integrating family planning into cshgp and mch programs

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Integrating Family Integrating Family Planning Into CSHGP Planning Into CSHGP and MCH Programs and MCH Programs Victoria Graham (USAID) Victoria Graham (USAID) April 29 2010 April 29 2010

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Integrating Family Planning Into CSHGP and MCH ProgramsVictoria Graham, USAIDCORE Group Spring Meeting, April 29, 2010

TRANSCRIPT

Page 1: Integrating Family Planning Into CSHGP and MCH Programs

Integrating Family Planning Integrating Family Planning Into CSHGP and MCH Into CSHGP and MCH

ProgramsPrograms

Victoria Graham (USAID)Victoria Graham (USAID)

April 29 2010April 29 2010

Page 2: Integrating Family Planning Into CSHGP and MCH Programs

Presentation OverviewPresentation Overview

Contribute of FP to MCH ProgramsContribute of FP to MCH Programs Historical Perspective of Flex Fund ProgramHistorical Perspective of Flex Fund Program Integration of FP into MCH ProgramsIntegration of FP into MCH Programs

Increasing Community Access to FPIncreasing Community Access to FP YouthYouth Birth SpacingBirth Spacing Postpartum Postpartum Abortion Prevention and Post Abortion CareAbortion Prevention and Post Abortion Care

Page 3: Integrating Family Planning Into CSHGP and MCH Programs

Contributions of Family Contributions of Family Planning to MCH Planning to MCH

ProgramsPrograms

Page 4: Integrating Family Planning Into CSHGP and MCH Programs

Saving Lives by Meeting Unmet Saving Lives by Meeting Unmet Need for Contraception, 2005-2015Need for Contraception, 2005-2015

Page 5: Integrating Family Planning Into CSHGP and MCH Programs

Estimated Total Contribution of Unintended Estimated Total Contribution of Unintended Pregnancies to Maternal MortalityPregnancies to Maternal Mortality

Total Unintended Pregnancies = 79 MillionTotal Unintended Pregnancies = 79 Million Abortions = 46 millionAbortions = 46 million

Abortion deaths = ~ 70,000Abortion deaths = ~ 70,000 Unintended Births = 33 millionUnintended Births = 33 million

Maternal Deaths = ~ 110,000Maternal Deaths = ~ 110,000

Total Maternal Deaths = ~180,000Total Maternal Deaths = ~180,000

% Contribution = 34%% Contribution = 34% among among 529,000 maternal deaths529,000 maternal deaths

Page 6: Integrating Family Planning Into CSHGP and MCH Programs

Why is it essential that family planning Why is it essential that family planning be an integral part of Community-be an integral part of Community-

Based PHC?Based PHC?Family planning –Family planning –

Is a service wanted by the women themselvesIs a service wanted by the women themselves Directly affects maternal and child survivalDirectly affects maternal and child survival Promotes family welfare by preventing Promotes family welfare by preventing

unintended pregnanciesunintended pregnancies Facilitates social development by slowing Facilitates social development by slowing

population growthpopulation growth Increases the capability to women to Increases the capability to women to

participate in the development processparticipate in the development process

Page 7: Integrating Family Planning Into CSHGP and MCH Programs

Health Workforce Needed Health Workforce Needed to Meet the MDGsto Meet the MDGs

To meet MDG goals, 2.5 health To meet MDG goals, 2.5 health workers/1000 pop. are neededworkers/1000 pop. are needed

An additional 2.4 million professionals An additional 2.4 million professionals needed globallyneeded globally

Sub-Saharan Africa has the largest need Sub-Saharan Africa has the largest need gap – requiring an increase of 140% gap – requiring an increase of 140%

Community-based provision of injectables Community-based provision of injectables can reduce the burden on clinic-based staff can reduce the burden on clinic-based staff as well as extend the reach of services.as well as extend the reach of services.

