Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
Population Council, Washington, DC, USA.
Lancet HIV. 2020 Oct;7(10):e711-e720. doi: 10.1016/S2352-3018(20)30201-0.
Despite a large and growing body of literature on sexual and reproductive health (SRH) and HIV integration, the drivers of integration of SRH and HIV services, from a health systems perspective, are not well understood. These drivers include complex so-called hardware (structural and resource) and software (values and norms, and human relations and interactions) factors. Two groups of software factors emerge as essential enablers of effective integration of SRH and HIV services that often interact with systems hardware: (1) leadership, management, and governance processes and (2) provider motivation, agency, and relationships. Evidence suggests the potential for software elements that are essential enablers to overcome some of the obstacles posed by the non-integration of health system hardware elements (eg, financing, guidelines, and commodity supplies). These enabling factors include flexible decision making, inclusive management, and support in motivating frontline staff who can work with agency as a team. Improved software, even within constrained hardware (especially in low-income and middle-income countries), can directly contribute to improved SRH and HIV service delivery.
尽管关于性健康和生殖健康（SRH）以及 HIV 整合的文献大量涌现且不断增加，但从卫生系统的角度来看，SRH 和 HIV 服务整合的驱动因素仍未得到很好的理解。这些驱动因素包括所谓的硬件（结构和资源）和软件（价值观和规范，以及人际关系和互动）因素的复杂性。有两组软件因素作为有效整合 SRH 和 HIV 服务的基本促成因素而出现，这些因素通常与系统硬件相互作用：（1）领导、管理和治理流程，以及（2）提供者的动机、能动性和关系。有证据表明，对于作为基本促成因素的软件要素来说，有可能克服卫生系统硬件要素整合不足所带来的一些障碍（例如，供资、准则和商品供应）。这些促成因素包括灵活的决策制定、包容性管理，以及激励一线工作人员的支持，他们可以作为一个团队开展工作。即使在硬件受限的情况下（尤其是在低收入和中等收入国家），改善软件也可以直接有助于改善 SRH 和 HIV 服务的提供。
