List of Figures and Tables - SRJC



National Integrated Sexual and Reproductive Health and Rights Policy2019National Department of Health Library Cataloguing-in-Publication DataNational Integrated Sexual and Reproductive Health & Rights Policy Ed. 1ISBNPublished by the National Department of Health, Republic of South Africa, 2019 Civitas Building, 222 Thabo Sehume St.,CBD Pretoria, 0001012 395 8000 consolidation of the various service guidelines presented in the National Integrated Sexual and Reproductive Health and Rights Policy provides an opportunity to define a package of service benefits for women throughout their reproductive lifecycle. The package of services will form a basis for the implementation of the National Health Insurance. The policy will respond to women’s needs on agency and choice in a rights-based approach. This policy is a demonstration of the Department of Health’s commitment to provide comprehensive sexual and reproductive health services with a rights-based approach, in order to achieve health for all. Embedded in the principles of equity and equality, this policy emphasises the autonomy and agency of clients seeking sexual reproductive health and rights (SRHR) services. Legal guidance in this policy has been taken from important statutes that govern the advancement of SRHR, such as the Criminal Law (Sexual Offences and Related Matters) Amendment Act 32 of 2007 and the Choice on Termination of Pregnancy Act 92 of 1996.This document consolidates several clinical and policy guidelines on various aspects of SRHR; including the National Contraception Clinical Guidelines; National Clinical Guidelines for Safe Conception and Infertility; National Guidelines for Implementation of Choice on Termination of Pregnancy; the Sexually Transmitted Infections Management Guidelines; National Clinical Guidelines for Cervical Cancer Control and management; National Clinical Guidelines for Breast Cancer Control and management; and the Guidelines on the Management of Post-Exposure Prophylaxis (PEP) in Occupational and Non-Occupational Exposures.In addition, reference is made to other documents that advance adolescent health and that address underserved and key populations with a focus on the reduction of gender-based violence. These documents include the National Adolescent and Youth Health Policy; National HIV Testing Services (HTS) Policy; National Strategic Plan for HIV, TB and STIs; Department Basic Education National Policy on HIV, STIs and TB; Prevention and Management of Learner Pregnancy in Schools; South African National LGBTI HIV Plan; and the South African National Sex Worker HIV Plan. International and regional policies and strategies that advance the SRHR agenda are not only acknowledged but guided the thinking behind this policy. The National Integrated Sexual and Reproductive Health and Rights Policy is drawn from the Department of Health commitment to achieving the Sustainable Development Goals (SDGs), the South African Development Community (SADC) minimum package for SRHR services, and the SADC SRHR strategy. Many issues have emerged since the adoption of the SDGs, and in line with the Department of Health’s plan to further reduce maternal mortality and morbidity, this policy couldn’t have come at a better time, creating further momentum for achieving the goals. The global Family Planning 2020 framework including the International Conference on Population and Development (ICPD) of 1994, the Beijing Platform for action and the Maputo Plan of Action (2006) particularly advance our global collaboration for the advancement of SRHR. The goal of this policy is to promote, through informed choice and with a rights based approach, high quality and safer reproductive health services and practices by men, women, and youth, therefore providing a framework through which the Department of Health manages SRHR services. It is positioned to facilitate coordination between all stakeholders, guide decision makers, protect clients and providers, and provide a justification for allocation of resources - noting that implementation of SRHR services are not only restricted to the health sector. Its implementation is therefore the prerogative of all government departments, industry, and civil society. Ms MP MatsosoDirector-General: HealthOctober 2019Table of Contents TOC \o "1-3" \h \z \u List of Figures and Tables PAGEREF _Toc2870220 \h ivAcronyms PAGEREF _Toc2870221 \h vDefinitions of Terms PAGEREF _Toc2870222 \h viGuiding principles and values PAGEREF _Toc2870223 \h 1Overview of the sections PAGEREF _Toc2870224 \h 2Section 1. Introduction PAGEREF _Toc2870225 \h 31.1 Vision PAGEREF _Toc2870226 \h 41.2 Mission PAGEREF _Toc2870227 \h 41.3 Policy Objectives PAGEREF _Toc2870228 \h 4Section 2. Key considerations in the organisation of SRHR services PAGEREF _Toc2870229 \h 72.1 SRHR in the context of South Africa’s modern history PAGEREF _Toc2870230 \h 72.2 Influence of social, cultural, and economic factors on SRHR in South Africa PAGEREF _Toc2870231 \h 82.3 Adolescent girls and young women PAGEREF _Toc2870232 \h 92.4 Influence of key SRHR indicators PAGEREF _Toc2870233 \h 12Section 3. Policy components and alignment PAGEREF _Toc2870234 \h 163.1 Alignment with global strategies and statutes PAGEREF _Toc2870235 \h 163.2 Alignment with national policies and strategies PAGEREF _Toc2870236 \h 173.3 Key focus areas PAGEREF _Toc2870237 \h 19Section 4. The national integrated SRHR policy objectives PAGEREF _Toc2870238 \h 21Objective 1: Pursue stakeholder alignment, generate demand, and provide user information and counselling to all clients to fulfil their SRHR needs PAGEREF _Toc2870239 \h 23Objective 2: Increase the quality and uptake of comprehensive and integrated SRHR care and treatment services across all life stages PAGEREF _Toc2870240 \h 25Objective 3: Ensure access to respectful and non-judgemental SRHR services for priority groups PAGEREF _Toc2870241 \h 34Objective 4: Strengthen the health system to deliver integrated SRHR services at the lowest feasible level in the health care system PAGEREF _Toc2870242 \h 39Objective 5: Promote multisectoral engagement and shared accountability for a sustainable and rights based service delivery PAGEREF _Toc2870243 \h 45Acknowledgements PAGEREF _Toc2870244 \h 47References PAGEREF _Toc2870245 \h 48List of Figures and Tables TOC \h \z \c "Figure" Figure 1. The SRHR policy encompasses several guidelines and complements the maternal, neonatal, child health (MNCH) policies PAGEREF _Toc2868809 \h 6Figure 2. Unmet need for contraception among youth under 25 years old PAGEREF _Toc2868810 \h 10Figure 3. Types of contraception used among 15-29 and 20-24 year olds PAGEREF _Toc2868811 \h 10Figure 4. Percentage of young women, age 15-19 years, who have begun childbearing PAGEREF _Toc2868812 \h 11Figure 5. Maternal deaths reported to the National Committee for the Confidential Enquiries into Maternal Deaths between 1998 and 2016 PAGEREF _Toc2868813 \h 13Figure 6. Unmet need for contraception of women aged 15-49 across the Provinces PAGEREF _Toc2868814 \h 14 TOC \h \z \c "Table" Table 1. Number and percentage of births by age of the mother PAGEREF _Toc2868815 \h 11Table 2. Selected SRHR indicators against national targets PAGEREF _Toc2868816 \h 12Table 3. SDGs related to the SRHR Policy PAGEREF _Toc2868817 \h 16Table 4. Alignment with national health policies, laws, and plans PAGEREF _Toc2868818 \h 18Table 5. Alignment with national service specific guidelines PAGEREF _Toc2868819 \h 19Table 6. SRHR policy objectives, sub-objectives, and intended results PAGEREF _Toc2868820 \h 21AcronymsACOAAntenatal client initiated on ART AGYWAdolescent girls and young womenANCAntenatal careART Antiretroviral therapyCSEComprehensive sexuality educationCPRContraceptive prevalence rateCTOP Choice on termination of pregnancy CYPRCouple year protection rateD&EDilation and evacuationDHISDistrict Health Information SystemESHREEuropean Society of Human Reproduction and Embryology GBVGender based violenceHIVHuman Immunodeficiency VirusHMISHealth Management Information SystemHPVHuman Papilloma VirusHRTHormone replacement therapyHTSHIV testing servicesICDInternational classification of diseasesICPDInternational Conference on Population and DevelopmentICSMIntegrated Clinical Services Management ManualIECInformation, education, and communicationiMMRInstitutional maternal mortality ratioIUDIntrauterine contraceptive deviceLGBTI+Lesbian, Gay, Bisexual, Transgender, and IntersexMNCH Maternal, neonatal, and child healthMVAManual vacuum aspirationNDOH National Department of HealthNHINational health insurancePEPPost-exposure prophylaxisPHCPrimary health carePrEPPre-exposure prophylaxisPMTCT Prevention of mother to child transmissionSADCSouthern African Development CommunitySAHPRASouth African Health Products Regulatory AuthoritySDGSustainable Development GoalsSGBVSexual and gender based violenceSRH Sexual and reproductive healthSRHR Sexual and reproductive health and rightsSTISexually transmitted infectionsTBTuberculosisTDFTenofovirVMMCVoluntary male medical circumcisionWHOWorld Health OrganizationDefinitions of TermsTermDefinitionAccessible and equitable health servicesAccessible health services are services that are available to all people who need them, and are free from any form of discrimination, irrespective of where a person was born, which language they speak, their cultural or religious background, their abilities, sex, or gender. Equitable health services mean that all people are treated fairly based on their need.AdolescentAny person between the ages of 10 and 19.Adolescent and youth-friendly health servicesHealth services that are both responsive and acceptable to the needs of adolescents and youth and which are provided in a non-judgmental, confidential, and private environment, in times and locations that are convenient for adolescents and prehensiveIn healthcare, the term “comprehensive” refers to services that comprise of many elements of care such as promotive, preventive, curative, and rehabilitative services. Comprehensive SRHR services bring together all the elements of SRHR to prevent and manage prehensive sexuality education (CSE)This refers to provision of age-appropriate, culturally relevant, scientifically accurate, realistic, non-judgmental information about sex and relationships. Sexuality education provides opportunities to explore one’s own values and attitudes and to build decision-making, communication, and risk-reduction skills about many aspects of sexuality.CounsellingA confidential two-way discussion between a client and trained counsellor to help the client to cope with stress and concerns and take informed decisions (e.g. about a medical sterilisation procedure).Early AdolescentAny person between the ages of 10 to 14 years. The package of services, including the Department of Basic Education comprehensive sexuality education (CSE) programme, should be highlighted for this age group. While few early adolescents are sexually active, most are sexually exposed, either due to socioeconomic circumstances or from sexual violence. A comprehensive response is needed at all levels. Gender equalityThe freedom of human beings to develop themselves and make their own choices and that the different behaviours and needs of individuals are valued and are equal. When genders are equal, they get the same treatment, the same access to services, and they have equal power in relationships.Gender-based violence (GBV)All acts perpetuated against women, men, boys, and girls on the basis of their sex, which causes or could cause them physical, sexual, psychological, emotional, or economic harm. This includes the threat to take such acts, or to undertake the imposition of arbitrary restrictions on or deprivation of fundamental freedoms in private or public life in peace time and during situations of armed or other forms of conflict. It also includes domestic violence, sexual harassment in the workplace, human trafficking, and sexual and emotional abuse.Gestational age or duration of pregnancyThe number of days or weeks since the first day of the client’s last normal menstrual period in clients with regular cycles ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "9781485004240", "author" : [ { "dropping-particle" : "", "family" : "Republic of South Africa", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issue" : "40970", "issued" : { "date-parts" : [ [ "2017" ] ] }, "page" : "1-8", "title" : "Choice on Termination of Pregnancy Amendment Bill", "type" : "legislation" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[88]", "plainTextFormattedCitation" : "[88]", "previouslyFormattedCitation" : "[88]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[REF]. The first trimester is generally considered to consist of the first 12 weeks of pregnancy. Throughout this document, gestational age is defined in both weeks and days, reflecting its definition in the international statistical classification of diseases (ICD).Health systemThe sum total of all the organizations, institutions, and resources whose primary purpose is to ensure delivery of quality services to all people, when and where they need them. The World Health Organization (WHO) identifies six core components or ‘building blocks’ of a health system: (i) service delivery, (ii) health workforce, (iii) health information systems, (iv) access to essential medicines, (v) financing, and (vi) leadership/governance,Informed decision makingInformed decision-making means that the client decides what is appropriate in a given situation, based on the advice received by a health professional, and taking into account the personal circumstances, belief system, and priorities. It may mean that the client either accepts or declines advice and recommendation from a health professional. The client’s decision is paramount and must be respected.IntegrationThe process of bringing together, in a holistic manner, different kinds of related SRHR and HIV interventions at the levels of legislation, policy, programming, and service delivery to ensure access to comprehensive services in an efficient and effective manner.Key populationsGroups of people who are more likely to transmit or be exposed to HIV and whose engagement is critical to a successful HIV response. These include young women, sex workers, mobile and displaced populations, injecting drug users, prisoners, and sexual minorities, or as defined by the Member States in alignment with international and regional standards.Late adolescentAny person between the ages of 15-19 years. Requires programmatic emphasis over and above the Department of Basic Education CSE program, including contraception.Person-centred services and careWhen individuals have control over their own health care and receive it as close as possible to where they live. This includes care focused on each client’s needs, to improve health and wellbeing. In a person-centred approach, people are seen as the experts of their lives and have the right to choose their own health professional and, together with health professionals, decide the most appropriate course of action. This takes into account their own desires, values, social and personal circumstances, and health-related behaviours, as well as medical or alternative treatment and management options. This empowers people to understand their condition and how they can get better. PregnancyThe period from implantation to birth. After the egg is fertilised by a sperm and then implanted in the lining of the uterus, it develops into the placenta and embryo, and later into a foetus. Pregnancy usually lasts 40 weeks, beginning from the first day of the last menstrual period, and is divided into three trimesters, each lasting approximately three months.Reproductive healthReproductive health implies that people have the capability to reproduce, and the freedom to decide if, when, and how often to do so. Implicit in this are the rights of all people to be informed and to have access to safe, effective, affordable, and acceptable methods of contraception of their choice, as well as to safe termination of pregnancy. People have the right to access appropriate health-care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant. [REF]Sexual and gender-based violence (SGBV)SGBV includes any physical, sexual, or emotional harm, including threats, bullying, or removals of rights in your public or private life, due to gender.Sexual and Reproductive Health (SRH)Sexual health and reproductive health overlap and, in addition to supporting normal physiological functions such as pregnancy and childbirth, aim to reduce adverse outcomes of sexual activity and reproduction. They are also about enabling people of all ages, including adolescents and those older than the reproductive years, to have safe and satisfying sexual relationships by tackling obstacles such as gender discrimination, inequalities in access to health services, restrictive laws, sexual coercion, exploitation, and gender-based violence. [REF] The five core components of SRH are: 1) improvement of antenatal, perinatal, postpartum, and new-born care; 2) provision of high-quality services for contraception and infertility services; 3) elimination of unsafe abortions; 4) prevention and treatment of STIs, including HIV, reproductive tract infections, cervical cancer, and other gynaecological morbidities; and 5) promotion of healthy sexuality. [REF] Sexual and Reproductive Health and Rights (SRHR)SRHR is defined as a state of physical, emotional, mental, and social wellbeing in relation to all aspects of sexuality and reproduction, not merely the absence of disease, dysfunction, or infirmity1. Therefore, a positive approach to sexuality and reproduction should recognise the part played by pleasurable sexual relationships, trust, and communication in the promotion of self-esteem and overall wellbeing. All individuals have a right to make decisions governing their bodies and to access services that support that right. Achievement of sexual and reproductive health relies on the realisation of sexual and reproductive rights, which are based on the human rights of all individuals to:Have their bodily integrity, privacy, and personal autonomy respected.Freely define their own sexuality, including sexual orientation and gender identity and expression.Decide whether and when to be sexually active.Choose their sexual partners.Have safe and pleasurable sexual experiences.Decide whether, when, and whom to marry.Decide whether, when, and by what means to have a child or children, and how many children to have.Have access over their lifetimes to the information, resources, services, and support necessary to achieve all the above, free from discrimination, coercion, exploitation, and violence.Sexual consentIn South Africa, the age of consent for all sexual acts is 16 years. The law prohibits sex with a child who is between 12 and 16 years and forbids an act of sexual violation with a child who is between 12 and 16 years. Sex between two children who are both between 12 and 16, or where one is under 16 and the other is less than two years older, is not a criminal act.Sexual healthSexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected, and fulfilled. [REF]Unwanted PregnancyUnwanted pregnancies are pregnancies that are not desired for myriad reasons, including relationship status, economic hardship, mistiming, unplanned or unintended at the time of conception. Unwanted pregnancies may result from lack of contraception, contraception not being effective or not being used correctly, or from non-consensual sex such as rape and sexual abuse.Guiding principles and valuesThe SRHR Policy prescribes that all norms, standards, and clinical practices related to SRH services should promote: Equity: Reaffirming national commitment to reducing gender and other inequalities borne from health disparities.Cohesion: Bringing together diverse efforts that share common goals.Unification: Linkage and alignment with related national and international policies.Quality: Delivering comprehensive, evidence-backed SRHR services.Integration: Integrating SRHR and HIV services is a key focus area and SRHR services will be integrated with all other service delivery platforms at the community, primary care (including school health) secondary, and tertiary care levels. Rights based approaches: Affirming choice, confidentiality, and individual agency in a non-discriminatory manner while seeking, accessing, and receiving all SRH related services at community