Page 8: Integrating Family Planning Into CSHGP and MCH Programs

Historical Perspective of Historical Perspective of the Flexible Fundthe Flexible Fund

Supporting Integration and Supporting Integration and Innovation in Family PlanningInnovation in Family Planning

Page 9: Integrating Family Planning Into CSHGP and MCH Programs

The Flexible Fund Goals The Flexible Fund Goals and Critical Inputsand Critical Inputs

Critical InputsFlex Fund will support CA’s to provide

Technical Assistance to Fund Recipients:

1) Monitoring and Evaluation2) Program Strengthening

Flex Fund will support centrally

funded CAs to promote shared learning among Fund recipients

Flex Fund will support PVO

Programs through the

CSHGP

Shared Learning

Goal #2 Increase Shared Learning of SOTA on community-based

FP/RH approaches

Goal #1 Increase access to quality

FP/RH services through NGO/PVO Activities.

Flex Fund will support PVO

Programs through the CSHGP

Page 10: Integrating Family Planning Into CSHGP and MCH Programs

0

1,000

2,000

3,000

4,000

5,000

6,000

FY03 FY04 FY05 FY06 FY07 FY08 FY10

CSHGP PVO/NGOTechnical SupportTOTAL

Breakdown of Flexible Fund Support by Fiscal Year

Fiscal Year

US

$ (0

00)

Page 11: Integrating Family Planning Into CSHGP and MCH Programs

PVO and NGO ProgramsPVO and NGO Programs

US-Based PVOsUS-Based PVOs ADRA/Ethiopia ADRA/Guinea ADRA/Madagascar CEDPA/Nepal HAI/East Timor MIHV/Uganda MCDI Madagascar Plan/Ethiopia Plan/Guinea Save/Ethiopia Save/Uganda Save/Guatemala

Local NGOsLocal NGOs AHS/MalawiAHS/Malawi ASDAP/MaliASDAP/Mali COCIN/NigeriaCOCIN/Nigeria GSPS/MaliGSPS/Mali Fair Foundation/BangladeshFair Foundation/Bangladesh

Organizational Organizational IntegrationIntegration

Child FundChild Fund International Youth International Youth

FoundationFoundation Save the ChildrenSave the Children World VisionWorld Vision

Page 12: Integrating Family Planning Into CSHGP and MCH Programs

CSHGP Projects w/ Flexible Fund SupportCSHGP Projects w/ Flexible Fund Support

Project Hope Uzbekistan Project Hope Uzbekistan 2003-20072003-2007

Navoi, Uzbekistan (target 94,000)Navoi, Uzbekistan (target 94,000)Cost XT $1,300,000 (FP $430,000)Cost XT $1,300,000 (FP $430,000)Program Level of EffortProgram Level of Effort 30% Maternal Child Health30% Maternal Child Health 30% Family Planning30% Family Planning 10% Breastfeeding10% Breastfeeding 10% Control of Diarrheal Disease10% Control of Diarrheal Disease 10% Pneumonia Case Mgmnt10% Pneumonia Case Mgmnt 10% Nutrition10% NutritionStrategies:Strategies: Focus on school program for Focus on school program for

youth youth Train peer educatorsTrain peer educators Develop training materials for Develop training materials for

adolescentsadolescents

World Vision IndiaWorld Vision India 2003-20082003-2008

Uttar Pradesh State (Target 1.2m)Uttar Pradesh State (Target 1.2m)Expanded Impact:$2.5 mil (FP $830,000)Expanded Impact:$2.5 mil (FP $830,000)Program Level of EffortProgram Level of Effort 40% Immunization40% Immunization 30% FP/Birth Spacing30% FP/Birth Spacing 20% Breastfeeding20% Breastfeeding 10% IMCI/Vitamin A10% IMCI/Vitamin AStrategiesStrategies Performance improvement AWW & Performance improvement AWW &

ANMANM Early registration of all pregnant Early registration of all pregnant

womenwomen Time and Targeted BCC for families Time and Targeted BCC for families Improve block and village level Improve block and village level

planning and use of dataplanning and use of data

Page 13: Integrating Family Planning Into CSHGP and MCH Programs

CSHGP Projects CSHGP Projects w/ 100% Flexible Fund Supportw/ 100% Flexible Fund Support

