Regina Benevides

Increasing Access to LAFP at the Community LevelPathfinder International Ethiopias Experience

Presented at Throughout the Reproductive Life Course Conference

Washington DCApril 02, 2014Presented by:Kidest Lulu, MD, MPHDeputy Country Representative, Pathfinder IntlCo-authors: Yewondwossen Tilahun, MD, Obs/GynKetsela Desalegn, MD 1Presentation OutlineBackground: EthiopiaEnabling Policy Environment: Family Planning (FP)Ethiopian Government ResponseIntegrated Family Health Programs ResponseIntervention MethodologyResultsLessons Learned

2Background: EthiopiaTotal Population - 84 million Annual Population Growth Rate - 2.6% TFR - 4.8 children per womanMaternal Mortality Ratio - 676 per 100,000 live birthsCPR (modern methods) 27.3%Unmet Need for FP 25%

3Enabling Policy Environment - FP

4

CPR, LAFP Use and Unmet-Need for FP, Ethiopia, EDHS 2000 20115Ethiopian Government Response

The FMOH expanded FP services to the community level through the Health Extension Workers (HEWs) Short acting methods including injectables Implanon scale-up program in 2009

The IUCD scale-up initiative in 2010Training mid-level health care providers on insertion and removal

6Integrated Family Health Programs (IFHP) ResponseIFHP: USAID funded program with Pathfinder Intl , JSI, and CORHA (July 2008 Dec. 2014) in Oromia, Amhara, SNNP and Tigray Regions

IFHP provided skill-based training for:HEWs on ImplanonHealth Center based providers on Implanon, Jadelle, and IUCD insertions removals

7IFHPs Response

During the practical trainings thousands of clients were served with methods that could not be provided at the health post (HP) level Indicating Implanon insertion alone at HPs would not address the need for appropriate method choiceImplant removal services could not be done by HEWs and need to be addressed at community level

(Jadelle and IUCD insertion, as well as removal services)

8Intervention Methodology

Starting in September 2011, the Back-Up support intervention was progressively instituted by 139 Health Centers

The Health Centers needed capacity-building to provide a regular back-up LAFP support to their PHCU health postsClinical skills and counseling training, Post- training equipment, commodity and consumable suppliesRegular follow-up

Data was collected from September 2011 to December 2012 from these sites where these Back-Up interventions took placeDefinition - Back-up support: Health center staff going down to health posts on demand to provide LAFP services at the HP

9Client Visits at Health Posts During Back-Up Support by Health Center Staff, Sept. 2011 Dec. 2012

Total visitsTotal = 48,587 NumberPercentFP service visits41,57385.6%Removal service visits7,01414.4%FP service visitsTotal = 41573Number PercentImplanon insertions7,10017.1%LAFP 21.3%Jadelle insertions1,0042.4%IUCD insertions7531.8%Depo-Provera injections25,23160.7%SAM 78.7%Contraceptive pills4,95011.9%Condoms2,5356.1%66% of removals were removals of implanon10Results During 16 months of Back-Up support, there were more than 48,000 visitsMore than 14% of the visits were for removal services, mostly for Implanon removal21.3% were for LAFP servicesThe Back-Up support also reduced the average time required to get to the service site from 65 to 47 minutes11Lessons Learned Capacitating the PHCU health centers enables them to integrate and provide Back-Up servicesIntegrating Back-Up services increases access to and use of LAFP Improves the FP method mix to levels not previously provided at the community/Health Post levelReduces the time and money required to receive the services, potentially increasing clients satisfaction

12THANK YOU !

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