levels and health facilities.In addition, the values espoused in the National Health Strategy are an essential thread of this document. These are:Universal access to healthInformed, autonomous, and voluntary decision-making Evidence-based and evidence-informed practicesPerson-centred differentiated care in service deliveryRights-based approach characterised by equality, confidentiality, and non-discrimination Life cycle approachStrong and visible stewardship for SRHR policy implementationMulti-sectoral collaboration between HIV and SRHOverview of the sectionsSection 1: Provides a specific vision and mission of the integrated sexual and reproductive health and right (SRHR) policy, which aims to consolidate and give policy direction for all the initiatives relating to SRHR in South Africa. This policy document becomes the superior policy reference document for all issues relating to SRHR in the country. This section also provides guiding principles, with reference to the human rights approach that governs the policy, embedded in the need to improve access, equity, and quality in the delivery of services. The consultation and participation process for the development of this policy is also highlighted in this section. Section 2: Provides the key considerations and rationale for this policy, whose implementation relies on strengthened health systems, improved sociocultural norms, and a strong economic landscape. As such, an effective implementation of such a policy calls for multi-stakeholder engagements that include government and both the public and private sectors. This section also outlines key areas of focus on adolescent SRHR, and concludes by providing various SRHR indicators that need to be collected in the implementation of this policy.Section 3: Delves into the various policy components and how they align with other national and international strategies and policy directions. These include, the National Department of Health Strategy; the National Health Insurance Policy, and other national policies and laws governing SRHR. Additionally, this section defines how this policy document aligns with regional and global initiatives including the SADC SRHR strategy, Family Planning 2020 strategy, the Guttmacher-Lancet Commission report, the Sustainable Development Goals, and the Beijing Platform of Action. The policy recognises the need account for the holistic view of an individual’s life, acknowledging sexual desire and function, and confronting sexual and gender based violence (SGBV), while zeroing on key issues that have emerged in South Africa’s SRHR landscape. These include: contraception; improving safe conception, while addressing fertility and subfertility; access to safe choice on termination of pregnancy services; ensuring comprehensive packages for HIV, TB, and STI prevention and management; addressing reproductive cancers, specifically cervical and breast cancer; covering all aspects of the reproductive life cycle, including menopause; and in the management of Post-Exposure Prophylaxis (PEP) in occupational and non-occupational exposures.Section 4: Provides an in-depth overview of the five policy objectives in this document: To enable all people to make informed decisions about their SRH and ensure that their human rights are respected, protected, and fulfilled.To increase the quality and uptake of SRHR care and treatment services across all life stages.To ensure access to respectful and non-judgemental SRHR services for priority groups.To strengthen the health system to deliver integrated SRHR services at the lowest feasible level in the health care system.To promote multi-sectoral engagement and shared accountability for a sustainable response.IntroductionA comprehensive definition of SRHR: “A state of physical, emotional, mental, and social wellbeing in relation to all aspects of sexuality and reproduction, not merely the absence of disease, dysfunction, or infirmity. Therefore, a positive approach to sexuality and reproduction should recognise the part played by pleasurable sexual relationships, trust, and communication in the promotion of self-esteem and overall wellbeing. All individuals have a right to make decisions governing their bodies and to access services that support that right.” ADDIN EN.CITE <EndNote><Cite><Author>World Health Organization</Author><RecNum>172</RecNum><DisplayText><style face="superscript">1</style></DisplayText><record><rec-number>172</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1541473340">172</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors><authors><author>World Health Organization, </author></authors></contributors><titles><title>Sexual and reproductive health: Defining sexual health</title></titles><dates></dates><urls><related-urls><url> South African National Integrated Sexual and Reproductive Health and Rights Policy, 2019 (SRHR Policy 2019) creates the conditions under which South Africans are able to enjoy good SRH across their lifespan. Sexual health encompasses aspects of reproductive health, such as contraception, fertility, and choice on termination of pregnancy, and includes many aspects of sexual health—including reproductive tract infections, sexual pleasure or dysfunction, and the health consequences of violence—which may not be directly associated with reproduction. ADDIN EN.CITE <EndNote><Cite><Author>World Health Organization</Author><Year>2006</Year><RecNum>176</RecNum><DisplayText><style face="superscript">2</style></DisplayText><record><rec-number>176</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1541475317">176</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors><authors><author>World Health Organization,</author></authors></contributors><titles><title>Defining Sexual Health: Report of a technical consultation on sexual health 28-31 January 2002, Geneva</title></titles><dates><year>2006</year></dates><urls><related-urls><url> The definition of SRHR suggests that people with good sexual and reproductive health have satisfying, safe sexual lives, and can make a choice as to whether, when, and how they would like to have children. It is the intention of this policy therefore, to acknowledge the breadth of SRHR services, thus unifying the inseparable link between sexual health, human rights, individual autonomy, and reproduction.Given the burden of disease on the health and socio-economic systems in South Africa and the social determinants of health and sociocultural norms that affect SRHR services, the intention of this policy is to highlight these issues and seek ways of tackling the multifaceted nature of SRHR service delivery. However, the implementation of the various programs is facilitated by separate guidelines that anchor this policy document. Quality SRH services, underpinned by a rights-based approach, are organized and delivered with respect for individual agency, ability, and right to undertake SRH decisions. Sexuality, gender, and the economy are interconnected: SRHR cannot be achieved without the recognition, respect, protection, and fulfilment of sexual and reproductive rights within human rights, essential for social justice, sustainable development, and public health. ADDIN EN.CITE <EndNote><Cite><Author>UNAIDS</Author><Year>2016</Year><RecNum>173</RecNum><DisplayText><style face="superscript">3, 4</style></DisplayText><record><rec-number>173</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1541473465">173</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors><authors><author>UNAIDS</author></authors></contributors><titles><title>Sexual and reproductive health and rights of people most affected by HIV: The right to development [Internet]</title></titles><dates><year>2016</year></dates><pub-location>Geneva</pub-location><urls><related-urls><url> Health Organization</Author><Year>2010</Year><RecNum>174</RecNum><record><rec-number>174</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1541473647">174</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors><authors><author>World Health Organization,</author></authors></contributors><titles><title>Developing sexual health programmes. A framework for action</title></titles><dates><year>2010</year></dates><pub-location>Geneva</pub-location><urls><related-urls><url>, 4 This policy exists to serve the people of South Africa through the leadership of the National Department of Health (NDoH). Integrated assembly of the key elements of the nation’s SRHR philosophy, strategic priorities, and practice guidance in the SRHR Policy provides concise reference for the administrators, financiers, managers, and health workers who dedicate their professional efforts to improving health outcomes for all South Africans. Efficient health systems are a prerequisite for effective service integration and require strengthening of six key components [From the WHO Health Systems Framework ADDIN EN.CITE <EndNote><Cite><Author>World Health Organization</Author><RecNum>177</RecNum><DisplayText><style face="superscript">5</style></DisplayText><record><rec-number>177</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1541475629">177</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors><authors><author>World Health Organization,</author></authors></contributors><titles><title>The WHO Health Systems Framework</title></titles><dates></dates><urls><related-urls><url>]: Quality service deliveryEssential medicines and suppliesHuman resources for healthHealth information systemsHealth care financingLeadership and governanceVisionAttainment by all South Africans of the highest possible level of comprehensive and integrated SRHR services by 2030.MissionAccelerate the equitable delivery of a comprehensive range of quality, integrated, and rights based SRHR services that are accessible, acceptable, effective, and safe to individuals, couples, and communities in South Africa.Policy ObjectivesThis policy consolidates various guidelines and policies on SRHR in South Africa, thereby providing a broad framework for provision of quality and comprehensive SRHR services recognising individual autonomy, enabling informed choice, and advancing human rights in the context of SRHR. There are five SRHR Policy Objectives, with accompanying policy statements to direct their implementation, as follows: Objective 1: Pursue stakeholder alignment, generate demand, and provide user information and counselling to all clients to fulfil their SRHR.Objective 2: Increase the quality and uptake of comprehensive and integrated SRHR care and treatment services across all life stages.Objective 3: Ensure access to respectful and non-judgemental SRHR services for priority groups.Objective 4: Strengthen the health system to deliver integrated SRHR services at the lowest feasible level in the health care system.Objective 5: Promote multi-sectoral engagement and shared accountability for sustainable and rights based service delivery.These services are also included in the following guideline documents:National Clinical Guideline for Contraception (2019)National Guideline for Implementation of Choice on Termination of Pregnancy Act (2019)National Clinical Guideline for Safe Conception and Infertility (2019)Sexually Transmitted Infections Management Guidelines (2015)National Guideline on the Management of Post-Exposure Prophylaxis (PEP) in Occupational and Non-Occupational Exposures (2019)National Clinical Guideline for Cervical Cancer Control and Management (2019)National Clinical Guideline for Breast Cancer Control and Management (2019)National Clinical Guidelines on Genetics Services (2018) National Guideline for the Prevention of Mother to Child Transmission of Communicable Infections (HIV, Hepatitis, Listeriosis, Malaria, Syphilis and TB) (2019)This document articulates the policy narrative for SRHR, and seeks to harmonize the coordination and service delivery for a comprehensive SRHR program in South Africa. It is yet another crucial pillar towards achieving the National Health Strategy and contributes to the country’s socio-economic development as set out in the National Development Plan. The integrated policy presents a cohesive framework that outlines the priorities, structure, and governance for SRHR service delivery in South Africa. The intention for this high level policy is to impact sexual health outcomes positively at a population level. Within the population, there are groups of people for whom this policy advocates keen attention and inclusion, including: all adolescents, young women and girls, sex workers, LGBTQI, migrants, people with disabilities, young men and male partners of women seeking SRHR services, and survivors of sexual violence. By calling attention to the spectrum of needs of the population, iterating the resources and guidance available within SRHR, prioritizing essential areas of SRHR service delivery, and illustrating comprehensive care, quality care is championed. The diagram below articulates the lifecycle approach to reproductive health. It is appropriate therefore to read and implement this policy in conjunction with the Maternal and Neonatal Policies and Programs. Figure SEQ Figure \* ARABIC 1. The SRHR policy encompasses several guidelines and complements the maternal, neonatal, and child health (MNCH) policiesKey considerations in the organisation of SRHR servicesThe context in which SRHR services are designed in South Africa needs to include an understanding of South Africa’s modern history in relation to SRHR; the current sociocultural and economic dynamics that drive SRHR service delivery; the performance of the SRHR program in general, as illustrated in the indicators to date; and, given the high incidence of HIV and teenage pregnancy, the need to have a sharpened focus on adolescents, young women, and girls. SRHR in the context of South Africa’s modern historyThis policy is a progressive movement towards ensuring access to quality and equitable SRHR services in the country.This policy is a progressive movement towards ensuring access to quality and equitable SRHR services in the country.The first democratic elections in 1994 ushered in a new era in South Africa, with the concepts of human rights and equity installed as the cornerstones of the new constitution. South Africa’s democratic transition provided unique opportunities to address racially-based political, socio-economic, and health inequalities.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Db29wZXI8L0F1dGhvcj48WWVhcj4yMDE2PC9ZZWFyPjxS

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ADDIN EN.CITE.DATA 6 While major investments to transform the health system into an integrated, comprehensive national health system have been made, there are several systemic challenges that the implementation of this policy faces, categorised into four themes:Complex burden of disease; Maternal, newborn and child health, HIV/AIDS, TB, non-communicable diseases, violence, and injury.Quality concerns, related to health care in general. An ineffective and inefficient, over-burdened health system, resulting in inefficiencies in service delivery and inequities in care delivery in both the public and private sectors.Costs, spiralling health care costs, particularly in the private health care environmentTackling these challenges is not necessarily the focus of this policy document, however, specific policy and health systems initiatives specific to SRHR are acknowledged and have produced results:At the higher levels of policy and law, the country has strengthened rights-based youth SRH legislation and policies, introduced new progressive sexual offences laws, and amended the Choice on Termination of Pregnancy (CTOP) act to ensure more effective implementation.At the systems level, the state has sustained well-established data collection systems, such as the Confidential Enquiry into Maternal Deaths Reviews and a strong civil registration and vital statistics system; made progress in the ideal clinic framework; and advanced the setting up of the National Health Insurance Fund (NHI).Specific SRHR programs are commendable, for example the Human Papilloma Virus (HPV) vaccine that will reduce significantly incidence of cervical cancer has been introduced for young girls and an expanded focus on reduction of new HIV infections among young women and girls.These successes have benefited all South Africans and need to be scaled especially among more vulnerable groups such as women in rural areas, teenagers, the marginalised, and key populations. ADDIN EN.CITE <EndNote><Cite><Author>SANAC</Author><Year>2017</Year><RecNum>196</RecNum><DisplayText><style face="superscript">7</style></DisplayText><record><rec-number>196</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542172658">196</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>The South African National Aids Council (SANAC),</author></authors></contributors><titles><title>National Strategic Plan on HIV, STIs and TB 2017-2022</title></titles><dates><year>2017</year></dates><pub-location>Pretoria</pub-location><urls></urls></record></Cite></EndNote>7 Influence of social, cultural, and economic factors on SRHR in South AfricaA variety of factors affect people’s access to and utilisation of SRHR services: these factors influence the patterns of use, the continuation and interruption of services, and affect the quality of services they receive. This policy acknowledges these factors as they affect outcomes. While this policy does not go into detail on how to overcome these challenges, there are legislative and implementation measures that have been put in place, in the form of guidelines, to help address some of these challenges. Broader views are needed however, that acknowledge the effect of the health economy, systemic inequities, and levels of educational attainment, that negatively impact access to, and adherence to, SRHR services. Key factors point to a need for a more considered and collaborative approach when implementing this policy, including:Socioeconomic status and rural residence: Women living in poor socioeconomic conditions, especially in rural areas and informal settlements, tend to have less access to SRHR services (i.e. safe choice of termination of pregnancy), higher in-facility maternal mortality, and lower delivery in facility. ADDIN EN.CITE <EndNote><Cite><Author>Michalow</Author><Year>2015</Year><RecNum>197</RecNum><DisplayText><style face="superscript">8</style></DisplayText><record><rec-number>197</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542174204">197</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Michalow, Julia</author><author>Chola, Lumbwe</author><author>McGee, Shelley</author><author>Tugendhaft, Aviva</author><author>Pattinson, Robert</author><author>Kerber, Kate</author><author>Hofman, Karen</author></authors></contributors><titles><title>Triple return on investment: the cost and impact of 13 interventions that could prevent stillbirths and save the lives of mothers and babies in South Africa</title><secondary-title>BMC pregnancy and childbirth</secondary-title></titles><periodical><full-title>BMC Pregnancy Childbirth</full-title><abbr-1>BMC pregnancy and childbirth</abbr-1></periodical><pages>39-39</pages><volume>15</volume><dates><year>2015</year></dates><publisher>BioMed Central</publisher><isbn>1471-2393</isbn><accession-num>25879579</accession-num><urls><related-urls><url> attainment: Education has a strong positive link with contraceptive and SRHR service use, improved employment opportunities, and economic independence. Higher levels of education, comprehensive sexual education, and retaining learners in school are also associated with lower levels of teenage pregnancy, HIV, and other STIs.Gender norms and entrenched cultural practices: Interventions to increase agency among women and efforts in engaging their male partners, men, and boys in fostering equitable SRHR in South Africa have been ongoing, but more are necessary, particularly linking existing initiatives to communities through multisector involvement to achieve sufficient scale and coverage. Changing attitudes embedded in sociocultural and political structures is important to promote contraceptive use and other proactive SRHR choices.Gender based violence: High levels of sexual, gender-based, and intimate partner violence affect South Africa, denying many women, including adolescents, the full enjoyment and attainment of SRHR services. It undermines development efforts, and increases women’s vulnerability to poor health and social outcomes. Various strategies have been deployed through multisector