Bottleneck analysis of challenges facing sexual and reproductive health and human immunodeficiency virus (HIV) services integration in Southwestern Nigeria

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