ADRA/Nepal ADRA/Nepal 2004-20092004-2009

Eastern Region (target 500,000)Eastern Region (target 500,000)Expanded Impact for $2.5 million (FP)Expanded Impact for $2.5 million (FP)Program Level of EffortProgram Level of Effort

100% Family Planning100% Family PlanningStrategiesStrategies BCC and Community Mobilization: BCC and Community Mobilization:

training peer educators and FCHV, training peer educators and FCHV, advocacy through religious leaders advocacy through religious leaders and decision makersand decision makers

Training for FP Service Provision: Training for FP Service Provision: public service providers (LAPM), VHW public service providers (LAPM), VHW and CHW, FCHV refresherand CHW, FCHV refresher

System Strengthening: quality System Strengthening: quality improvement through COPE and PDQ; improvement through COPE and PDQ; strengthen referral system; strengthen referral system; strengthening contraceptive logistics strengthening contraceptive logistics management; improved M&E systemsmanagement; improved M&E systems

Increasing Access to LAPMs: Increasing Access to LAPMs: Mobile Mobile LAPM service provisionLAPM service provision

Save the Children/MaliSave the Children/Mali2004-20092004-2009

Segou Region (target 184,000)Segou Region (target 184,000)Expanded Impact for $2.5 million (FP) Expanded Impact for $2.5 million (FP) Program Level of EffortProgram Level of Effort 100% Family Planning100% Family PlanningProgram StrategiesProgram Strategies Behavior Change: Behavior Change: messages messages

through individual and group; through individual and group; advocacy through religious leaders advocacy through religious leaders and decision-makers; radioand decision-makers; radio

Training for FP Service Provision; Training for FP Service Provision; health care providers, CBDshealth care providers, CBDs

System Strengthening: logistics System Strengthening: logistics management; improved M&Emanagement; improved M&E

Training; strengthening referral Training; strengthening referral system for LAPMs; PDQsystem for LAPMs; PDQ

Increasing Community Access: Increasing Community Access: Establishing network of CBD and Establishing network of CBD and youth PE to sell contraceptives in youth PE to sell contraceptives in villages w/o health centersvillages w/o health centers

Page 14: Integrating Family Planning Into CSHGP and MCH Programs

CSHGP Projects with a CSHGP Projects with a Portion of Family Planning SupportPortion of Family Planning Support

Project Hope Uzbekistan Project Hope Uzbekistan 2003-20072003-2007

Navoi, Uzbekistan (Targeted 94,000)Navoi, Uzbekistan (Targeted 94,000)Cost XT $1,300,000 (FP $430,000)Cost XT $1,300,000 (FP $430,000)Program Level of EffortProgram Level of Effort 30% Maternal Child Health30% Maternal Child Health 30% Family Planning30% Family Planning 10% Breastfeeding10% Breastfeeding 10% Control of Diarrheal Disease10% Control of Diarrheal Disease 10% Pneumonia Case Mngt-10% Pneumonia Case Mngt- 10% Nutrition10% NutritionStrategies:Strategies: Target youth and adolescents with Target youth and adolescents with

messages on about SRHmessages on about SRH Train peer educatorsTrain peer educators Develop training materials for Develop training materials for

adolescent for use in schoolsadolescent for use in schools Scaled-up to national levelScaled-up to national level

World Vision IndiaWorld Vision India 2003-20082003-2008

Uttar Pradesh State (1.2m targeted)Uttar Pradesh State (1.2m targeted)Expanded Impact:$2.5 mil (FP $830,000)Expanded Impact:$2.5 mil (FP $830,000)Program Level of EffortProgram Level of Effort 40% Immunization40% Immunization 30% FP/Birth Spacing30% FP/Birth Spacing 20% Breastfeeding20% Breastfeeding 10% IMCI/Vitamin A10% IMCI/Vitamin AStrategiesStrategies Performance improvement AWW & Performance improvement AWW &

ANMANM Early registration of all pregnant Early registration of all pregnant

womenwomen Time and Targeted BCC for families Time and Targeted BCC for families Improve block and village level Improve block and village level

planning and use of dataplanning and use of data

Page 15: Integrating Family Planning Into CSHGP and MCH Programs

CSHGP Projects CSHGP Projects with 100% Family Planning Supportwith 100% Family Planning SupportADRA/Nepal ADRA/Nepal