collaboration, but these need more strategic implementation and enforcement. Partner, family, and community expectations around fertility: Pressure on teenagers and young women to ‘prove their love’ by childbearing, troubled negotiations between partners concerning condom and contraceptive use, and societal and familial expectations for women to have children, are all examples. De-linking of sex, marriage, and reproduction: Marriage does not always precede sexual activity- the increase in the age of first marriage and changing norms and values are resulting in more childbearing outside of formal marriage. Many mothers raise children without spousal support, for example in 2016, two thirds of registered births omitted the name of the child’s father in South Africa. ADDIN EN.CITE <EndNote><Cite><Author>Government of South Africa</Author><Year>2017</Year><RecNum>74</RecNum><DisplayText><style face="superscript">9</style></DisplayText><record><rec-number>74</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1516849112">74</key></foreign-keys><ref-type name="Government Document">46</ref-type><contributors><authors><author>Government of South Africa,</author></authors><secondary-authors><author>Department of Health</author></secondary-authors></contributors><titles><title>Adolescent and Youth Health Policy</title></titles><dates><year>2017</year></dates><urls></urls></record></Cite></EndNote>9Knowledge about conception: Many people do not have a sufficient understanding about the fertile period and when pregnancy is most likely to occur. This influences their choices around contraception and can result in unwanted pregnancy. There are important missed opportunities in a variety of health and educational settings to provide information on reproduction.Knowledge about contraceptive methods: Although almost all South Africans know of at least one type of contraceptive, most have a limited knowledge of the range of contraceptive methods available. This hampers the ability to make informed choices and limits community experience with newer methods. Misinformation about methods may also affect uptake negatively. Stigma and discrimination: Women who are not in a formal union - such as unmarried, widowed, and peri-menopausal women, present with specific sexual health concerns and yet stigma is ripe among these groups. Due consideration is therefore needed when addressing their specific needs, with a focus on ensuring access to services and emphasizing agency in a non-discriminatory approach. In our approach to SRHR, due consideration has been made to advance the rights of sex workers, LGBTI+ people, disabled people, and refugees to ensure they enjoy a meaningful sexual life. In addition, these groups often experience stigma from a wide range of people, including judgemental service providers, limiting their access to SRHR services. As such, reference should also be made to some documents that have been put forward to advance the individual rights of sex workers and the LGBTQI rights, such as the South African National Sex Worker HIV plan, 2016 – 2019; and the South African National LGBTI HIV plan, 2017-2022. ADDIN EN.CITE <EndNote><Cite><Author>SANAC</Author><RecNum>198</RecNum><DisplayText><style face="superscript">10, 11</style></DisplayText><record><rec-number>198</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542270242">198</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>The South African National Aids Council (SANAC),</author></authors></contributors><titles><title>South African National Sex Worker HIV plan, 2016 – 2019</title></titles><dates><year>2016</year></dates><pub-location>Pretoria</pub-location><urls><related-urls><url> South African National Aids Council (SANAC)</Author><Year>2017</Year><RecNum>215</RecNum><record><rec-number>215</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542354603">215</key></foreign-keys><ref-type name="Generic">13</ref-type><contributors><authors><author>The South African National Aids Council (SANAC),</author></authors></contributors><titles><title>The South African National LGBTI HIV Plan, 2017-2022</title></titles><dates><year>2017</year></dates><pub-location>Pretoria</pub-location><urls><related-urls><url>, 11Adolescent girls and young womenUnmet need for contraception among youthAdolescents girls and young women (AGYW) exhibit high incidence of HIV and high levels of unmet need for contraception (around 30%). ADDIN EN.CITE <EndNote><Cite><Author>National Department of Health</Author><Year>2011</Year><RecNum>200</RecNum><DisplayText><style face="superscript">12</style></DisplayText><record><rec-number>200</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542273038">200</key></foreign-keys><ref-type name="Generic">13</ref-type><contributors><authors><author>National Department of Health,</author></authors></contributors><titles><title>Sexual and reproductive health and rights: Literature review and situation analysis undertaken to inform: Sexual and reproductive health: Fulfilling our Commitments</title></titles><dates><year>2011</year></dates><pub-location>Pretoria</pub-location><publisher>Soul City</publisher><urls><related-urls><url> This has been demonstrated consistently from the demographic health surveys as shown in REF _Ref530059147 \h Figure 2. Figure SEQ Figure \* ARABIC 2. Unmet need for contraception among youth under 25 years old The mix of methods of contraception used by young women is also uneven. For example the popularity of progestin only injectable contraception in South Africa, specifically among AGYW, is attributed to its convenience, high acceptability among clients and health providers, and cost effectiveness. ADDIN EN.CITE <EndNote><Cite><Author>National Department of Health</Author><Year>2011</Year><RecNum>200</RecNum><DisplayText><style face="superscript">12</style></DisplayText><record><rec-number>200</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542273038">200</key></foreign-keys><ref-type name="Generic">13</ref-type><contributors><authors><author>National Department of Health,</author></authors></contributors><titles><title>Sexual and reproductive health and rights: Literature review and situation analysis undertaken to inform: Sexual and reproductive health: Fulfilling our Commitments</title></titles><dates><year>2011</year></dates><pub-location>Pretoria</pub-location><publisher>Soul City</publisher><urls><related-urls><url> This has resulted in a poor contraceptive mix among young women.Figure SEQ Figure \* ARABIC 3. Types of contraception used among 15-29 and 20-24 year oldsHIV acquisition risk among youthMany South African youth are sexually active and practice risky sexual behaviour. There is a need to accelerate the implementation of strategies that specifically address HIV among young people, where the incidence of unwanted pregnancies and HIV displays worrying trends. When asked about sexual behaviour in the past 12 months, youth aged 15-24 years reported ADDIN EN.CITE <EndNote><Cite><Author>National Department of Health</Author><Year>2011</Year><RecNum>200</RecNum><DisplayText><style face="superscript">12</style></DisplayText><record><rec-number>200</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542273038">200</key></foreign-keys><ref-type name="Generic">13</ref-type><contributors><authors><author>National Department of Health,</author></authors></contributors><titles><title>Sexual and reproductive health and rights: Literature review and situation analysis undertaken to inform: Sexual and reproductive health: Fulfilling our Commitments</title></titles><dates><year>2011</year></dates><pub-location>Pretoria</pub-location><publisher>Soul City</publisher><urls><related-urls><url> of young women reported two or more sexual partners 52% of young women reported sex with a partner who is not their spouse or living with them 62% of young, unmarried women not living with a partner used a condom at last sexOnly 38% of young women 15-19 and 67% aged 20-24 years reported that they tested for HIVOnly 29% of young men 15-19 and 49% of men 20-24 years reported that they tested for HIVTeen pregnancy and motherhoodSouth Africa’s teenage pregnancy rate has shown little change since 1998.Figure SEQ Figure \* ARABIC 4. Percentage of young women, age 15-19 years, who have begun childbearing00Nationally, 16% of women 15-19 years have begun childbearing: ranging from 8% in Western Cape to 20% in Northern Cape and North West. REF _Ref530061221 \h \* MERGEFORMAT Figure 4 illustrates the modest shifts in teen motherhood from 1998 to 2016 - most notable is the increase in motherhood among the youngest age group and the decline among 19 year olds.Nationally, 16% of women 15-19 years have begun childbearing: ranging from 8% in Western Cape to 20% in Northern Cape and North West. REF _Ref530061221 \h \* MERGEFORMAT Figure 4 illustrates the modest shifts in teen motherhood from 1998 to 2016 - most notable is the increase in motherhood among the youngest age group and the decline among 19 year olds.Overall, 12% of teens between the ages of 15 and 19 years have begun childbearing, indicated by the red box in REF _Ref530061364 \h Table 1Table SEQ Table \* ARABIC 1. Birth registrations by age of the mother, 2017Age of motherNumber birth occurrencesPercentage10-14 3 261 0,3%15-19 119 645 12,1%20-24 244 190 24,7%25-29 247 507 25,0%30-34 200 490 20,3%35-40 108 362 11,0%40-44 32 737 3,3%45-49 2 679 0,3%50-54 340 0,0%Unspecified30 1073,0%Total 989 318 100.0%Teens between the ages of 10 and 19 contributed 12.4% to registered childbirths in 2017. In an attempt to stem learner pregnancy in South African schools, the Department of Basic Education included the reduction of unwanted teen pregnancy as a separate objective in its HIV, STI, and TB Policy. ADDIN EN.CITE <EndNote><Cite><Author>Government of South Africa</Author><Year>2017</Year><RecNum>42</RecNum><DisplayText><style face="superscript">13</style></DisplayText><record><rec-number>42</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1501168541">42</key></foreign-keys><ref-type name="Government Document">46</ref-type><contributors><authors><author>Government of South Africa,</author></authors><secondary-authors><author>Department of Basic Education,</author></secondary-authors></contributors><titles><title>National Policy on HIV, STI, TB</title></titles><dates><year>2017</year></dates><urls></urls></record></Cite></EndNote>14Influence of key SRHR indicatorsAnother consideration for this policy is the current trends in key SRHR indicators, which may suggest both wide access to primary healthcare and substantial scope for improving quality of care. Observing change in indicator measurement over time and in relation to national targets highlights areas of achievement and those in need of extra support. REF _Ref530123561 \h Table 2 below summarizes:Table SEQ Table \* ARABIC 2. Selected SRHR indicators against national targetsCategoryIndicator201120122013201420152016TargetFacility DeliveryDelivery in facility under 18 years rate (%)8.17.77.87.47.16.8N/AMaternal mortality in facility ratio (iMMR) (per 100,000 live births)144.9132.9133.3132.5119.1116.9120Prevention of mother-to-child-transmission (PMTCT)ANC 1st visit before 20 weeks rate40.244.050.053.961.265.262ANC client initiated on ART rate80.481.676.391.293.095.195Sexual HealthCervical cancer screening coverage50.250.354.154.556.661.562Couple year protection rate (CYPR)---63.466.770.250HIVHIV testing coverage (including ANC)--26.132.134.535.990Male condom distribution 15.721.827.938.444.447.53 billionFacility delivery rates for under 18 years: The proportion of in-facility deliveries to women under 18 years old can be used as a proxy for the adolescent birth rate. There was a downward trend from 7.7% in 2012/13 to 6.8% in 2016/17. ADDIN EN.CITE <EndNote><Cite><Author>Government of South Africa</Author><Year>2017</Year><RecNum>42</RecNum><DisplayText><style face="superscript">13</style></DisplayText><record><rec-number>42</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1501168541">42</key></foreign-keys><ref-type name="Government Document">46</ref-type><contributors><authors><author>Government of South Africa,</author></authors><secondary-authors><author>Department of Basic Education,</author></secondary-authors></contributors><titles><title>National Policy on HIV, STI, TB</title></titles><dates><year>2017</year></dates><urls></urls></record></Cite></EndNote>15 While the decline is commendable, strategies encompassed in this policy call for accelerated multi-stakeholder approaches from the National Departments of Health, Basic Education, and Social Development for multisector solutions.Institutional Maternal Mortality Ratio (iMMR): South Africa has shown a decreasing trend in the iMMR over the past five years. The national iMMR in 2016/17 met the target of 120 per 100 000 live births with 116.9 per 100 000 live births, down from 132.9 in 2012/13. The target for 2019 is less than 100/100 000 live births and is on track for the SDG targets on maternal mortality reduction. 84% of women with a live birth since 2015 received a postnatal check during the first 2 days after birth, compared with only 63 % in 2014. ADDIN EN.CITE <EndNote><Cite><Author>Government of South Africa</Author><Year>2017</Year><RecNum>42</RecNum><DisplayText><style face="superscript">13</style></DisplayText><record><rec-number>42</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1501168541">42</key></foreign-keys><ref-type name="Government Document">46</ref-type><contributors><authors><author>Government of South Africa,</author></authors><secondary-authors><author>Department of Basic Education,</author></secondary-authors></contributors><titles><title>National Policy on HIV, STI, TB</title></titles><dates><year>2017</year></dates><urls></urls></record></Cite></EndNote>16 Figure SEQ Figure \* ARABIC 5. Maternal deaths reported to the National Committee for the Confidential Enquiries into Maternal Deaths between 1998 and 2016 (SOURCE REF?)Fertility trends: Fertility is on the decline in South Africa, the number of children ever born per woman in 2016 was 2.6, compared to 2.9 from 1996-98. [REF] A current challenge, however is that more than two-thirds of births, particularly among 20-29 year olds, do not contain information on fathers. ADDIN EN.CITE <EndNote><Cite><Year>2016</Year><RecNum>201</RecNum><DisplayText><style face="superscript">14</style></DisplayText><record><rec-number>201</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542337246">201</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors></contributors><titles><title>Recorded live births</title></titles><dates><year>2016</year></dates><pub-location>Pretoria</pub-location><urls><related-urls><url> First antenatal visit before 20 weeks: The NDoH aims to have 66.0% of first antenatal visits before 20 weeks gestation by 2019/20. In 2016/17, the rate in South Africa was 65.2%, 3.2 percentage points above the current target of 62%.[REF] Focused interventions by the Department to improve early antenatal care (ANC) booking rates contributed to this improvement through:Implementation of the 90-90-90 strategies [REF]The announcement of the Last Mile Plan ADDIN EN.CITE <EndNote><Cite><Author>Sherman</Author><Year>2017</Year><RecNum>202</RecNum><DisplayText><style face="superscript">15</style></DisplayText><record><rec-number>202</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542337601">202</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sherman, G., </author><author>Doherty, T., </author><author>Barron, P.,</author></authors></contributors><titles><title>Eliminating mother-to-child transmission of HIV in South Africa, 2002–2016: progress, challenges and the Last Mile Plan</title><secondary-title>South African Heal. Rev.</secondary-title></titles><periodical><full-title>South African Heal. Rev.</full-title></periodical><pages>137–46</pages><dates><year>2017</year></dates><urls></urls></record></Cite></EndNote>15The launch of ward-based community outreach teams ADDIN EN.CITE <EndNote><Cite><Author>Government of South Africa</Author><Year>2017</Year><RecNum>203</RecNum><DisplayText><style face="superscript">16</style></DisplayText><record><rec-number>203</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542337686">203</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>Government of South Africa,</author></authors></contributors><titles><title>Policy Framework and Strategy for Ward Based Primary Healthcare Outreach Teams</title></titles><dates><year>2017</year></dates><pub-location>Pretoria</pub-location><publisher>National Department of Health</publisher><urls></urls></record></Cite></EndNote>16Implementation of the 2015 National Consolidated Guidelines ADDIN EN.CITE <EndNote><Cite><Author>Government of South Africa</Author><Year>2015</Year><RecNum>204</RecNum><DisplayText><style face="superscript">17</style></DisplayText><record><rec-number>204</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542337789">204</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>Government of South Africa,</author></authors></contributors><titles><title>National Consolidated Guidelines for the Prevention of Mother-To-Child Transmission of HIV (PMTCT) and the Management of HIV in Children, Adolescents and Adults</title></titles><dates><year>2015</year></dates><pub-location>Pretoria</pub-location><publisher>National Department of Health</publisher><urls></urls></record></Cite></EndNote>17Annual PMTCT stock-take workshopsANC client initiated on antiretroviral treatment (ACOA) rate: The 2014/15 move to option B+ and the introduction of 90-90-90 [REF] in 2016 have ensured a high coverage of antiretroviral therapy (ART) to pregnant women accessing ANC services. In 2016/17, the ACOA rate in South Africa was 95.1% only 0.1 percentage points above the national target of 95% for this year. [REF]Cervical cancer screening coverage: Data collection prescribed by the National Policy on Cervical Cancer policy was implemented in April 2017. Prior to April 2017, cervical cancer screening was monitored only once within a 10-year interval. National cervical cancer screening coverage has increased over the past three years (to 61.5%), nearly reaching the national target of 62% in 2016/17. [REF]Couple year protection rate (CYPR) and Contraception Protection Rate (CPR): The CYPR measures the proportion of women protected against pregnancy by using modern contraceptive methods, which is currently estimated at 59.3% considerably higher than the national target of 50% for the country. [REF]Contraceptive use has risen at a much slower pace with a high unmet need for contraception. The district health information system (DHIS) reported the 2016/17 CYPR at 70.2%. When comparing 1998 data with the 2016 data, modern CPR among married women in South Africa remained almost unchanged at 55% and 54%, respectively. From 1998 to 2016, the modern CPR among sexually active unmarried women has actually declined (68% vs. 64%). [REF] Shift in methods used is notable, even though comprehensive data is not readily available: Use of oral and injectable contraceptives has decreasedUse of condoms for contraception has increased Modest uptake of contraceptive implants (5-6% in 2016) was observedUnmet need for contraception has increasedUnmet need for contraception: Unmet need for contraception varies between 11% and 24% across provinces, as shown in Figure 6. This issue needs more attention as it demonstrates there has not been much improvement over the years: with an average of 18% among married and sexually active women of 15-49 years; and 30% of married or sexually active women 15-24 years.Figure SEQ Figure \* ARABIC 6. Unmet need for contraception (15-49) across the Provinces (SOURCE REF)HIV testing coverage: The average HIV testing coverage rate (including ANC) for the country has been increasing steadily from 26.1% in 2013/14 to 35.9% in 2016/17 translating to more than 10 million HIV tests annually. HIV testing coverage reports on testing done within public health facilities and those in non-medical sites that report data to the DHIS. South Africa’s target is to ensure that 90% of all persons and 95% of ANC clients living with HIV know their HIV status. ADDIN EN.CITE <EndNote><Cite><Author>Government of South Africa</Author><Year>2016</Year><RecNum>39</RecNum><DisplayText><style face="superscript">18</style></DisplayText><record><rec-number>39</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1501168093">39</key></foreign-keys><ref-type name="Government Document">46</ref-type><contributors><authors><author>Government of South Africa,</author></authors><secondary-authors><author>Department of Health,</author></secondary-authors></contributors><titles><title>National HIV Testing Services: Policy</title></titles><dates><year>2016</year></dates><urls></urls></record></Cite></EndNote>18 In terms of the national effort to increase HIV testing to 90% of people living with HIV, 59% of women and 44% of men aged 15-49 years reported that they were tested for HIV and received their result in the past 12 months. [REF]Access to safe choice of termination of pregnancy (CTOP): Data on the availability of abortion services is still limited. However, since the CTOP Amendment Act in 2002 trends indicate an increase in the rates of safe abortion, a proxy for access. However, more needs to be done. Many facilities are still not providing abortion, even though they have the capacity to, with some districts not providing any abortion services at all. With an abortion rate of approximately 31 per 1000 women aged 15-44 [REF], it is estimated that the public sector provides 20% of all abortions while the illegal sector provides 26% unsafe abortions, which burdens the public sector when the resulting morbidity has to be managed.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MaW5jZS1EZXJvY2hlPC9BdXRob3I+PFllYXI+MjAxODwv

