Integrating Sexual Health Services Into Primary Care: An Overview of Health Systems Issues and Challenges in Developing Countries

ABSTRACT

Current attempts to address the high burden of sexual health morbidity and mortality in developing countries remain limited in scale due to a range of health system constraints. We conducted a literature review of the policy and programmatic issues that influence the integration of sexual health into primary care services in developing countries. Forty-seven reports were identified from a search of both peer-reviewed and gray literature. Key issues identified were intersectoral and intergovernmental coordination; management and organizational issues including decentralization, health sector reform, logistics, and referral systems; human resources, including training and support required to increase service scope; relationships between the public and private sectors; and scaling-up and financing issues.

KEYWORDS:

• Sexual health
• reproductive health
• health systems
• primary care

This manuscript not been published elsewhere and has not been submitted simultaneously for publication elsewhere.

This article is partly based on the final chapter of a draft World Health Organization (WHO) report, Integrating Sexual Health Interventions into Reproductive Health Services: Programme Experience from Developing Countries. We would like to acknowledge the significant input of other contributors to that report: Manuela Colombini (London School of Hygiene and Tropical Medicine, London, United Kingdom), Anke van der Kwaak (Royal Tropical Institute [KIT], Amsterdam, The Netherlands), Maria-Pia Waelkens (Leopold Institute, Antwerp, Belgium), César Eduardo Wong Alcázar (Médecins du Monde), Eli Coleman (World Association for Sexual Health), as well as the inputs of staff members at the WHO's Department of Reproductive Health and Research, Jane Cottingham, Dale Huntington, Peter Fajans, and Paul Van Look. We would also like to thank Ann Canavan (KIT) for commenting on this manuscript. The original WHO report was funded by the Dutch Ministry of Foreign Affairs and WHO.