2004-20092004-2009Eastern Region (targeting 500,000)Eastern Region (targeting 500,000)Expanded Impact for $2.5 million (FP)Expanded Impact for $2.5 million (FP)Program Level of EffortProgram Level of Effort

100% Family Planning100% Family PlanningStrategiesStrategies BCC and Community Mobilization:BCC and Community Mobilization:

training peer educators and FCHV, training peer educators and FCHV, advocacy through religious leaders advocacy through religious leaders and decision makersand decision makers

Training for FP Service ProvisionTraining for FP Service Provision: : public service providers (LAPM), VHW public service providers (LAPM), VHW and CHW, FCHV refresherand CHW, FCHV refresher

System Strengthening:System Strengthening: quality quality improvement through COPE and PDQ; improvement through COPE and PDQ; strengthen referral system; strengthen referral system; strengthening contraceptive logistics strengthening contraceptive logistics management; improved M&E systemsmanagement; improved M&E systems

Increasing Access to LAPMsIncreasing Access to LAPMs: : Mobile LAPM service provisionMobile LAPM service provision

Save the Children/MaliSave the Children/Mali2004-20092004-2009

Segou Region (targeting 184,000)Segou Region (targeting 184,000)Expanded Impact for $2.5 million (FP) Expanded Impact for $2.5 million (FP) Program Level of EffortProgram Level of Effort 100% Family Planning100% Family PlanningProgram StrategiesProgram Strategies BCC and Community Mobilization:BCC and Community Mobilization:

individual and group messaging; individual and group messaging; advocacy advocacy w/ religious leaders and decision-makers; w/ religious leaders and decision-makers; radioradio

Training for FP Service ProvisionTraining for FP Service Provision; health ; health care providers, CBDscare providers, CBDs

System StrengtheningSystem Strengthening: logistics : logistics management; improved M&E, management; improved M&E, strengthening referral system for LAPMs; strengthening referral system for LAPMs; PDQPDQ

Increasing Access to FPIncreasing Access to FP: Establishing : Establishing network of CBD and youth PE to sell network of CBD and youth PE to sell contraceptives in villages w/o health centerscontraceptives in villages w/o health centers

Page 16: Integrating Family Planning Into CSHGP and MCH Programs

Birth Spacing Messages Birth Spacing Messages

Page 17: Integrating Family Planning Into CSHGP and MCH Programs

Healthy Timing and Spacing of Healthy Timing and Spacing of PregnanciesPregnancies

A child born three to five A child born three to five years after the birth of its years after the birth of its sibling is about 2.5 times sibling is about 2.5 times more likely to survive than more likely to survive than children born at shorter children born at shorter intervals and less likely to be intervals and less likely to be malnourished malnourished

Too young, too late, and too Too young, too late, and too closely spaced result in high closely spaced result in high risk for the mother and childrisk for the mother and child

Adverse Outcomes Increased Risk

Induced Abortion 650%Miscarriage 230%Newborn Death 170%Maternal Death 150%Preterm Birth 70%Stillbirth 60%Low Birth Weight 60%

Low Birth Weight 170%Maternal Anemia 160%Pre-Term Birth 80%

Adjusted Increased Risk of Adverse Outcome when

Pregnancy Occurs Six Months After a Live Birth

Adjusted Increased Risk of Adverse Outcome when

Pregnancy Occurs One or Two Months After an Abortion or

Miscarriage

Sources: Conde-Agudelo, 2000: 2005-2006;DaVanzo, 2004; 2008; Razzaque, 2005; Rutstein, 2005. All studies adjusted for 10-15 confounding factors.