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AG==

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AG==

ADDIN EN.CITE.DATA 19 The reasons for so many illegal abortions are multifaceted, including mere lack of knowledge, skills paucity among frontline health care workers, conscientious objections, and stigma that is often associated with seeking such services.Male condom distribution: This indicator monitors the distribution of male condoms for prevention of HIV and other STIs, as well as contraception. A steady increase in the numbers distributed is shown in REF _Ref530123561 \h Table 2. More effort is still required to ensure utilisation. Policy components and alignmentSouth Africa’s laws and policies support a rights-based framework for SRH – aligned with regional and international frameworks: the 1994 International Conference on Population and Programme of Action, 1995 Beijing Fourth Conference on Women, the SDGs, the Guttmacher–Lancet Commission report on SRHR, Family planning 2020, and the SADC SRH strategy.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Vbml0ZWQgTmF0aW9ucyBQb3B1bGF0aW9uIEluZm9ybWF0

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ADDIN EN.CITE.DATA 20-24 SRHR improvement, prevention, diagnosis, treatment, and care should be evidence-based and in line with global and national policies, protocols, and clinical guidelines. Alignment with global strategies and statutesSustainable Development GoalsAlthough they exclude explicit mention of sexual rights, several SDGs are inclusive of SRHR goals for health, education and gender equality, incorporating certain key SRHR aspects into the targets, such as access to SRHR services, CSE, and the ability to make decisions about one’s own health. ADDIN EN.CITE <EndNote><Cite><Author>Galati</Author><Year>2015</Year><RecNum>226</RecNum><DisplayText><style face="superscript">25</style></DisplayText><record><rec-number>226</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542365399">226</key></foreign-keys><ref-type name="Generic">13</ref-type><contributors><authors><author>Galati, A.J.,</author></authors></contributors><titles><title>Onward to 2030: Sexual and Reproductive Health and Rights in the Context of the Sustainable Development Goals</title><secondary-title>Guttmacher Policy Rev</secondary-title></titles><pages>77-84</pages><volume>18</volume><dates><year>2015</year></dates><urls><related-urls><url> SEQ Table \* ARABIC 3. SDGs related to the SRHR PolicyGoal 3: Ensure healthy lives and promote well-being for all at all agesTarget 3.1By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live birthsTarget 3.3 By 2030, end the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases, and combat hepatitis, water-borne diseases, and other communicable diseasesTarget 3.7By 2030, ensure universal access to sexual and reproductive health-care services, including for contraception, information and education, and the integration of reproductive health into national strategies and programmesGoal 5: Achieve gender equality and empower all women and girlsTarget 5.1End all forms of discrimination against all women and girls everywhereTarget 5.2Eliminate all forms of violence against all women and girls in the public and private spheres, including trafficking and sexual and other types of exploitationTarget 5.3Eliminate all harmful practices, such as child, early, and forced marriage and female genital mutilationTarget 5.6Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferencesGoal 10: Reduce inequality within and among countries, relates to achieving SRHR for priority populations most affected by HIV, discrimination, and fulfilling the right to developmentGuttmacher – Lancet CommissionThe 2018 Guttmacher-Lancet Commission report proposes a comprehensive and integrated definition of SRHR, recommending an essential package of SRHR services and a positive, progressive, evidence-based agenda for progress on SRHR to 2030 and beyond. ADDIN EN.CITE <EndNote><Cite><Year>2018</Year><RecNum>175</RecNum><DisplayText><style face="superscript">23</style></DisplayText><record><rec-number>175</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1541473902">175</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors></contributors><titles><title>Guttmacher-Lancet Commission on Sexual and Reproductive Health and Rights </title></titles><dates><year>2018</year></dates><publisher>The Lancet</publisher><urls><related-urls><url> guidance, including SADCThe SRHR Policy is aligned with global clinical and service delivery guidance, and reference is made in several areas of this document: WHO Clinical practice handbook for safe abortion ADDIN EN.CITE <EndNote><Cite><Author>World Health Organization</Author><Year>2014</Year><RecNum>219</RecNum><DisplayText><style face="superscript">26</style></DisplayText><record><rec-number>219</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542356462">219</key></foreign-keys><ref-type name="Generic">13</ref-type><contributors><authors><author>World Health Organization,</author></authors></contributors><titles><title>Clinical practice handbook for safe abortion</title></titles><dates><year>2014</year></dates><pub-location>Geneva</pub-location><publisher>WHO</publisher><urls><related-urls><url> planning: A global handbook for providers ADDIN EN.CITE <EndNote><Cite><Author>World Health Organization Department of Reproductive Health and Research (WHO/RHR) and Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs (CCP) Knowledge for Health Project</Author><Year>2018</Year><RecNum>95</RecNum><DisplayText><style face="superscript">27</style></DisplayText><record><rec-number>95</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1533287736">95</key></foreign-keys><ref-type name="Standard">58</ref-type><contributors><authors><author>World Health Organization Department of Reproductive Health and Research (WHO/RHR) and Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs (CCP) Knowledge for Health Project,</author></authors></contributors><titles><title>Family Planning: A Global Handbook for Providers (2018 update).</title></titles><dates><year>2018</year></dates><pub-location>Baltimore and Geneva: CCP and WHO</pub-location><urls><related-urls><url> Practice Recommendations for Contraceptive Use ADDIN EN.CITE <EndNote><Cite><Author>World Health Organization</Author><Year>2016</Year><RecNum>220</RecNum><DisplayText><style face="superscript">28</style></DisplayText><record><rec-number>220</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542356666">220</key></foreign-keys><ref-type name="Generic">13</ref-type><contributors><authors><author>World Health Organization,</author></authors></contributors><titles><title>Selected practice recommendations for contraceptive use - 3rd edition</title></titles><dates><year>2016</year></dates><pub-location>Geneva</pub-location><publisher>WHO</publisher><urls><related-urls><url> Health Sector Strategy on STIs ADDIN EN.CITE <EndNote><Cite><Author>World Health Organization</Author><Year>2016</Year><RecNum>221</RecNum><DisplayText><style face="superscript">29</style></DisplayText><record><rec-number>221</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542356752">221</key></foreign-keys><ref-type name="Generic">13</ref-type><contributors><authors><author>World Health Organization,</author></authors></contributors><titles><title>Global health sector strategy on sexually transmitted infections: Towards ending STIs, 2016-2021</title></titles><dates><year>2016</year></dates><pub-location>Geneva</pub-location><publisher>WHO</publisher><urls><related-urls><url> Global Family Planning 2020 framework ADDIN EN.CITE <EndNote><Cite><RecNum>209</RecNum><DisplayText><style face="superscript">24</style></DisplayText><record><rec-number>209</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542350979">209</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors></contributors><titles><title>FamilyPlanning2020</title></titles><dates></dates><urls><related-urls><url> Minimum Standards for the Integration of HIV and Sexual and Reproductive Health in the SADC Region ADDIN EN.CITE <EndNote><Cite><Author>Southern African Development Community (SADC)</Author><Year>2015</Year><RecNum>222</RecNum><DisplayText><style face="superscript">30</style></DisplayText><record><rec-number>222</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542356976">222</key></foreign-keys><ref-type name="Generic">13</ref-type><contributors><authors><author>Southern African Development Community (SADC),</author></authors></contributors><titles><title>Minimum Standards for the Integration of HIV and Sexual &amp; Reproductive Health in the SADC Region</title></titles><dates><year>2015</year></dates><urls><related-urls><url> Protocol on Health, Article 16 ADDIN EN.CITE <EndNote><Cite><Author>Southern African Development Community (SADC)</Author><Year>1998</Year><RecNum>223</RecNum><DisplayText><style face="superscript">31</style></DisplayText><record><rec-number>223</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542357157">223</key></foreign-keys><ref-type name="Generic">13</ref-type><contributors><authors><author>Southern African Development Community (SADC), </author></authors></contributors><titles><title>Protocol on Health</title></titles><dates><year>1998</year></dates><urls><related-urls><url> and Reproductive Health Strategy for the SADC Region 2006-2015 ADDIN EN.CITE <EndNote><Cite><Author>Southern African Development Community (SADC)</Author><Year>2008</Year><RecNum>224</RecNum><DisplayText><style face="superscript">32</style></DisplayText><record><rec-number>224</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542360392">224</key></foreign-keys><ref-type name="Generic">13</ref-type><contributors><authors><author>Southern African Development Community (SADC), </author></authors></contributors><titles><title>Sexual and Reproductive Health Strategy for the SADC Region 2006-2015</title></titles><dates><year>2008</year></dates><urls><related-urls><url> Alignment with national policies and strategies This SRHR Policy is aligned with the following key documents, strategies, and approaches: National Department of Health Strategic Plan 2015/16 – 2019/20The SRHR Policy implementation supports, and is also dependent on, the efficient execution of the National Department of Health’s five year strategic goals for 2015/16-2019/20, with key objectives as follows ADDIN EN.CITE <EndNote><Cite><Author>Government of South Africa</Author><Year>2014</Year><RecNum>211</RecNum><DisplayText><style face="superscript">33</style></DisplayText><record><rec-number>211</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542353078">211</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>Government of South Africa,</author></authors></contributors><titles><title>Department of Health Strategic Plan 2014/15–2018/19</title></titles><dates><year>2014</year></dates><pub-location>Pretoria</pub-location><publisher>National Department of Health</publisher><urls></urls></record></Cite></EndNote>33:Prevent disease and reduce its burden, and promote health; Make progress towards universal health coverage through the development of the National Health Insurance scheme, and improve the readiness of health facilities for its implementation; Re-engineer primary healthcare by: increasing the number of ward based outreach teams, contracting general practitioners, and district specialist teams; and expanding school health services; Improve health facility planning by implementing norms and standards; Improve financial management by improving capacity, contract management, revenue collection and supply chain management reforms; Develop an efficient health management information system (HMIS) for improved decision makingImprove the quality of care by setting and monitoring national norms and standards, improving system for user feedback, increasing safety in health care, and by improving clinical governance Improve human resources for health by ensuring appropriate appointments, adequate training and accountability measures.National Strategic Plan for HIV, TB and STI’s 2017-2022This SRHR Policy also supports cross-cutting goals of the National Strategic Plan for HIV, TB and STI’s 2017-2022. ADDIN EN.CITE <EndNote><Cite><Author>Government of South Africa</Author><Year>2017</Year><RecNum>18</RecNum><DisplayText><style face="superscript">34</style></DisplayText><record><rec-number>18</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1500970965">18</key></foreign-keys><ref-type name="Government Document">46</ref-type><contributors><authors><author>Government of South Africa,</author></authors><secondary-authors><author>Department of Health,</author></secondary-authors></contributors><titles><title>South Africa’s National Strategic Plan on HIV, TB and STIs 2017-2022</title></titles><dates><year>2017</year></dates><urls></urls></record></Cite></EndNote>34 Fostering an enabling policy environment to accelerate prevention of HIV and STIs, reducing associated morbidity and mortality, reaching key populations, and grounding policy in human rights, are all key alignments between the SRHR Policy and the HIV, TB and STI strategic plan. Sexual and Reproductive Health and Rights: Fulfilling our Commitments 2011-2022SRHR: Fulfilling our Commitments 2011-2022 ADDIN EN.CITE <EndNote><Cite><Author>National Department of Health</Author><Year>2011</Year><RecNum>210</RecNum><DisplayText><style face="superscript">35</style></DisplayText><record><rec-number>210</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542351297">210</key></foreign-keys><ref-type name="Generic">13</ref-type><contributors><authors><author>National Department of Health,</author></authors></contributors><titles><title>Sexual and Reproductive Health and Rights: Fulfilling our Commitments, 2011-2021 and Beyond</title></titles><dates><year>2011</year></dates><pub-location>Pretoria</pub-location><urls><related-urls><url> created the platform for a multi-sectoral framework, further informed by the CTOP Act, in which SRHR are recognised and valued for delivery of equitable and accessible SRH services in South Africa.National Health InsuranceThe NHI, as one of the mechanisms to facilitate universal health coverage, will offer all South Africans and residents access to a defined package of comprehensive health services, including SRHR services. The NHI seeks to create a health financing system that ensures that all citizens of South Africa, and legal long-term residents, are provided with essential healthcare, regardless of their employment status and ability to make a direct monetary contribution to the NHI Fund. The first phase of NHI is underway, with full implementation expected in the financial year 2025/26. ADDIN EN.CITE <EndNote><Cite><Author>National Department of Health</Author><Year>2017</Year><RecNum>212</RecNum><DisplayText><style face="superscript">36</style></DisplayText><record><rec-number>212</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542353430">212</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors><authors><author>National Department of Health,</author></authors></contributors><titles><title>NHI White Paper</title></titles><dates><year>2017</year></dates><pub-location>Pretoria</pub-location><urls><related-urls><url> National Policies, Laws, and GuidelinesTable 3, below, lists a summary of additional relevant South African policies, plans, and laws:Table SEQ Table \* ARABIC 4. Alignment with national health policies, laws, and plansSouth African policies and laws informing the SRHR PolicyNational Adolescent SRHR Framework Strategy (ASRH&R), 2014-2019 ADDIN EN.CITE <EndNote><Cite><Author>National Department of Health</Author><Year>2015</Year><RecNum>213</RecNum><DisplayText><style face="superscript">37</style></DisplayText><record><rec-number>213</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542353678">213</key></foreign-keys><ref-type name="Generic">13</ref-type><contributors><authors><author>National Department of Health, </author></authors></contributors><titles><title>National Adolescent Sexual and Reproductive Health and Rights Framework Strategy (ASRH&amp;R), 2014-2019 </title></titles><dates><year>2015</year></dates><pub-location>Pretoria</pub-location><urls><related-urls><url> Adolescent and Youth Health Policy 2016-2020 ADDIN EN.CITE <EndNote><Cite><Author>Government of South Africa</Author><Year>2017</Year><RecNum>74</RecNum><DisplayText><style face="superscript">9</style></DisplayText><record><rec-number>74</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1516849112">74</key></foreign-keys><ref-type name="Government Document">46</ref-type><contributors><authors><author>Government of South Africa,</author></authors><secondary-authors><author>Department of Health</author></secondary-authors></contributors><titles><title>Adolescent and Youth Health Policy</title></titles><dates><year>2017</year></dates><urls></urls></record></Cite></EndNote>9National HIV Testing Services (HTS) Policy ADDIN EN.CITE <EndNote><Cite><Author>Government of South Africa</Author><Year>2016</Year><RecNum>39</RecNum><DisplayText><style face="superscript">18</style></DisplayText><record><rec-number>39</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1501168093">39</key></foreign-keys><ref-type name="Government Document">46</ref-type><contributors><authors><author>Government of South Africa,</author></authors><secondary-authors><author>Department of Health,</author></secondary-authors></contributors><titles><title>National HIV Testing Services: Policy</title></titles><dates><year>2016</year></dates><urls></urls></record></Cite></EndNote>18National Strategic Plan for HIV, TB and STIs, 2017-2022 ADDIN EN.CITE <EndNote><Cite><Author>Government of South Africa</Author><Year>2017</Year><RecNum>38</RecNum><DisplayText><style face="superscript">38</style></DisplayText><record><rec-number>38</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1501168054">38</key></foreign-keys><ref-type name="Government Document">46</ref-type><contributors><authors><author>Government of South Africa,</author></authors><secondary-authors><author>National Department of Health,</author></secondary-authors></contributors><titles><title>National Strategic Plan for HIV, STIs, and TB 2017-2022</title></titles><dates><year>2017</year></dates><urls></urls></record></Cite></EndNote>38Department Basic Education National Policy on HIV, STIs and TB ADDIN EN.CITE <EndNote><Cite><Author>Government of South Africa</Author><Year>2017</Year><RecNum>42</RecNum><DisplayText><style face="superscript">13</style></DisplayText><record><rec-number>42</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1501168541">42</key></foreign-keys><ref-type name="Government Document">46</ref-type><contributors><authors><author>Government of South Africa,</author></authors><secondary-authors><author>Department of Basic Education,</author></secondary-authors></contributors><titles><title>National Policy on HIV, STI, TB</title></titles><dates><year>2017</year></dates><urls></urls></record></Cite></EndNote>13 and the National Policy on the Prevention and Management of Learner Pregnancy in Schools ADDIN EN.CITE <EndNote><Cite><Author>Government of South