Today the large majority of women in developing countries still lack access to even the most basic sexual and reproductive health services. This is often the highest in marginalised populations who face increased risks because of limited access to health services, increased exposure to infection, general poor health, and the considerable effects of living in poverty.

Improving women’s sexual and reproductive health (SRH) requires innovative strategies to maximise potential synergies between components of care. Most adverse reproductive health outcomes stem from unintended pregnancy, and acquisition and transmission of reproductive tract infections. Although proven solutions exist, their implementation has been fragmented, with limited population impact, and little access for populations most at risk, such as sex workers. Integration of SRH services is key to achieving universal access to reproductive health.

However, with weakened health systems and an HIV pandemic, the way forward is uncertain. The essential package of services and models for delivering them at high coverage in resource-limited settings are unclear. To address this, we will implement a ‘diagonal’ strategy, incorporating both ‘horizontal’ health systems strengthening and more targeted ‘vertical’ approaches. Horizontal programmes can reach large numbers of women, while vertical programs target high-risk populations, difficult to reach through a horizontal approach.

The aim is improved SRH services through identifying best practices in delivering a combined package of interventions for general population women and female sex workers. This project will help to define packages of SRH services and models for delivery that meet the needs of all women and impact positively on their health.