Page 18: Integrating Family Planning Into CSHGP and MCH Programs

Birth Spacing Birth Spacing RecommendationsRecommendations

Wait 24 months before attempting the next Wait 24 months before attempting the next pregnancy after a live birth (a birth-to-birth pregnancy after a live birth (a birth-to-birth interval of 33 months) to reduce the risk of interval of 33 months) to reduce the risk of adverse:adverse: Maternal Maternal Perinatal and Perinatal and Infant outcomesInfant outcomes

Wait six months after a miscarriage or induced Wait six months after a miscarriage or induced abortion to reduce the risks of adverse abortion to reduce the risks of adverse Maternal and Maternal and Perinatal outcomesPerinatal outcomes

Page 19: Integrating Family Planning Into CSHGP and MCH Programs

Postpartum Family Postpartum Family Planning Planning

An Essential Component of MCH An Essential Component of MCH ProgramsPrograms

Page 20: Integrating Family Planning Into CSHGP and MCH Programs

Postpartum Need for FPPostpartum Need for FP 99% of women postpartum want to delay or 99% of women postpartum want to delay or

avoid the next pregnancyavoid the next pregnancy A 36 month birth-to-birth interval improves A 36 month birth-to-birth interval improves

health of mother and child health of mother and child 50% of births occur outside a hospital 50% of births occur outside a hospital 70% of women receive no postpartum care70% of women receive no postpartum care

Reaching postpartum women has the potential to provide FP information and

services to over 90% of women of reproductive age!

Page 21: Integrating Family Planning Into CSHGP and MCH Programs

Key Postpartum FP MessagesAntenatal Period

• LAM and immediate & exclusive BF• Reproductive intentions• Return to fertility• Pregnancy spacing for women who

want another child• Contraceptive options including

(LAPM – IUD, tubal ligation, and vasectomy) for women who have reached their desired family size.

Immediate Postpartum (1 week)

• All of the above +• LAM and Exclusive breastfeeding• Importance of postnatal care for the

mother and the newborn

Post Natal Care Contact (within 6 wks)

• LAM and exclusive breastfeeding• Reproductive intentions• Return to sexual activity• Return to fertility• Pregnancy spacing for women

wanting another child• Appropriate contraceptive options

for women who do not want another child.

• Importance of well baby care.

Child Health Contacts during 1st year (immun., sick child, etc.)

•All of the above +•Exclusive breastfeeding through first six months, then breastfeeding with complementary feeding

Page 22: Integrating Family Planning Into CSHGP and MCH Programs

What are the Appropriate Post Partum Contraceptives Options?

Page 23: Integrating Family Planning Into CSHGP and MCH Programs

World Vision’s StrategyWorld Vision’s StrategyTimed and Targeted Counseling:Timed and Targeted Counseling:

Getting the Right Messages to the Right People at Getting the Right Messages to the Right People at the Right Timethe Right Time

Page 24: Integrating Family Planning Into CSHGP and MCH Programs

World Vision’s World Vision’s Timed and Targeted Counseling Timed and Targeted Counseling

Strategies and ResultsStrategies and Results

Provide a set of Provide a set of standard messages for standard messages for counseling at counseling at designated timeframedesignated timeframe

Utilize registers to Utilize registers to track conception and track conception and birth birth

Identify and track Identify and track pregnant women over pregnant women over timetime

Train Community VolunteersTrain Community VolunteersNFHS: Uttar Pradesh India

  1998/99 2005/06 1998/99 2005/06

Total Fertility Rate 4.1 3.8 2.9 2.7

Contraceptive Use 28% a 44% 48% 56%

Unmet need for FP 25% b 22% 16% 13%

Infant Mortality 89 c 73 68 57

a Among married women aged 15-49

b Among married women aged 15-49 who want to delay next pregnancy or want no more pregnancies

c per 1,000 live births      

Page 25: Integrating Family Planning Into CSHGP and MCH Programs

Increasing Community Increasing Community Access to Family Access to Family

PlanningPlanningBringing FP services to Bringing FP services to

underserved and rural populationsunderserved and rural populations

Page 26: Integrating Family Planning Into CSHGP and MCH Programs

Community-based Strategies for Community-based Strategies for Increasing Community Access to FPIncreasing Community Access to FP

Community-based Distribution Programs* Community-based Distribution Programs* (shorter term methods including (shorter term methods including DepoProvera)DepoProvera) Community volunteers Community volunteers Trained health workersTrained health workers