Africa</Author><Year>2018</Year><RecNum>214</RecNum><DisplayText><style face="superscript">39</style></DisplayText><record><rec-number>214</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542354431">214</key></foreign-keys><ref-type name="Generic">13</ref-type><contributors><authors><author>Government of South Africa, </author></authors></contributors><titles><title>DBE Draft National Policy on the Prevention and Managemetn of Learner Pregnancy in Schools</title></titles><dates><year>2018</year></dates><pub-location>Pretoria</pub-location><publisher>Department of Basic Education, </publisher><urls><related-urls><url> South African National LGBTI HIV Plan, 2017-2022 ADDIN EN.CITE <EndNote><Cite><Author>The South African National Aids Council (SANAC)</Author><Year>2017</Year><RecNum>215</RecNum><DisplayText><style face="superscript">11</style></DisplayText><record><rec-number>215</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542354603">215</key></foreign-keys><ref-type name="Generic">13</ref-type><contributors><authors><author>The South African National Aids Council (SANAC),</author></authors></contributors><titles><title>The South African National LGBTI HIV Plan, 2017-2022</title></titles><dates><year>2017</year></dates><pub-location>Pretoria</pub-location><urls><related-urls><url> South African National Sex Worker HIV Plan, 2016-2019 ADDIN EN.CITE <EndNote><Cite><Author>The South African National Aids Council (SANAC)</Author><Year>2016</Year><RecNum>198</RecNum><DisplayText><style face="superscript">10</style></DisplayText><record><rec-number>198</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542270242">198</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>The South African National Aids Council (SANAC),</author></authors></contributors><titles><title>South African National Sex Worker HIV plan, 2016 – 2019</title></titles><dates><year>2016</year></dates><pub-location>Pretoria</pub-location><urls><related-urls><url> Breast Cancer Prevention and Control Policy ADDIN EN.CITE <EndNote><Cite><Author>Government of South Africa</Author><Year>2017</Year><RecNum>216</RecNum><DisplayText><style face="superscript">40</style></DisplayText><record><rec-number>216</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542355289">216</key></foreign-keys><ref-type name="Generic">13</ref-type><contributors><authors><author>Government of South Africa,</author></authors></contributors><titles><title>Breast Cancer Prevention and Control Policy</title></titles><dates><year>2017</year></dates><pub-location>Pretoria</pub-location><publisher>National Department of Health</publisher><urls><related-urls><url> Cervical Cancer and Control Policy ADDIN EN.CITE <EndNote><Cite><Author>Government of South Africa</Author><Year>2017</Year><RecNum>217</RecNum><DisplayText><style face="superscript">41</style></DisplayText><record><rec-number>217</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542355573">217</key></foreign-keys><ref-type name="Generic">13</ref-type><contributors><authors><author>Government of South Africa,</author></authors></contributors><titles><title>Cervical Cancer Prevention and Control Policy</title></titles><dates><year>2017</year></dates><pub-location>Pretoria</pub-location><publisher>National Department of Health</publisher><urls><related-urls><url> Sector HIV Prevention Strategy 2016 ADDIN EN.CITE <EndNote><Cite><Author>Government of South Africa</Author><Year>2016</Year><RecNum>218</RecNum><DisplayText><style face="superscript">42</style></DisplayText><record><rec-number>218</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542355830">218</key></foreign-keys><ref-type name="Generic">13</ref-type><contributors><authors><author>Government of South Africa,</author></authors></contributors><titles><title>Health Sector HIV Prevention Strategy</title></titles><dates><year>2016</year></dates><pub-location>Pretoria</pub-location><publisher>National Department of Health</publisher><urls><related-urls><url> on Termination of Pregnancy Act and CTOP Amendment Bill 2004 [REF]Building upon the 2011 NDOH Sexual and Reproductive Health and Rights: Fulfilling our commitments 2011-2022, ADDIN EN.CITE <EndNote><Cite><Author>National Department of Health</Author><Year>2011</Year><RecNum>210</RecNum><DisplayText><style face="superscript">35</style></DisplayText><record><rec-number>210</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542351297">210</key></foreign-keys><ref-type name="Generic">13</ref-type><contributors><authors><author>National Department of Health,</author></authors></contributors><titles><title>Sexual and Reproductive Health and Rights: Fulfilling our Commitments, 2011-2021 and Beyond</title></titles><dates><year>2011</year></dates><pub-location>Pretoria</pub-location><urls><related-urls><url> components of SRHR services will focus on the key focus areas detailed in Section 3.4 below. This SRHR Policy provides an overarching foundation for the SRHR service specific clinical guidelines listed in the following table. Table SEQ Table \* ARABIC 5. Alignment with national service specific guidelinesSouth African national service specific guidelinesNational Clinical Guideline for Contraception (2019)National Guideline for Implementation of Choice on Termination of Pregnancy Act (2019)National Clinical Guideline for Safe Conception and Infertility (2019)Sexually Transmitted Infections Management Guidelines (2015)National Guideline on the Management of Post-Exposure Prophylaxis (PEP) in Occupational and Non-Occupational Exposures (2019)National Clinical Guideline for Cervical Cancer Control and Management (2019)National Clinical Guideline for Breast Cancer Control and Management (2019)National Clinical Guidelines on Genetics Services (2018) National Guideline for the Prevention of Mother to Child Transmission of Communicable Infections (HIV, Hepatitis, Listeriosis, Malaria, Syphilis and TB) (2019) In addition, there are several other documents which are relevant to the healthcare provider: National Policy on HIV Pre-Exposure Prophylaxis (PrEP) and Test and Treat (T&T) (2016)Guidelines for Expanding Combination Prevention and Treatment Options: Oral Pre-Exposure Prophylaxis (PrEP) and Test and Treat (T&T) (2017) Guidelines for Maternity Care in South Africa (2015)Ideal Clinic Manual (2018) The Integrated Clinical Services Management Manual (ICSM)Key focus areasSexual health – sexual desire, pleasure and functionPromote healthy sexuality, including in relation to self-acceptance, sexual orientation, gender identity, sexual function and pleasure, and sexuality throughout the human life-cycle Comprehensive sexuality education and friendly services for youth, community and individual education on and support for cultural values that foster SRHR, and positive health seeking behaviours Counselling and support in relation to all dimensions of the SRHR packageConfronting sexual and gender based violencePromote individual and cultural values that decrease SGBVProvide comprehensive clinical management of SGBVChoice on termination of pregnancyEnsure that every woman who seeks an abortion can access the service without delay. No woman should have to wait more than 7 days from the first request to access servicesEnable all abortion clients to make informed decisions and ensure their human rights are respected, protected, and fulfilledProvide a standardised approach to CTOP services in all regions of South AfricaIncrease access and uptake of CTOP servicesDeliver integrated CTOP services at the lowest appropriate level of carePromote multi-sectoral collaboration and shared accountability related to the provision of abortion within the context of SRHR servicesReducing unmet need for contraceptionImprove access to modern methods of contraceptionImprove the method mix for contraceptionSafe conception and Fertility managementIncrease access to, management of, and provision of psychosocial care for safer conception services Increase access to, management of, and provision of psychosocial care for people seeking infertility treatmentProvide uniformity, standardisation of care, and cost-effective treatment for infertile patientsPrevention of mother-to-child transmission of HIV and other transmittable infectionsProvide comprehensive ANC services Increase the number of pregnant women who attend the first ANC visit before 20 weeksEliminate mother-to-child transmission of HIV with interventions like retesting of HIV-negative pregnant and breastfeeding women, adherence support, and monitoring viral load for HIV-positive pregnant and breastfeeding womenProvide safe delivery care Provide postpartum care, including post-partum contraception counselling and serviceHIV and other STIsPrevention, detection, and treatment of HIV and other STIs, with emphasis on elimination of congenital syphilisCancers of the reproductive systemPrevention and management of cervical cancerEarly detection and management of breast cancerMenopauseManagement of SRHR beyond child-bearing yearsOccupational and non-occupation exposure risk Prevention and management of exposures to HIV, STI, pregnancy, hepatitis, and tetanusThe national integrated SRHR policy objectives The following table summarizes the five SRHR policy objectives and sub-components: Table SEQ Table \* ARABIC 6. SRHR policy objectives, sub-objectives, and intended resultsSRHR Policy ObjectivesIntended ResultObjective 1: Equip all people to make informed decisions about their SRHR and ensure that their SRH rights are respected, protected, and fulfilled1.1Disseminate the SRHR Policy to all levels in Department of Health and collaborating implementing partnersInformed and autonomous decision-making at provincial, district and individual levels1.2Disseminate the SRHR Policy to all levels in Department of Health and collaborating implementing partners1.3Offer person-centred counselling to all clients who access SRHR servicesObjective 2: Increase the access to and uptake of comprehensive and integrated SRHR care and treatment services across all life stages2.1Reduce the unmet need for contraception for women and men of reproductive age through provision of comprehensive family planning services at all levels of care; and improve the contraceptive method mix, together with counselling and information to encourage informed choiceA comprehensive and integrated package of SRHR services is provided in an equitable, accessible and rights based manner for all South Africans.2.2Provide safer conception, subfertility and infertility services to all clients which include prevention, diagnostics and treatment- for all clients who experience difficulty with conception2.3Provide safe abortion related and post abortion services for clients who need choice on termination of pregnancy services, offering appropriate care at all facilities2.4Provide HIV, TB and STIs services, including prevention, detection and management at all level of facilities 2.5Provide programmes for the prevention, detection and management of cervical cancer and breast cancer2.6Provide occupational and non-occupational PEP to clients at risk of HIV, STIs, pregnancy, hepatitis B and C, and tetanus Objective 3: Ensure access to respectful and non-judgmental SRHR services for priority groups3.1Adolescents and young people (10-24 years)Rights-based approach characterised by non-discrimination, confidentiality, and privacy3.2Peri-menopausal women3.3LGBTQI people3.4Female sex workers3.5People living with disabilities3.6Migrants and asylum seekers3.7Male partner and male involvementObjective 4: Strengthen the health system to deliver integrated SRHR services at the lowest feasible level in the healthcare system4.1Provide quality SRHR services at primary health care level or the lowest level possibleEnabling environment for high quality services delivered by trained providers4.2Ensure uninterrupted supply of commodities and drugs, including pregnancy tests at all facilities4.3Ensure healthcare providers have the skills and knowledge to deliver integrated SRHR services4.4Maximise the use of programmatic data and research to improve service provision and increase impact4.5Mobilise financial resources and maximise efficiencies to support implementation4.6Promote strong leadership and management to enforce the SRHR PolicyObjective 5: Promote multisector engagement and shared accountability5.1Strengthen partnerships with civil society, government and private sector to implement the SRHR PolicyCoordinated implementation for a sustainable response5.2Improve collaboration and co-operation between government, civil society, development partners and the private sector5.3Strengthen collaboration between and co-ordination of accountable government departmentsObjective 1: Pursue stakeholder alignment, generate demand, and provide user information and counselling to all clients to fulfil their SRHR needsPolicy statement: Cooperation and collaboration of intergovernmental departments; all provinces, district health systems, and other collaborating partners are required for full implementation.O1.1Disseminate the SRHR Policy to all levels of NDOH and collaborating implementation partnersO1.1.1Ensure the policy is incorporated into provincial and district health plans through stakeholder engagement and alignmentHost provincial workshops to introduce the SRHR Policy and get buy-inUse existing channels and create new channels to distribute policy documents to all districts in the country Conduct value clarification workshops with provider groups and other implementers to ensure equitable comprehensive SRHR service delivery to all clients, specifically priority populations. A workshop should result in planning and the policy should be reflected in provincial and district planning.Policy statement: Through innovative use of media and communication strategies, populations, especially the underserved, must have information related to services that they need, to generate increased demand.O1.2Create awareness and improve SRHR knowledge to stimulate demand for SRHR services in the general populationO1.2.1Inform the general population about available SRHR services through a robust demand generation strategy Establish and implement a communication and advocacy plan for demand generation and information sharing across all levels Use a variety of communication channels, including technology based, to inform the public of available SRHR services Reduce stigma and discrimination through community dialogues and mass media Provide comprehensive sexuality education in all schoolsO1.2.2Provide knowledge and information to clients accessing SRHR servicesDevelop and share information, education, and communication (IEC) materials at points of SRH service deliveryMake IEC materials available at other potential entry points, for example voluntary medical male circumcision (VMMC), outreach HTS, family planning outreach services, and any other mobile servicesPolicy statement: All clients seeking SRHR services should receive appropriate counselling and informed consent.Policy statement: SRHR services must focus on attracting new users, improving continuation rates, and encouraging past users who still want to avoid pregnancy to resume use, using effective, non-coercive counselling as a primary tool.O1.3Offer person-centred counselling to all clients who access SRHR servicesO1.3.1Offer person-centred counsellingTo provide accurate, evidence-informed information to all clients accessing SRHR servicesTo learn about the lived experience of the client through non-judgemental, open-ended questions to inform SRHR service choicesTo avoid coercion, emphasizing non-directive communicationTo provide clients with information to make healthy choices about their bodies and sexuality, and services that could mitigate social, political and economic challenges To avoid stigmatisation, undermining autonomy, or compounding inequalities ADDIN EN.CITE <EndNote><Cite><Author>Department of Social Development</Author><Year>2015</Year><RecNum>225</RecNum><DisplayText><style face="superscript">43</style></DisplayText><record><rec-number>225</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542365217">225</key></foreign-keys><ref-type name="Generic">13</ref-type><contributors><authors><author>Department of Social Development,</author></authors></contributors><titles><title>Fifteen year progress review of the implementation of the Population Policy for South Africa (1998) and the ICPD programme of action (1994)</title></titles><dates><year>2015</year></dates><pub-location>Pretoria</pub-location><urls><related-urls><url> 2: Increase the quality and uptake of comprehensive and integrated SRHR care and treatment services across all life stagesThis objective should be read in coordination with the national service specific guidelines detailed in REF _Ref530391679 \h \* MERGEFORMAT Table 5. The SRHR Policy provides for a comprehensive package of services that is available and accessible to all. A sustained increase in the uptake of, demand for, and access to SRHR services is only possible if service delivery meets the demand and the needs of individual clients.Policy statement: Provision of contraception services must be guided by the principle of informed choice, non-coercion, and availability of a varied method mix.Policy statement: Multiple contraceptive methods, including sterilisation, must be offered to meet the individual needs of clients. Policy statement: Encourage all sexually active clients to practice dual protection—contraception plus HIV and STI prevention. Policy statement: Emergency contraception shall be made available to all women needing or requesting it.O2.1Offer a range of modern contraceptive methods, together with counselling and information to encourage informed choiceThe following modern contraceptive methods are available in public health facilities:Subdermal hormonal implants Female sterilisation Male sterilisationLevonorgestrel intra-uterine device (LNG-IUD) Copper-bearing intra-uterine devices (Cu-IUD) Progestin-only injectables Combined oral contraceptives Progestin-only pills Male and female condoms and lubrication Emergency contraception Policy statement: Childbearing decisions are the right of the client, irrespective of HIV status, and service providers must not interfere with those decisions.O2.2Safe conception and infertility: Provide support to all clients who experience difficulty with conception, including safe conception support to HIV serodiscordant couplesO2.2.1All clients who desire a child and are planning a pregnancy should be advised about preparing for safe conception, pregnancy, delivery, having a healthy child, and contraception for purposes of birth spacing and deciding when their family is complete.Ensure a holistic reproductive life-span for all women, rather than focusing only on prevention of pregnancyEnsure availability of pregnancy tests at all levels of care, including in appropriate community settings such as mobile clinicsProvide IEC to promote:the importance of planning for healthy conception, healthy spacing of pregnancies, and contraceptiondual protection for both HIV and pregnancy preventionavailable methods and the relative advantages of respective methodsissues such as choice, informed decision-making, and shared responsibilityHIV testing at ANC visitsInclude future fertility plans as part of the history taking for all clientsProvide timely access to safe delivery, post-partum contraceptives, and prevention, detection, and treatment of infections to reduce secondary infertility Motivate pregnant clients to attend ANC early in pregnancy, ideally before week 12Policy statement: Services for subfertility and infertility management are provided at the tertiary level and are not included in the free service for maternal and child care package O2.2.2Fertility and subfertility treatmentHealthcare providers should use every opportunity to identify the clients at risk of infertility and subfertility, and manage the risk appropriately: Provide basic fertility services at primary care levelPrimary health care clinics, general practitioners, and urologists to perform initial assessment of fertility and evaluate patients prior to referral to a gynaecologist Refer complicated cases for specialist services at secondary and tertiary level institutionsPreconception counselling is important to all clients seeking fertility treatment in an effort to optimise the pregnancy outcomes. Communication strategies should be in place to support clients emotionally to manage the psychological effects of infertility, and