Zulu JM, Ngwenya Z, Silukena M, Phiri Z, Chiseni A
Background: To improve accessibility to sexual and reproductive health (SRH) services by young female sex workers (FSWs) at district level in Zambia, an innovative project, the Emerging Voices, was introduced in the health system in 2012. Meanwhile, there is limited knowledge on the factors that shape the integration process of such innovations into health systems. This paper aimed at addressing this knowledge gap by exploring the factors that shaped the integration process of the project into the health system at district level. Materials: Data collected through observations, focus group discussions and in-depth interviews with project staff, peer educators, queen mothers and Task Force members were analysed using thematic analysis. Project activities included sensitization campaigns, referring FSWs to SRH services and building networks. Results: The relative advantage of the project in terms of the use of the Task Force, comprising key stakeholders, in the implementation process compared to other existing SRH strategies facilitated the integration of the project into the governance, resources and service delivery health systems functions. The integration was possible because the Task Force members sensitised other staff in their organisations or departments on the importance of paying attention to the SRH needs of FSWs. Such sensitisation helped the police and health workers for example change their attitude towards FSWs and become friendly when providing services to FSWs. Furthermore, the compatibility of the project with SRH health care expectations of FSWs facilitated the integration process of the project into the population or community health system function. Compatibility at the community level was triggered by the use of community structures that were acceptable to FSWs such as queen mothers’ houses in delivering SRH services. Use of such structures positively facilitated the acceptability and adoption of SRH services by FSWs by triggering the perceived legitimacy, credibility and relevance of the SRH services. Meanwhile, limited confidentiality in some health facilities and mobility of FSWs affected acceptability of SRH services. Conclusion: The use of a multisectoral Task Force and community structures that are accepted by FSWs in delivering SRH services facilitated the integration process of the Emerging Voices project into the health system.
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