet to which only providers and
supervisors have access
Medical records should never leave the clinic
unless required for patient referral to another
clinic
8. Respect
All health staff should talk with patients politely
and manage patient care in a compassionate and
non-judgmental fashion
9. Integrating Services
Reproductive health services should be integrated into
primary health care
Integration may occur in relation to the place at which
services are provided or the personnel who provide those
services
The potential to integrate services provided at any particular
site will depend on the skills and resources available
Successful integration is dependent on the quality
of communication among the various personnel, at
different levels, within the overall service
All personnel must be fully aware of how the
system operates, what services are provided at
each level, and how those who want to use the
services can do so
The staff at one level must be able to provide
information about all other levels
When referrals are made between levels,
adequate information about the patient must
travel in both directions and must cover both the
reasons for a referral and the eventual
consequences of any action taken
10. Information, Education and
Communication (IEC)
Reproductive health requires knowledge and
understanding about human sexuality and
appropriate, adequate and accessible information
Scientifically validated knowledge should be
shared to promote free and informed choice
and to counter misperceptions and harmful
practices
IEC activities are essential for sharing
this knowledge
Such activities range from “one-to one”
conversations between service providers and
clients to highly developed formal campaigns
There are also effective IEC strategies that
promote community participation and in
dividual commitment to changing behaviours
11 Advocacy for Reproductive Health
The active promotion of reproductive health should be
part of all communities’ assistance programmes
A lack of awareness of the issues involved in protecting
and promoting reproductive health may be found in all
groups involved in a community setting, from the
providers of health care to the community they serve
This lack of awareness may become a real barrier to
improved reproductive health and responsible sexual
behaviour
However, opportunities to promote RH issues may
be limited. Any advocacy that is undertaken must
demonstrate understanding of the culture, values
and belief systems of the local population
Advocacy that is insensitive or disrespectful may be
counterproductive and prompt rejection, or even reprisals,
within the community
12. Coordinating Activities Among Relief Agencies
Coordination is needed among sectors (health, community
services, protection), implementing agencies (government,
NGOs, UN agencies), Levels of service providers (doctors,
midwives,
Traditional Birth Attendants, health assistants)
To foster this coordination, it is recommended that
an individual be identified as RH Coordinator in each
community situation
This person would assume the responsibility for overall
organisation and supervision of RH activities, as well as
the integration of these services within other health
services
The issue of sexual violence provides an excellent
illustration of the need to coordinate among
sectors
To deal with the causes and consequences of
violence, health professionals must work closely
with staff in the protection and community
services sectors
By doing so, staff can develop detailed procedures on
appropriate care for survivors and strategies to
prevent the occurrence of sexual violence
Coordination among implementing agencies requires
that, although each agency has its own expertise and
range of qualified staff, there should be a standard
approach used by all agencies involved
Even though an agency may not provide a full
range of RH services, coordination with others
would ensure that the end product is
complementary and
comprehensive RH care
Uncoordinated activities result in inappropriate
allocations of scarce resources and reduced impact
of the project
SUMMARY
This is the end of unit 1. In this unit we covered
the definition of both RH and IRH and went on to
look at the components of IRH
We also looked at the reproductive health policy
and its guiding principles
Find time to go through the work we have
covered in unit one so that you can
understand the content well
You are welcome to consult me in case of
concerns that need to be addressed
In the next session I will introduce unit 2
which covers a component of safe
motherhood