otherwise be in accordance with the WHO preconception care package of preconception care interventions and the European Society of Human Reproduction and Embryology (ESHRE) Guidelines for Routine Psychosocial care in infertility and medically assisted reproduction. ADDIN EN.CITE <EndNote><Cite><Author>European Society of Human Reproduction and Embryology</Author><Year>2015</Year><RecNum>227</RecNum><DisplayText><style face="superscript">44</style></DisplayText><record><rec-number>227</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542606775">227</key></foreign-keys><ref-type name="Generic">13</ref-type><contributors><authors><author>European Society of Human Reproduction and Embryology,</author></authors></contributors><titles><title>Routine psychosocial care in infertility and medically assisted reproduction – A guide for fertility staff</title></titles><dates><year>2015</year></dates><publisher>ESHRE</publisher><urls><related-urls><url> statement: Health care providers must provide appropriate guidance about safe conception to clients in HIV serodiscordant relationships planning pregnancyO2.2.3Safe conception for HIV serodiscordant couplesA couple can safely conceive a child if one partner has HIV while the other does not (a serodiscordant couple):The HIV-positive partner should take ART consistently and correctly, until viral load is undetectableIf the HIV-positive partner is not virally suppressed on ART, the HIV-negative partner can consider taking PrEP during the period when they are trying to conceiveWhere available, a safe option for conception is artificial insemination with the HIV-negative partner’s sperm. Other options include self-insemination or timed ovulatory intercourse. Both partners should be screened and treated for any STIs before trying for conceptionPolicy statement: Safe termination of pregnancy services should be available in every facility that performs deliveries and at the lowest level possible; as stipulated in the guidelinesO2.3Safe CTOP services: Provide safe CTOP-related services at all health facilitiesO2.3.1Access to safe CTOPEnsure pregnancy testing is available at all public and private health facilities, including community settings such as mobile clinicsAll clients presenting for CTOPs, must be welcomed, supported and given careIf the facility is unable to provide medical or surgical abortion, the client should be provided with a clear list of facilities that will be able to accommodate her O2.3.2Pre-CTOP careProvide information in a way that the client can understand, enabling her to make informed decisions about her pregnancy, and what method of CTOP to choose, if appropriateGive an opportunity to discuss contraception choices for the future, and affirm that consent to contraception is not a prerequisite to accessing a CTOPAll clients who need CTOP services should enter the health system at the primary health care level irrespective of whether the facility provides CTOP services In most cases, CTOP care can and should be offered in an outpatient setting Facilities providing CTOP services, which currently are all facilities that are able to perform a delivery, should have trained staff, appropriate equipment, and communication available, so that emergency care is available 24 hoursO2.3.3Pain managementClients undergoing a CTOP have the right to pain relief, which should be provided proactively PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MaXZzaGl0czwvQXV0aG9yPjxZZWFyPjIwMDk8L1llYXI+

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ADDIN EN.CITE.DATA 45, 46Following the principal that experience of pain varies by individual, by gestational age, and maternal age and parity, estimate the client's pain perception and evaluate pain treatment given to achieve optimal pain relief O2.3.4Medical CTOPCTOPs through the first trimester may be performed by a registered nurse or midwife in primary healthcare clinics using medical or surgical methodsO2.3.5Surgical CTOPSurgical CTOP can be performed by either manual vacuum aspiration (MVA) up to 14 weeks gestation, or dilation & evacuation (D&E) after 12-14 weeks gestationClients who cannot tolerate the surgical CTOP can be referred to theatre for the procedureO2.3.6Post CTOP careWomen receiving CTOPs should be provided clear instructions on signs and symptoms of excessive bleeding post procedure and how to get help should that occurProvide access to comprehensive SRHR services including for HIV and other STIs, cervical cancer screening, and contraception Policy statement: No health care worker has the right to refuse a client access to CTOP services, directly or indirectly, by not providing information about the facilities or providers where abortions services are available or by providing erroneous information, including in an emergency situations.O2.3.7Conscientious objectionAccess to abortion under the CTOP Act is regarded a constitutional right grounded in human rights. This right needs to be balanced with other individual rights and moral objections, but never to the detriment of the client seeking a CTOP:All health professionals are under legal and ethical obligation to provide care for patients presenting with complications arising from an abortion, regardless of whether the abortion was induced or spontaneous, or how or by whom it was performed In non-emergency cases, health providers who believe that their religious or moral beliefs may affect the treatment or the advice that they provide may refuse to participate in an abortion but must fulfil the requirements stipulated in the National Abortion Guidelines (under development)Conscientious objection should not be invoked by persons not directly conducting CTOP procedures, such as support personnel Management of public sector facilities are obliged to ensure that clients have access to the services to which they are legally entitled; conscientious objection may not be the basis for a facility staff to limit or deny access to safe CTOP at that facility Refusal only applies to trained health professionals and not to groups, institutions, support personnel, or complementary services The clients’ right to information and access to health care services must always be respected PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5GaWFsYTwvQXV0aG9yPjxZZWFyPjIwMTc8L1llYXI+PFJl

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ADDIN EN.CITE.DATA 47At minimum, information and facilitation of referral about where to obtain a safe CTOP must be provided respectfully to the client seeking aCTOP ADDIN EN.CITE <EndNote><Cite><Author>Department of Justice and Constitutional Development</Author><Year>1996</Year><RecNum>231</RecNum><DisplayText><style face="superscript">48</style></DisplayText><record><rec-number>231</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542607484">231</key></foreign-keys><ref-type name="Government Document">46</ref-type><contributors><authors><author>Department of Justice and Constitutional Development,</author></authors></contributors><titles><title>Constitution of the Republic of South Africa</title></titles><dates><year>1996</year></dates><urls></urls></record></Cite></EndNote>48Health professionals not willing to conduct CTOPs must document the unwillingness in writing, addressed to the facility manager, when applying for a position Facility managers need to confirm whether a staff member is fit for purpose in terms of providing abortion services when appointing staffEach objecting staff member must be dealt with individually; never in a group, or through group action at facilitiesPolicy statement: No health worker can deny a CTOP or post-CTOP services to any client in an emergency situationO2.3.8Obligations in emergency settingsWhen continuation of a pregnancy poses a serious danger to the life or health of a client or the foetus, regardless of gestational age, health workers cannot recuse themselves from duties: A health care worker cannot legally or ethically object to the rendering of care in cases of life-or health-endangering emergencies, including suicidality, where CTOP or post CTOP service provision is part of addressing the emergency If a health care worker denies access to CTOP services under such circumstances, she or he may be charged with negligence where disciplinary steps may need to be takenWhere a health professional refuses to assist in performing the TOP in emergency circumstances, she or he will be disciplined for misconduct or failure to carry out instructions as per the CTOP Act and may be vulnerable to legal action taken by the client or her family Policy statement: Lifelong ART is recommended for all adults and children from the time their HIV-positive status is knownO2.4HIV and other STIs: Prevent, diagnose, and treat HIV and other STIsO2.4.1Increase access to HIV and STI services for vulnerable groups including young women and girlsYoung people are especially susceptible to HIV and other STIs, but all sexually active people can be at risk of infection at any rm clients about their risk for HIV and other STIs and how to protect themselves and othersInform clients of behaviours and situations that could increase riskOffer HTS to all clientsOffer treatment to all clients who test positive for HIV and other STIsO2.4.2Contraceptives for clients living with HIV and other STIsPeople with HIV and other STIs can start and continue to use most contraceptive methods safely. O2.4.3PMTCT for pregnant HIV positive clientsPMTCT has been accelerated in South Africa through various elimination strategies. This policy emphasises the need to offer HTS to all pregnant clients reporting for ANC, where those who are infected with HIV need to be started on treatment; and continued HIV prevention services for those who are not infected Offer and start clients on ART immediately after a positive HIV diagnosis to reduce the chances that she will become ill, or that baby will be infected with HIV in utero, during delivery, or postpartum and during breastfeedingOffer and start clients at high risk if HIV infection on oral pre-exposure prophylaxis (PrEP) containing tenofovir (TDF) immediately after a negative HIV diagnosis New-borns of mothers living with HIV should receive new-born PEP to further reduce the chances of HIV transmission in the period around birth in accordance with PMTCT clinical guidance 28Policy statement: The HPV vaccine must be offered to all girls aged nine to 12 years, as primary prevention of cervical cancer. Policy statement: Secondary cervical cancer prevention, screening, and treatment of cervical lesions, is a national priority and must be offered by the public healthcare system free of charge to all eligible clients.O2.5Provide programmes for the prevention and management of cervical cancer and breast cancerO2.5.1Cervical cancerComprehensive cervical cancer prevention and control requires equitable and affordable access to careProvide access to 4 key interventions, along with IEC: Primary prevention with HPV vaccination for girls aged 9–13 years Secondary prevention with cervical screening, diagnosis, and treatment of precancerous lesionsTreatment for invasive cervical cancerPalliative care ADDIN EN.CITE <EndNote><Cite><Author>World Health Organization</Author><Year>2014</Year><RecNum>232</RecNum><DisplayText><style face="superscript">49</style></DisplayText><record><rec-number>232</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542608642">232</key></foreign-keys><ref-type name="Generic">13</ref-type><contributors><authors><author>World Health Organization,</author></authors></contributors><titles><title>Comprehensive Cervical Cancer Control</title></titles><dates><year>2014</year></dates><pub-location>Geneva</pub-location><urls><related-urls><url> all clients 30-50 years for cervical cancer once every three years, as prescribed in the Cervical Cancer Prevention and Control PolicyScreen all clients with HIV at time of diagnosis and repeat as per HIV treatment guidelinesOffer all clients found with HG-SIL or CIN 2/3 appropriate pre-cancer treatment using ablative or excisional methods All clients with histologically diagnosed cervical cancer must undergo staging before any treatment is initiatedPolicy statement: All clients attending primary health care (PHC) clinics will be taught breast self-examination and given printed educational material, while female clients over 40 years attending a PHC clinic will have clinical breast examination as well.O2.5.2Breast cancerIt is critical to improve survival of clients by decreasing time to presentation, so that cancers are identified at earlier stages and time to treatment is decreased:Perform a clinical breast examination on all clients with breast symptoms, and refer immediately to a designated specialised breast unit as per protocolDiagnose all eligible patients using triple assessment (clinical examination, imaging, and histological confirmation), followed by staging and referral to appropriate servicesAll clients with early breast cancer should undergo breast cancer surgery, mastectomy (with or without reconstruction), or treatment to obtain cancer clearance at an appropriate facility including access to life saving treatment such as Herceptin for those who qualify for such treatmentPalliative care services should be available to every eligible patient (Stage 4 disease) All clients should receive an appropriate cost-effective strategy for follow-upPolicy statement: The menopausal transition must be utilised as a window of opportunity to assess and manage specific SRHR and general health mattersO2.6Ensure SRHR well-being of clients after child-bearing age, during, and after menopauseThis section references the Primary Care 101: Symptom-based integrated approach to the adult in primary care ADDIN EN.CITE <EndNote><Cite><Author>National Department of Health</Author><Year>2014</Year><RecNum>233</RecNum><DisplayText><style face="superscript">50</style></DisplayText><record><rec-number>233</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542609089">233</key></foreign-keys><ref-type name="Generic">13</ref-type><contributors><authors><author>National Department of Health,</author></authors></contributors><titles><title>Primary Care 101: Symptom-based integrated approach to the adult in primary care</title></titles><dates><year>2014</year></dates><pub-location>Pretoria</pub-location><urls><related-urls><url> clients older than 35 years:If younger than 50 years continue contraception for 2 years after last periodTake a medical history at every visit and perform general breast and gynaecological examinations at first visit and when due according to guidelinesOrder special investigations, if indicated, for example - bleeding between periods or after sex Initiate hormone replacement therapy (HRT) for proven indications, provided there are no contraindications, and individualise according to each client’s needs Inform clients of all risks and benefits regarding HRT ADDIN EN.CITE <EndNote><Cite><Author>Guidozzi</Author><Year>2014</Year><RecNum>234</RecNum><DisplayText><style face="superscript">51</style></DisplayText><record><rec-number>234</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542609266">234</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Guidozzi, F</author><author>Alperstein, A</author><author>Bagratee, J S</author><author>Dalmeyer, P</author><author>Davey, VM</author><author>de Villiers, T J</author><author>Hirschowitz, S</author><author>Kopenhager, T</author><author>Moodley, S P</author><author>Roos, P</author><author>Shaw, A</author><author>Shimange, O</author><author>Smith, T</author><author>Thomas, C</author><author>Titus, J</author><author>van der Spuy, Z</author><author>van Waart, J</author></authors></contributors><titles><title>South African Menopause Society revised consensus position statement on menopausal hormone therapy, 2014</title><secondary-title>SAMJ: South African Medical Journal</secondary-title></titles><periodical><full-title>SAMJ: South African Medical Journal</full-title></periodical><pages>537-543</pages><volume>104</volume><dates><year>2014</year></dates><isbn>0256-9574</isbn><urls><related-urls><url> on lifestyle modifications such as cessation of smoking, adjustment of diet, maintenance of a healthy weight, adequate exercise, and stress control Provide psychosocial support if necessary Policy statement: The comprehensive PEP for HIV, PEP, and package should be available at all levels of careO2.7Provide occupational and non-occupational PEP to clients at risk of HIV, STIs, pregnancy, Hepatitis B and C, and tetanusProvide a comprehensive PEP package to all exposed clients in occupational and non-occupational settings:Provide information, advocacy, and social mobilisation on PEP Provide appropriate counselling and psychosocial supportSupply comprehensive PEP services including referral at all health facilities Recognise the additional needs of children and people with disabilitiesIdentify possible abuse and protection from ongoing abuse Adhere to medico-legal responsibilities, if indicatedRecord, monitor, and evaluate all incidents of potential exposure O2.7.1Occupational exposureProvide comprehensive PEP services to all healthcare providers exposed to body fluids, semen, and vaginal secretions through percutaneous injury or contact of mucous membranes or non-intact skinAll employers to enforce and all employees to practice universal precautions to prevent exposureO2.7.1Non-Occupational exposureProvide comprehensive PEP services to all individuals exposed to rape, sexual assault, condom burst during sexual activities, condomless sex, human bite, abandoned babies within 72 hours of birth, and any unintended exposure to blood or other body fluidsObjective 3: Ensure access to respectful and non-judgemental SRHR services for priority groupsPeople who do not fit gender stereotypes, people living with HIV, adolescent girls, sex workers, and LGBTQI people (priority groups) experience unique barriers to accessing services and may require additional services tailored to their needs.Policy statement: All clients must be treated equally and in a prompt fashion regardless of age, ethnicity, socioeconomic, marital status, or similar characteristic.Policy statement: Adolescents, including disabled, male, and rural clients should be provided with comprehensive sexuality education and SRHR services, including gender based and sexual violence prevention and treatment, in non-judgemental, accessible environments.O3.1Adolescents and young people308927569215Priority groups:Adolescents and young people (10-24 years) LGBTQI peopleSex workersPeople with disabilitiesMigrants Male partners of women00Priority groups:Adolescents and young people (10-24 years) LGBTQI peopleSex workersPeople with disabilitiesMigrants Male partners of womenAdolescents, especially girls, are a key population for nearly all SRHR services, including prevention, detection, and treatment of HIV and other STIs. Adolescents and young people must have access to youth-friendly services and school-based services, including comprehensive sexuality education, the prevention of unwanted pregnancies and risks associated with teen pregnancy, prevention of HIV and other STIs, and access to safe CTOP. Facilities should remove barriers to accessing SRHR services by:Refraining from moral judgement and discrimination by health workers Welcoming adolescents to access SRHR services and information Promoting personal choice in decisions guided by friendly, non-judgemental, and empathetic health-, social-, and community workers with the support of familyChallenging taboos, myths, misperceptions, stereotyping, and discrimination on sexuality, cultural, and traditional practices, as well as against certain groupings in a positive manner and with facts and opennessInforming adolescents of risky sexual behaviours, such as early sexual debut, intergenerational sex and multiple concurrent partners, often driven by patriarchal gender norms and povertyPolicy statement: Five interlinked peer-led service packages shall be implemented to serve the needs of LGBTI groups in the areas of health, empowerment, psychosocial services, human rights, and strategic information as outlined in the National LGBTI HIV Plan.O3.2LGBTI+ peopleAlthough there are many differences between the groups, and further variation within subgroups, LGBTI+ persons share common challenges. Facilities should remove barriers to accessing SRHR services by:Addressing negative staff attitudesSensitising staff on stereotypical assumptions about the needs of LGBTI personsTraining