Assessing Integration Methodology (AIM): A Handbook for Measuring and Assessing the Integration of Family Planning and Other Reproductive Health Services

This manual provides a roadmap for Assessing Integration Methodology (AIM), which is a tool for describing and measuring attempts to integrate the provision of family planning (FP) information and services with other relevant services. The focus of this handbook is on the AIM and the instruments that can be used to collect data at health facilities offering, or considering offering, integrated services.

According to the manual's publisher, the Population Council, many rationales underlie the move toward integrating FP with other services. Benefits include: (1) meeting multiple reproductive health needs of a client simultaneously, (2) reducing the stigma associated with providing a service independently, (3) combining several services needed for a multifaceted health condition, and (4) achieving cost efficiencies through sharing staff skills, infrastructure, and equipment. The Population Council's experience indicates, however, that creating service configurations for integrated services is usually not straightforward and can place a strain on the underlying logistics, training, supervisory, and management systems. This may be the case especially if the services are provided through different programmes, as is the case with sexual and reproductive health (SRH) and HIV/AIDS services. In addition, these situations may overstretch service providers who have limited skills and support.

In this context, AIM has been designed to fill the information gaps embedded in questions such as the following: Which service combinations are feasible? Which services are acceptable to clients and providers? Which services can effectively increase access to one or both services without compromising the quality or safety of their delivery? Does their joint provision lead to a synergistic impact on both the individual client's health status and that of the population served? In short, the rationale behind AIM is that offering services in a combined fashion requires appropriate methodologies for determining the feasibility of various combinations, assessing and monitoring the quality of service received, and evaluating their effect on utilisation.

To that end, the handbook:

• explains the basic principles of conducting studies using AIM,
• provides tips for the data collection, and
• makes available data collection instruments that have been validated in projects throughout the developing world for the integration of:
  • FP and antenatal care (ANC) services,
  • FP and postnatal care (PNC),
  • FP in postabortion care services, and
  • FP and HIV and sexually transmitted infection (STI) prevention and detection.

Each section includes:

• a facility inventory of services, infrastructure, equipment, and supplies;
• an observation guide for recording provider-client interactions;
• a standardised questionnaire for exit interviews with clients; and
• a questionnaire for interviews with providers (the questions included here have been tested and validated in more than one setting).

AIM has been developed from experience gained by the Population Council in undertaking assessments of various combinations of integrated services in many developing countries, most of which was undertaken through the United States Agency for International Development (USAID)-funded Frontiers in Reproductive Health Program (FRONTIERS). This methodology derives from the Situation Analysis (SA), a methodology originally devised by the Population Council in the 1990s to better understand the range of programmatic factors that influence the quality of care received by a client during facility-based FP services. Over the past decade, FRONTIERS has implemented more than 15 projects in a dozen countries that have assessed the feasibility, acceptability, and effectiveness of integrating FP services with maternal and child health, postabortion care services, and HIV/STI prevention.