Mobile Services for LAPMs* (implants, Mobile Services for LAPMs* (implants, IUD, female and male sterilization)IUD, female and male sterilization)

Establishment of Depots Establishment of Depots Pharmacy Sale and AdministrationPharmacy Sale and Administration

Page 27: Integrating Family Planning Into CSHGP and MCH Programs

Community-based Distribution Community-based Distribution NetworksNetworks

Community health workers:Community health workers: Volunteers from public or private sectorVolunteers from public or private sector Paid providers typically from the public sectorPaid providers typically from the public sector

Possible RolesPossible Roles Awareness and disseminating messagesAwareness and disseminating messages Counseling on FPCounseling on FP Referrals (active and passive)Referrals (active and passive) Provision of FP (condoms, pills, injectables*, Provision of FP (condoms, pills, injectables*,

SDM)SDM)

Page 28: Integrating Family Planning Into CSHGP and MCH Programs

Issues for Establishing Issues for Establishing NetworksNetworks

Selection CriteriaSelection Criteria TrainingTraining Commodities and LogisticsCommodities and Logistics Supervision and ReportingSupervision and Reporting Incentives/MotivationIncentives/Motivation RetentionRetention SustainabilitySustainability

Page 29: Integrating Family Planning Into CSHGP and MCH Programs

The Rationale for Using Community The Rationale for Using Community Health Workers to Administer Health Workers to Administer

Injectable ContraceptionInjectable Contraception

It is safe and effectiveIt is safe and effective Expands access beyond health facilities to reach Expands access beyond health facilities to reach

underserved populations (rural and urban)underserved populations (rural and urban) Alleviates some of the burden on declining numbers of Alleviates some of the burden on declining numbers of

professional health care providers professional health care providers Increasing access to injectable contraception has Increasing access to injectable contraception has

increased contraceptive prevalence rates at the national increased contraceptive prevalence rates at the national level in many countrieslevel in many countries

MDGs and country-specific FP and other health goals MDGs and country-specific FP and other health goals cannot be met without increasing access to FPcannot be met without increasing access to FP

Page 30: Integrating Family Planning Into CSHGP and MCH Programs

Provision of Injectables by Community Health Provision of Injectables by Community Health Workers is Safe, Effective, FeasibleWorkers is Safe, Effective, Feasible

Research and programmatic evidence from Africa, Asia, and Research and programmatic evidence from Africa, Asia, and Latin America: Provision of Depo-Provera by trained CHWs is Latin America: Provision of Depo-Provera by trained CHWs is extremely effectiveextremely effective

June 2009 Technical Consultation at WHO: Evidence supports June 2009 Technical Consultation at WHO: Evidence supports provision of injectables by trained CHWsprovision of injectables by trained CHWs

CHWs repeatedly demonstrate they:CHWs repeatedly demonstrate they: Provide injections safely and maintain suppliesProvide injections safely and maintain supplies Know when to refer to a clinicKnow when to refer to a clinic Counsel about side effectsCounsel about side effects Administer injectables using a regular scheduleAdminister injectables using a regular schedule Provide services satisfactory to clienteleProvide services satisfactory to clientele

Page 31: Integrating Family Planning Into CSHGP and MCH Programs

Adding injectables to the Method Mix Adding injectables to the Method Mix has Increased CPR in some African countrieshas Increased CPR in some African countries

