Bottleneck investigation of difficulties confronting sexual and regenerative wellbeing and human immunodeficiency infection (HIV) administrations combination in Southwestern Nigeria

Abstract

Services integration ensures easy access to multiple services in a cost effective way. Integration of 
sexual and reproductive health (SRH) and human immunodeficiency virus (HIV) services is poor in 
Nigeria. Removing bottlenecks to successful integration has been of high programmatic priority most 
especially in resource poor settings. This study determined bottlenecks to effective SRH/HIV services 
integration in Osun State in Southwestern Nigeria. This study combined descriptive cross sectional and 
retrospective study designs by collecting validated routine data on SRH/HIV integration from 100 
randomly selected health care facilities. Research instruments for descriptive data collection were semi 
structured self administered questionnaires for health care workers, and exit interviews for patients 
using a designed checklist. Data was analyzed using a combination of Statistical Package for Social 
Sciences (SPSS) and Excel software(s). The study found that only 31.9% of the health facilities had been 
trained on SRH/HIV integration, 42.1% of the health facilities were providing services within reach of the 
communities served, while 32.4% said they regularly complete the integrative referral process. Using 
the World Bank model of the bottlenecks analysis (BNA) process, three major bottlenecks to SRH/HIV 
services integration were determined. These include inadequate capacity building and poor access to 
SRH/HIV integrated services on the supply side. On the demand side, the major bottleneck identified 
was poor continuous utilization of services. Commodity challenges, poor initial utilization and poor 
quality of services were not among the leading bottlenecks identified. Several reasons were given as 
causes of these bottlenecks. Circumventing identified bottlenecks would strengthen SRH/HIV 
integration in order for patients to benefit from the two services simultaneously. All efforts should be 
geared towards removing these evidence based bottlenecks.