staff on required knowledge and skills to provide quality SRHR care appropriate to the needs of respective groupsProviding psychosocial support for mental health problems, alcohol, and substance abuse Policy statement: Six interlinked peer-led packages related to health, social, legal, human rights, social capital, and economic empowerment services addressing the needs of sex workers, shall be implemented as outlined in The National Sex Worker HIV Plan.O3.3Female sex workersFemale sex workers are particularly vulnerable to HIV and other STIs. They are exposed to many human rights violations that limit their access to good SRHR interventions.Facilities should remove barriers to accessing SRHR services by:Ensuring access and referral to support services for mental health problems, social grants, substance and alcohol use, and legal support Providing support for sexual-, verbal-, and gender-based violenceAdapting facility opening hours and modes of delivery to suit sex workersSensitising staff to the needs of sex workersProviding the comprehensive package of services described in South African national sex worker HIV planPolicy statement: People with disabilities to be afforded an opportunity to gain agency, choice, and control over their sexuality and relationships. Emphasis to be placed in reducing vulnerability to sexual and gender based violence and HIV.O3.4Persons with disabilitiesPeople living with disabilities are an underserved population subjected to harmful stereotypes and myths. They have similar SRHR needs as able-bodied people; however, they are much more likely to be victims of physical and sexual abuse and rape, even by their caretakers in some situations. They are also more likely to be subjected to forced or coerced procedures, such as sterilisation, abortion, and contraception. ADDIN EN.CITE <EndNote><Cite><Author>Women Enabled International</Author><Year>2016</Year><RecNum>235</RecNum><DisplayText><style face="superscript">52</style></DisplayText><record><rec-number>235</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542613883">235</key></foreign-keys><ref-type name="Generic">13</ref-type><contributors><authors><author>Women Enabled International,</author></authors></contributors><titles><title>Submission to OHCHR Report on Mental Health and Human Rights</title></titles><dates><year>2016</year></dates><pub-location>Washington DC</pub-location><urls><related-urls><url> Facilities should remove barriers to accessing SRHR services by ADDIN EN.CITE <EndNote><Cite><Author>Schneider</Author><Year>2010</Year><RecNum>236</RecNum><DisplayText><style face="superscript">53</style></DisplayText><record><rec-number>236</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542614012">236</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>Schneider, M., </author><author>Couper, J., </author><author>Swartz, L.,</author></authors></contributors><titles><title>Assessment of accessibility of health facilities to persons with disabilities Report submitted to Directorate: Chronic Diseases, Disabilities and Geriatrics</title></titles><pages>1-63</pages><dates><year>2010</year></dates><pub-location>Cape Town</pub-location><urls></urls></record></Cite></EndNote>53:Informational access, for example the availability of information in a range of formats, including sign language and braillePhysical access comprising the distance between the facility and users’ homes, transport, the structure of entrances/exits, passages, and structures within the facility buildings Financial access comprising the cost of the health service to an individual, including the hidden cost of transportation and loss of income when going to the health facility To ensure people living with disabilities have access to comprehensive SRHR, all facilities are accessible for people in wheelchairsProvide a toilet with wheelchair access indicated by a pictogramFast track people living with disabilitiesPolicy statement: Offer a basic package of SRHR care in emergency situations. Policy statement: Build and enhance the capacities of health care providers to render culturally competent, gender-sensitive, age-responsive, and migrant-friendly reproductive health services.O3.5Migrants and asylum seekersSRHR needs are heightened for displaced people and refugees. All migrants and asylum seekers should receive SRHR services, with full respect for the client rights:Provide information on contraceptive options, HIV and STI prevention, detection and treatment, abortion, emergency contraception, PMTCT, and antenatal and postnatal services in South Africa. Information is available in a range of languages, especially South African languages. Where necessary a translator (trained in correct translation and in confidentiality) is engaged for non-English speakers. In the context of SRHR, translators should preferably be the same gender as the client. Provide specialist referral services where clinic staff do not have the required skills (for example to provide services for women who have a subdermal implant from their home country). Implement a referral system and training programme for staff. Provide all HIV services, including HTS, initiation onto ART, PMTCT, and PEP, where indicated. For some cross-border migrants this may require the switching of ART regimens. In such cases, national ART guidelines should be followed. Pregnant women on PMTCT should be encouraged to delay moving away from the area so they can complete PMTCT treatment with continuity of care and in the case there is no PMTCT programme where they plan to move. Thereafter, clear referral direction, documentation, and letters should be provided.Issue clients with ‘health passports’ where information about all contraceptive methods being used, treatment, and testing are recorded. Encourage clients to keep these health passports with them and to make a note and memorise all contraceptive methods, medication, and the doses thereof, in case they need to move to another location and/or lose their health passport (or other records). Encourage clients to come to the clinic before they relocate and provide sufficient treatment and a referral letter for their next health facility.Encourage informed decision-making and provide choice in contraception methods. Methods provided should take into account the client’s risk, mobility, and fertility plans for the future. Some migrant groups are more vulnerable to violence, sexual assault, and exploitation. The provision of additional counselling may be necessary, given the trauma experienced by some migrants. Such trauma may relate to circumstances and experiences in their home country and during their journey to South Africa, as well as the particular vulnerabilities to which they may be exposed, such as rape, bribes, sexual exploitation and abuse. As with all clients, post-rape management should include PEP, STI management, and emergency contraception. Policy statement: In implementing partner involvement, a client centred approach must be adopted that does not limit engagement to legally defined groups such husband and wife.Policy statement: Individuals and couples should be empowered to decide freely and responsibly the number, spacing, and timing of children and be provided the means to do so without coercion.O3.6Promoting SRHR services to males and male partners Men account for half of the reproductive-age population but are often reluctant to seek care at health facilities that cater primarily to pregnant clients and their infants, leaving them underserved and inhibiting them from playing a greater role in supporting sexual and reproductive health. Men play a key role in bringing about gender equality since, in most societies, men exercise greater power in nearly every sphere of life, ranging from personal decisions regarding the size of families to the policy and programme decisions taken at all levels of government. Yet, most awareness and implementation efforts related to SRHR and HIV prevention disregard the cultural and gender norms that may affect a client’s decision-making regarding SRHR issues. Partners often lack information to support their spouses’ SRHR decisions and the roles they might play in promoting overall family health. Increased knowledge will also increase partner access to and utilisation of HIV and other SRHR services. Male and male partner involvement provides an opportunity to offer SRHR services to men. Facilities must promote partner and male involvement by:Emphasising shared responsibility, gender equality, and active involvement in parenthood and sexual and reproductive behaviour in the delivery of SRHR servicesOffering services that cater for the needs of men. It is critical that services are welcoming to all clientele and that staff are competent to meet everybody’s needsCompetent male and priority population-friendly staff are essential to make male clients more comfortable to talk about sensitive subjectsConfronting gender inequality and violence in counselling sessionsEncouraging clients to bring their partners with them to the clinic for joint consultation and testing, to get mutual commitment to both HIV, STI, and pregnancy prevention and managementOffering alternative HIV testing methods such as HIV self-screening, mobile clinics, workplace testing, and door-to-door testing, which have been shown to increase uptake of services and reduce stigmaPromoting the role of partners as supportive spouses and parentsDeveloping outreach strategies including community events to engage partners Actively promoting SRHR services for male partners, which can include provision or referral for the following: condoms, male sterilisation, and counselling about other contraceptive methods; counselling and help for sexual problems; TB prevention and treatment; HIV counselling, prevention, testing and treatment; infertility counselling; screening for penile, testicular and prostate cancer; and VMMC Appropriate integration: using opportunities such as medical and traditional male circumcision and STI services to promote uptake of SRHR servicesObjective 4: Strengthen the health system to deliver integrated SRHR services at the lowest feasible level in the health care systemThis section should be read with the Ideal Clinic Manual ADDIN EN.CITE <EndNote><Cite><Author>National Department of Health</Author><Year>2018</Year><RecNum>239</RecNum><DisplayText><style face="superscript">54</style></DisplayText><record><rec-number>239</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542617654">239</key></foreign-keys><ref-type name="Generic">13</ref-type><contributors><authors><author>National Department of Health,</author></authors></contributors><titles><title>Ideal Clinic Manual v18</title></titles><dates><year>2018</year></dates><pub-location>Pretoria</pub-location><urls><related-urls><url>(26%20July%202018).pdf</url></related-urls></urls></record></Cite></EndNote>54, the Integrated Clinical Services Management Manual ADDIN EN.CITE <EndNote><Cite><Author>National Department of Health</Author><Year>2018</Year><RecNum>240</RecNum><DisplayText><style face="superscript">55</style></DisplayText><record><rec-number>240</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542617765">240</key></foreign-keys><ref-type name="Generic">13</ref-type><contributors><authors><author>National Department of Health,</author></authors></contributors><titles><title>Integrated Clinical Services Management Manual </title></titles><dates><year>2018</year></dates><pub-location>Pretoria</pub-location><urls><related-urls><url>, and the Primary Healthcare Laboratory Handbook ADDIN EN.CITE <EndNote><Cite><Author>National Department of Health</Author><Year>2017</Year><RecNum>238</RecNum><DisplayText><style face="superscript">56</style></DisplayText><record><rec-number>238</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542617554">238</key></foreign-keys><ref-type name="Generic">13</ref-type><contributors><authors><author>National Department of Health,</author></authors></contributors><titles><title>Primary Healthcare Laboratory Handbook</title></titles><dates><year>2017</year></dates><pub-location>Pretoria</pub-location><urls><related-urls><url> success of South Africa’s health system will depend on a well-functioning primary health care system. Community based services must be complimented by primary health care facilities that provide equitable access to South Africans, prioritising health services to those most in need. To achieve optimal primary healthcare delivery, the Ideal Clinic Programme provides a framework for implementation, which outlines systematic preparation of optimal conditions to provide quality, integrated services. Policy statement: Ensure all clients, including priority populations, receive integrated services tailored to their needs, and that all clients who need additional support are referred and followed up. Policy statement: All facilities must adhere to Ideal Clinic standards to ensure all SRHR services are offered, effective referral networks and practices are in place, adequate transport between levels of care are available, and co-ordination between the units within hospitals and other larger referral facilities are functional.O4.1Service integrationO4.1.1Integrated service delivery: Provide quality integrated SRHR services at PHC level, or lowest level possibleO4.1.2Deliver integrated services within the district health system:Provide SRH services at the appropriate level of care in accordance with the service delivery guidelines Integrate SRH services with HIV services and other streams of primary care Establish linkages to ensure complicated cases and emergencies can be accommodated within the district health systemO4.1.3Provide integrated SRH services within a single facility:Integration within a facility requires that all units be well co-coordinated to ensure clients receive appropriate care:Organise all planned streams of care efficientlyUse a functional patient appointment system Ensure each client has only 1 file across their lifespan Ensure that linkages between facilities provide all elements of the SRHR service package Establish referral paths for services not availablePolicy statement: Every facility providing SRHR services should adhere to quality standards prescribed in the ideal clinic manual.Policy statement: Every effort shall be made to implement effective infection control systems throughout facilities.O4.2Quality of careEnsure quality of care in delivering SRHR services:Regular clinical audits are conducted (see Clinical Audit Guidelines)Respectful treatment by technically competent providersImproved informed choice and empowered individuals and couples make choices in line with their SRHR needsClient are satisfied with SRHR services Clients can complain about the services they receive, to have complaints investigated and receive a full response on investigationsPolicy statement: The facility manager and /or person in charge of ordering drugs, supplies and other commodities must deal with the logistics of obtaining necessary equipment and supplies, and supervise its maintenance.O4.3Ensure uninterrupted supply of SRH commodities and drugs“A well-functioning health system ensures equitable access to essential medical products, vaccines, and technologies of assured quality, safety, efficacy, and cost-effectiveness, and their scientifically sound and cost-effective use.”Looking at the value chain for commodities, this objective would be fulfilled through a clear coordination framework between the suppliers, the regulatory pathways within the South African Health Products Regulatory Authority (SAHPRA), and the distribution systems to a facility, and eventually to a client level. Building upon existing systems such as the Centralised Chronic Medicines Dispensing and Distribution (CMMDD) program, commodities could equally be distributed through the same mechanism. The following activities need to be accelerated:Build capacity of responsible health workers to ensure efficient forecasting and procurement of essential SRHR commoditiesDevelop and implement systems to ensure joint planning, procurement and supply chains for essential SRHR commoditiesDevelop an efficient procurement, distribution and supply chain management system to enable consistent and regular provision of essential SRHR commodities Prevent stock outs and ensure that SRHR drugs and commodities are always in stock Pre-pack chronic prescriptions and keep buffer stock of medicines and supplies to pre-empt stock outs Include surgical equipment in SRHR commodity supply chains to ensure that adequate equipment is available and that updated clinical techniques are used Policy statement: Staff must receive adequate training in SRHR service delivery and linked to refresher training, debriefing and continuing professional development.O4.4Ensure healthcare providers have the skills and knowledge to deliver integrated SRHR services2242969106761“A well-performing health workforce is one which works in ways that are responsive, fair and efficient to achieve the best health outcomes possible, given available resources and circumstances, i.e. there are sufficient numbers and mix of staff, fairly distributed; they are competent, responsive and productive.”0“A well-performing health workforce is one which works in ways that are responsive, fair and efficient to achieve the best health outcomes possible, given available resources and circumstances, i.e. there are sufficient numbers and mix of staff, fairly distributed; they are competent, responsive and productive.”Health workers benefit from continuing education and competency improvement: training and capacity building to ensure adequate knowledge, attitude, and skills to provide holistic, quality SRHR services. The following must be offered according to the staff category’s scope of practice, current skills, and the level of care permitted at their home facility: Develop a national core curriculum, in line with the SRHR Policy, to provide the basis for all institutions providing training, including universities, further education and training institutions, nursing colleges, provincial training units, non-governmental organisations, and other organisations that provide SRHR training, including a specific focus on training on CTOP care and values clarificationUpdate the curriculum every five years and include new research findings as addendums to the curriculum in-between revisionsDevelop a package of in-service and post-qualification/advanced training for the following categories of health professionals: doctors (including specialists with obstetrics/gynaecology training), medical officers, public health practitioners, midwives, nurses, and pharmacists Strengthen collaboration and liaison with regional training centres Develop an agreed package of in-service training for the following non-medical staff: social workers, health promoters, HIV support personnel (such as HTS counsellors, ART adherence counsellors), community health and outreach workersDevelop provider or supervisor job aids and distribute at all points of care to standardise policy implementationInclude a rights-based approach into curricula and training with emphasis on improved access and integrated carePolicy statement: Facilities must record and report accurate client data in the national health information system. All client data are treated as confidential.Policy statement: The SRHR Policy is underpinned by research evidence to guide best practices, policies, and the legal framework for improving SRHR outcomes for all.O4.5Maximise the use of programmatic data and research to increase impact1785620141605“A well-functioning health information system is one that ensures the production, analysis, dissemination and use of reliable and timely information on health determinants, health systems performance and health status.”0“A well-functioning health information system is one that ensures the production, analysis, dissemination and use of reliable and timely information on health determinants, health systems performance and health status.”South Africa has a range of information, review, and monitoring systems in place, including routinize public health monitoring and evaluation activities, a variety of robust surveillance activities, and rigorous epidemiologic, laboratory, and programmatic research. To improve the ability to fully leverage this capability for progress against targets, improve programmes over time, maximise efficiencies, and close research gaps, the following are necessary:O4.5.1Optimise routinely