Feasibility, acceptability and potential sustainability of a ‘diagonal’ approach to health services for female sex workers in Mozambique
Date
2018-10-03
Journal Title
Journal ISSN
Volume Title
Publisher
BMC (part of Springer Nature)
Abstract
Background: Female sex workers (FSWs) in many settings have restricted access to sexual and reproductive health
(SRH) services. We therefore conducted an implementation study to test a ‘diagonal’ intervention which combined
strengthening of FSW-targeted services (vertical) with making public health facilities more FSW-friendly (horizontal).
We piloted it over 18 months and then assessed its performance.
Methods: Applying a convergent parallel mixed-methods design, we triangulated the results of the analysis of
process indicators, semi-structured interviews with policy makers and health managers, structured interviews with
health care providers and group discussions with peer outreach workers. We then formulated integrated conclusions
on the interventions’ feasibility, acceptability by providers, managers and policy makers, and potential sustainability.
Results: The intervention, as designed, was considered theoretically feasible by all informants, but in practice the
expansion of some of the targeted services was hampered by insufficient financial resources, institutional capacity
and buy-in from local government and private partners, and could not be fully actualised. In terms of acceptability,
there was broad consensus on the need to ensure FSWs have access to SRH services, but not on how this might be
achieved. Targeted clinical services were no longer endorsed by national government, which now prefers a strategy
of making public services more friendly for key populations. Stakeholders judged that the piloted model was not fully
sustainable, nor replicable elsewhere in the country, given its dependency on short-term project-based funding, lack
of government endorsement for targeted clinical services, and viewing the provision of community activities as a
responsibility of civil society.
Conclusions: In the current Mozambican context, a ‘diagonal’ approach to ensure adequate access to sexual and
reproductive health care for female sex workers is not fully feasible, acceptable or sustainable, because of insufficient
resources and lack of endorsement by national policy makers for the targeted, vertical component.
Description
CITATION: Lafort, Y., et al. 2018. Feasibility, acceptability and potential sustainability of a ‘diagonal’ approach to health services for female sex workers in Mozambique. BMC Health Services Research, 18:752, doi:10.1186/s12913-018-3555-2.
The original publication is available at https://bmchealthservres.biomedcentral.com
The original publication is available at https://bmchealthservres.biomedcentral.com
Keywords
Reproductive health services, Sex workers
Citation
Lafort, Y., et al. 2018. Feasibility, acceptability and potential sustainability of a ‘diagonal’ approach to health services for female sex workers in Mozambique. BMC Health Services Research, 18:752, doi:10.1186/s12913-018-3555-2