Illness associated with sexual and reproductive health (SRH) accounts for nearly 20 % of female health problems worldwide. Women in developing countries are at higher risk for SRH illnesses such as HIV. This means they are more likely to become exposed to infection and have restricted access to health services. The EU-funded DIFFER (Diagonal interventions to fast-forward enhanced reproductive health) project worked to broaden the range of SRH services provided in developing countries. DIFFER mostly focused on female sex workers (FSWs) and women who attend public health facilities in India, Kenya, Mozambique and South Africa. After thorough policy and situational analysis along with a literature review on SRH integration of high-risk services, researchers mapped the national SRH and SW policy environment. Surveys, focus group discussions and interviews with FSWs helped pinpoint the strengths and shortcomings of SRH services. DIFFER developed a generic intervention package that was adapted to design four country-specific intervention action plans. These plans addressed FSW community mobilisation, equitable access to improved SRH services, and better coordination between targeted and general health services. Country-specific interventions were successfully initiated during the third year of the project. Local policy and community advisory boards as well as periodic stakeholder meetings and workshops ensured that research findings were translated into policies. As India is far ahead of the African countries in terms of mobilising FSW needs, measures were implemented such as capacity building in India and exchange visits to Africa. Analyses revealed an increase in FSW service uptake with community engagement proving to be important for success. Furthermore, they saw an improvement in FSW empowerment and equity of access to services. However, government endorsement, supportive policy and funding are key to ensure sustainability of such interventions. The DIFFER intervention models have provided an invaluable knowledge base for policymakers. Better policies and guidelines for facilitating equitable access with improved quality of SRH services should positively impact the health of women.
Intervention strategy, sexual and reproductive health, DIFFER, policy environment, service uptake