collected data to improve planning and managementData collection needs to be accurate and centralised to guide decision-making:Review indicators and reporting tools to ensure the correct aspects of implementation are measuredDisaggregate data collection by age, gender, and priority populationsIdentify service access gaps and outcomes and report on these indicatorsRevise, adapt, or develop tools and standard operating procedures for quality assurance in the provision of comprehensive integrated SRHR services Revise or develop single or linked registers and tools for integrated SRHR services to facilitate recording, monitoring, and reporting of integration indicatorsO4.5.2Monitor and evaluate implementation and outcomes of the SRHR PolicyIt is essential that multi-sectoral data are collected at all levels and across all stakeholders to reflect on the progress of improving SRHR outcomes and integration of services. Develop an M&E framework to track progress against targetsEstablish efficient mechanisms to collate, analyse, and use the routine data collected (through the District Health Information System) for responsive programming at the provincial, district, and sub-district levelDisseminate data to policy-makers and service providersO4.5.3Strengthen surveillance and research activities for improved efficiency and impactResearch helps develop and eventually adopt new technologies and drugs, optimise the delivery of interventions and strategies, and answer key implementation questions not fully addressed through surveillance and surveys:Include SRHR Policy indicators in routine surveysIdentify research questions aimed at improving SRHR outcomesIntegrate SRHR research questions into the national research agendaDevelop systems for the documentation and sharing of best practices on SRHR and HIV integrationPolicy statement: Facility managers must plan for comprehensive SRHR services, including effective systems for managing the flow of clients through a facility despite fluctuations in caseload to ensure information flows to the district levels for budgeting purposes.O4.6Financing of SRHR services: mobilise resources and maximise efficiencies to support the achievement of the SRHR Policy Goal1783715140700“A good health financing system raises adequate funds for health, in ways that ensure people can use needed services, and are protected from financial catastrophe or impoverishment associated with having to pay for them.”0“A good health financing system raises adequate funds for health, in ways that ensure people can use needed services, and are protected from financial catastrophe or impoverishment associated with having to pay for them.”The National Health Insurance will be one of the key lever to improve access to SRHR services without exposing clients to financial vulnerability. The implementation of the policy will further ensure more effective and efficient use of resources that are already allocated to SRHR-related services. Additionally, the Policy will serve as a platform for further resource mobilisation. To ensure adequate financing for the implementation of the SRHR Policy, all responsible implementers at all levels: Ensure buy-in from all stakeholders and departments for the purposes of aligning existing for resources for integrated service deliveryDevelop a resource mobilisation plan, including the reallocation of funds from vertical programmesReview and revise budget line items, nationally and provincially, in-line with projected needs for both method procurement, training, and communication strategiesDevelop costed implementation plans for integration in collaboration with other stakeholders, including civil society organisations, donors, and development partnersAlign donor funding with the costed plans for the provision of integrated SRHR servicesPolicy statement: Provide oversight, platforms for collaboration and institute coordination frameworks that ensure program delivery transparency and accountability.O4.7Promote strong leadership and management to enforce and implement the SRHR PolicyO4.7.1National and provincial levels1786890149941“Leadership and governance involves ensuring strategic policy frameworks exist and are combined with effective oversight, coalition-building, the provision of appropriate regulations and incentives, attention to system-design, and accountability.”0“Leadership and governance involves ensuring strategic policy frameworks exist and are combined with effective oversight, coalition-building, the provision of appropriate regulations and incentives, attention to system-design, and accountability.”At a national and provincial level, implementation of integrated services is supported by an enabling environment, which includes strong political support as this policy espouses the principles of the National Development Plan. Leadership is needed to ensure scopes of practice are aligned with the goals of this policy, that the regulatory pathways that anchor a successful programme, such as SAHPRA, are efficient and that effective tendering, procurement, and supply systems are established through strong leadership. Leadership is also necessary at various other levels.Policy statement: Facility managers must ensure that clients are provided the health services prescribed by South African laws and policies.O4.7.1Facility levelsImplementation of the SRHR policy requires leadership, management, and accountability at all facilities ADDIN EN.CITE <EndNote><Cite><Author>National Department of Health</Author><Year>2011</Year><RecNum>237</RecNum><DisplayText><style face="superscript">57</style></DisplayText><record><rec-number>237</rec-number><foreign-keys><key app="EN" db-id="eare2taxlax2sqezt0kv0afm2vr2vt95dwsz" timestamp="1542616418">237</key></foreign-keys><ref-type name="Generic">13</ref-type><contributors><authors><author>National Department of Health,</author></authors></contributors><titles><title>Human Resources for Health, South Africa: HRH Strategy for the Health Sector: 2012/13 – 2016/17</title></titles><dates><year>2011</year></dates><pub-location>Pretoria</pub-location><urls><related-urls><url>, including:Facility managers monitor current caseload frequently and remain alert to developments that could affect waiting timesClients presenting for emergency procedures receive care or are referred for services Facility managers train staff members on clients’ rights to access to SRHR, ensuring availability of sufficient staff for rendering comprehensive SRHR services Facility managers match the skills and capacity of the team to implement comprehensive and integrated SRHR and primary healthcare servicesFacility managers create an enabling environment for staff to perform their work responsibilities Staff have access to confidential counselling and debriefing, if neededFacilities implement the SRHR policy in the context of the health needs of the community and populations served Facilities cooperate with schools and school health teams to assist with the removal of health related barriers to learningThe facility maintains functional home- and community-based services where coordination takes place at district and provincial levels Objective 5: Promote multi-sectoral engagement and shared accountability for a sustainable and rights based service deliveryThe impact of the SRHR Policy will first and foremost be through improved coordination, synergy, and alignment with the programme of government, civil society, and development partners that already work in the area of SRHR. This includes both intragovernmental collaboration and shared accountability, and with other sectors such as the private sector and civil society. Policy statement: The SRHR Policy implementation framework depends on intergovernmental collaboration, multi-stakeholder engagement, and partnerships that include government, industry, and private sector.O5.1Strengthen partnerships to enforce and implement the SRHR PolicyTo increase access to SRHR services for all through channels other than public sector health facilities, form and strengthen partnerships with other government sectors, the private sector, development partners, non-governmental organisations, and communities. These may include, for example:Non-clinic-based delivery systems, such as social marketing and community-based programmesCommunity health workersSchool-based clinicsWorkplace-based clinicsPublic–private partnerships, especially within the context of NHIO5.2Improve collaboration and co-operation between government, civil society, development partners, and the private sectorEstablish and strengthen multi-sectoral coordination mechanisms, such as SRH social pacts and structures at all levels, ensuring clear terms of referenceEstablish, strengthen, and coordinate effective and seamless referral systems between government facilities and non-governmental organisations Engage the private sector in hybrid service delivery models, for example private general practitioners, clinics, retail, and courier pharmaciesEngage civil society groups and others committed to advancing SRHR to hold governments accountable to their commitments to improve health and to uphold human rightsDevelop strategies, including supportive supervision and mentorship, for health workers and other service providers, to ensure quality assurance in the provision of integrated servicesO5.3Strengthen collaboration between and co-ordination of accountable government departmentsCollaborate with the Department of Basic Education for the provision of SRHR services in schools and provision of comprehensive sexuality educationCollaborate with the South African social security agency (SASSA) and Department of Housing to align policy implementationCollaborate with the Department of Justice and police service, for example as with Thuthuzela centres for one stop shop for survivors of violence seeking legal and medical attentionPut in place systems to ensure availability of information and commodities in other government departments, for example condoms and IEC materialsIn collaboration with other stakeholders, develop innovative specific interventions to address economic-related structural factors among priority groups that hinder access to SRHRDevelop strategies to ensure the involvement of adolescents and youth in the design, implementation, monitoring, and evaluation of interventions Develop strategies that support SRHR programmes in national youth movements and in government departments and unitsDevelop strategies and interventions for integration of SRHR and other communicable and non-communicable diseasesAcknowledgementsThe process of drafting this SRHR policy was led by the Directorate for Women’s Health and Genetics within the National Department of Health, in close consultation with key stakeholders at a national and provincial level. Drafting was collaborative, and final input was sought through extensive consultation with frontline healthcare workers, technical partners, academic partners, non-governmental organisations, civil society, and private sector institutions. The Department of Health urges all public and private institutions to make maximum use of this policy for proper guidance during implementation of SRHR services. The development of the policy involved consultations and meetings with a broad range of stakeholders to identify the issues that could be addressed at a policy level, and wishes to acknowledge the contributions of several government departments, nongovernment organizations, and regional and international organizations. The whole exercise would have not been possible without technical support from CHAI and other technical partners. Evidence for this policy is derived from the intellectual input of many practitioners and academics, literature reviews on available evidence, and contextual insights from several frontline practitioners and partners. The Department of Health would therefore like to acknowledge the exceptional contribution of all individuals and institutions who were drafting this document. Contribution from several individuals has been tremendous, including:NDoH leads: Dr Yogan Pillay and Dr M Makua Clinical experts: Key contributors/technical experts: National Department of Health contributors: Partners and CSOs: Other contributors: It is our sincere hope that this document would advance the sexual and reproductive health and rights of all citizens, thereby improving health and well-being, and an essential ingredient of a thriving economy. References ADDIN EN.SECTION.REFLIST ADDIN EN.REFLIST 1.World Health Organization. Sexual and reproductive health: Defining sexual health. Available from: Health Organization. Defining Sexual Health: Report of a technical consultation on sexual health 28-31 January 2002, Geneva. 2006; Available from: . Sexual and reproductive health and rights of people most affected by HIV: The right to development [Internet]. 2016; Available from: Health Organization. Developing sexual health programmes. A framework for action. 2010; Available from: Health Organization. The WHO Health Systems Framework. Available from: , D., J. Harries, J. Moodley, D. Constant, R. Hodes, C. Mathews, et al., Coming of age? Women's sexual and reproductive health after twenty-one years of democracy in South Africa. Reprod Health Matters, 2016. 24(48): p. 79-89.7.The South African National Aids Council (SANAC), National Strategic Plan on HIV, STIs and TB 2017-2022. 2017: Pretoria.8.Michalow, J., L. Chola, S. McGee, A. Tugendhaft, R. Pattinson, K. Kerber, et al., Triple return on investment: the cost and impact of 13 interventions that could prevent stillbirths and save the lives of mothers and babies in South Africa. BMC pregnancy and childbirth, 2015. 15: p. 39-39.ernment of South Africa, Adolescent and Youth Health Policy, D.o. Health, Editor. 2017.10.The South African National Aids Council (SANAC), South African National Sex Worker HIV plan, 2016 – 2019. 2016: Pretoria.11.The South African National Aids Council (SANAC), The South African National LGBTI HIV Plan, 2017-2022. 2017: Pretoria.12.National Department of Health (NDoH), Statistics South Africa (Stats SA), South African Medical Research Council (SAMRC), and ICF, South Africa Demographic and Health Survey 2016: Pretoria.13. 13. National Department of Health, Sexual and reproductive health and rights: Literature review and situation analysis undertaken to inform: Sexual and reproductive health: Fulfilling our Commitments. 2011, Soul City: Pretoria.ernment of South Africa, National Policy on HIV, STI, TB, Department of Basic Education, Editor. 2017.14.Recorded live births. 2016; Available from: , G., T. Doherty, and P. Barron, Eliminating mother-to-child transmission of HIV in South Africa, 2002–2016: progress, challenges and the Last Mile Plan. South African Heal. Rev., 2017: p. 137–46.ernment of South Africa, Policy Framework and Strategy for Ward Based Primary Healthcare Outreach Teams. 2017, National Department of Health: Pretoria.ernment of South Africa, National Consolidated Guidelines for the Prevention of Mother-To-Child Transmission of HIV (PMTCT) and the Management of HIV in Children, Adolescents and Adults. 2015, National Department of Health: Pretoria.ernment of South Africa, National HIV Testing Services: Policy, Department of Health, Editor. 2016.19.Lince-Deroche, N., J. Harries, D. Constant, C. Morroni, M. Pleaner, T. Fetters, et al., Doing more for less: identifying opportunities to expand public sector access to safe abortion in South Africa through budget impact analysis. Contraception, 2018. 97(2): p. 167-176.20.United Nations Population Information Network, Report of the ICPD (94/10/18). 1994: Cairo.21.United Nations Children’s Fund, Beijing Declaration and Platform for Action. Fourth World Conf. Women. 1995: Beijing.22.United Nations. Sustainable Development Goals (SDGs). Available from: Commission on Sexual and Reproductive Health and Rights 2018; Available from: . Available from: , A.J., Onward to 2030: Sexual and Reproductive Health and Rights in the Context of the Sustainable Development Goals, in Guttmacher Policy Rev. 2015. p. 77-84.26.World Health Organization, Clinical practice handbook for safe abortion. 2014, WHO: Geneva.27.World Health Organization Department of Reproductive Health and Research (WHO/RHR) and Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs (CCP) Knowledge for Health Project, Family Planning: A Global Handbook for Providers (2018 update). 2018: Baltimore and Geneva: CCP and WHO.28.World Health Organization, Selected practice recommendations for contraceptive use - 3rd edition. 2016, WHO: Geneva.29.World Health Organization, Global health sector strategy on sexually transmitted infections: Towards ending STIs, 2016-2021. 2016, WHO: Geneva.30.Southern African Development Community (SADC), Minimum Standards for the Integration of HIV and Sexual & Reproductive Health in the SADC Region. 2015.31.Southern African Development Community (SADC), Protocol on Health. 1998.32.Southern African Development Community (SADC), Sexual and Reproductive Health Strategy for the SADC Region 2006-2015. 2008.ernment of South Africa, Department of Health Strategic Plan 2014/15–2018/19. 2014, National Department of Health: Pretoria.ernment of South Africa, South Africa’s National Strategic Plan on HIV, TB and STIs 2017-2022, Department of Health, Editor. 2017.35.National Department of Health, Sexual and Reproductive Health and Rights: Fulfilling our Commitments, 2011-2021 and Beyond. 2011: Pretoria.36.National Department of Health. NHI White Paper. 2017; Available from: Department of Health, National Adolescent Sexual and Reproductive Health and Rights Framework Strategy (ASRH&R), 2014-2019 2015: Pretoria.ernment of South Africa, National Strategic Plan for HIV, STIs, and TB 2017-2022, National Department of Health, Editor. 2017.ernment of South Africa, DBE Draft National Policy on the Prevention and Managemetn of Learner Pregnancy in Schools. 2018, Department of Basic Education, : Pretoria.ernment of South Africa, Breast Cancer Prevention and Control Policy. 2017, National Department of Health: Pretoria.ernment of South Africa, Cervical Cancer Prevention and Control Policy. 2017, National Department of Health: Pretoria.ernment of South Africa, Health Sector HIV Prevention Strategy. 2016, National Department of Health: Pretoria.43.Department of Social Development, Fifteen year progress review of the implementation of the Population Policy for South Africa (1998) and the ICPD programme of action (1994). 2015: Pretoria.44.European Society of Human Reproduction and Embryology, Routine psychosocial care in infertility and medically assisted reproduction – A guide for fertility staff. 2015, ESHRE.45.Livshits, A., R. Machtinger, L.B. David, M. Spira, A. Moshe-Zahav, and D.S. Seidman, Ibuprofen and paracetamol for pain relief during medical abortion: a double-blind randomized controlled study. Fertil Steril, 2009. 91(5): p. 1877-80.46.Kapp, N., Pain management in abortion care. FIAPAC, 2014.47.Fiala, C. and J.H. Arthur, There is no defence for 'Conscientious objection' in reproductive health care. Eur J Obstet Gynecol Reprod Biol, 2017. 216: p. 254-258.48.Department of Justice and Constitutional Development, Constitution of the Republic of South Africa. 1996.49.World Health Organization, Comprehensive Cervical Cancer Control. 2014: Geneva.50.National Department of Health, Primary Care 101: Symptom-based integrated approach to the adult in primary care. 2014: Pretoria.51.Guidozzi, F., A. Alperstein, J.S. Bagratee, P. Dalmeyer, V. Davey, T.J. de Villiers, et al., South African Menopause Society revised consensus position statement on menopausal hormone therapy, 2014. SAMJ: South African Medical Journal, 2014. 104: p. 537-543.52.Women Enabled International, Submission to OHCHR Report on Mental Health and Human Rights. 2016: Washington DC.53.Schneider, M., J. Couper, and L. Swartz, Assessment of accessibility of health facilities to persons with disabilities Report submitted to Directorate: Chronic Diseases, Disabilities and Geriatrics. 2010: Cape Town. p. 1-63.54.National Department of Health, Ideal Clinic Manual v18. 2018: Pretoria.55.National Department of Health, Integrated Clinical Services Management Manual 2018: Pretoria.56.National Department of Health, Primary Healthcare Laboratory Handbook. 2017: Pretoria.57.National Department of Health, Human Resources for Health, South Africa: HRH Strategy for the Health Sector: 2012/13 – 2016/17. 2011: Pretoria. ................
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