0

5

10

15

20

25

30 Orals

Implt

Steril

IUD

Inject

Page 32: Integrating Family Planning Into CSHGP and MCH Programs

Status of Paramedical Provision of Depo-Provera by CHWs in Africa 2004

TUNISIAMOROCCO

SAHARA

ALGERIA

MAURITANIA MAL

I NIGER

LIBYA

CHAD

EGYPT

SUDAN

ETHIOPIA

DJIBOUTI

ERITREA

SOMALIAKENY

A

TANZANIA

DEMOCRATIC

CENTRAL

RWANDA

GABON

EQUATORIAL

ANGOLA

CONGO

NIGERIA

BENIN

DTVOIRE

SIERRA

SENEGAL

GHANA

THE

GUINEA

LIBERIA

CAMEROON

MALAWI

ZAMBIA

MOZAMBIQUE MADAGASCARZIMBABWE

BOTSWANA

SWAZILANDLESOTHO

NAMIBIA

ANGOLA

WESTERN

UGANDA

OF THE CONGO

REPUBLIC

BURUNDI

GUINEAREP. OF

TOGOCOTE

BURKINA FASOGUINEA

LEONE

GAMBIA

BISSAU

SOUTH

REPUBLIC

AFRICAN

THE

AFRICA

Pilot or limited program implementation with MOH approval; national policy restrictions remain in place

Page 33: Integrating Family Planning Into CSHGP and MCH Programs

TUNISIAMOROCCO

SAHARA

ALGERIA

MAURITANIA

MALI

NIGER

LIBYA

CHAD

EGYPT

SUDAN

ETHIOPIA

DJIBOUTI

ERITREA

SOMALIA

KENYA

TANZANIA

DEMOCRATIC

CENTRAL

RWANDA

GABON

EQUATORIAL

CONGO

NIGERIABENI

NSIERRA LEONE

SENEGAL

GHANA

THE

GUINEA

LIBERIA

CAMEROON

MALAWI

ZAMBIA

MOZAMBIQUE MADAGASCARZIMBABWE

BOTSWANA

SWAZILANDLESOTHO

NAMIBIA

ANGOLA

WESTERN

UGANDA

OF THE CONGO

REPUBLIC

BURUNDI

GUINEAREP. OF

TOGOCOTE

D’VOIRE

BURKINA FASOGUINEA

GAMBIA

BISSAU

SOUTH

REPUBLIC

AFRICAN

THE

AFRICA

National policies now permit scale-up. Scale-up in planning or implementation phase.

Countries where pilots are being conducted or will be conducted by 2010

Potential for introduction of a demonstration project and/or policy change

Countries are pilot testing CHW provision of Countries are pilot testing CHW provision of injectables and instituting policy changeinjectables and instituting policy change

Page 34: Integrating Family Planning Into CSHGP and MCH Programs

A Promising New Technology – A Promising New Technology – Depo-SubQ in UnijectDepo-SubQ in Uniject

A new all-in-one single-use delivery system that combines A new all-in-one single-use delivery system that combines the needle and a pre-filled dose of Depo-Provera the needle and a pre-filled dose of Depo-Provera formulated for subcutaneous injection (Depo-SubQ) into formulated for subcutaneous injection (Depo-SubQ) into one device.one device.

Designed to give subcutaneous injections safely by all Designed to give subcutaneous injections safely by all trained providers including doctors, nurses, and CHWs. trained providers including doctors, nurses, and CHWs.

Product may be available for purchase in 2011. However, cost of Product may be available for purchase in 2011. However, cost of the commodity is still unknown. USAID has not committed to the commodity is still unknown. USAID has not committed to purchase Depo-SubQ in Uniject. purchase Depo-SubQ in Uniject.

For now, programs are encouraged to move forward with the For now, programs are encouraged to move forward with the promotion of Depo-Provera delivered intramuscularly. promotion of Depo-Provera delivered intramuscularly.

Page 35: Integrating Family Planning Into CSHGP and MCH Programs

Abortion Prevention and Abortion Prevention and Post Abortion CarePost Abortion Care

An Opportunity for Integration An Opportunity for Integration through MCH Programsthrough MCH Programs

Page 36: Integrating Family Planning Into CSHGP and MCH Programs

Induced AbortionsInduced Abortions The Extent of the ProblemThe Extent of the Problem

205 million pregnancies worldwide:205 million pregnancies worldwide: One third are unintended and 20% will end in abortionOne third are unintended and 20% will end in abortion

20 million unsafe abortions annually: 20 million unsafe abortions annually: Developing countries: 55% of abortions are unsafeDeveloping countries: 55% of abortions are unsafe Developed regions: 8% are unsafe Developed regions: 8% are unsafe

68,000/yr women die unnecessarily from unsafe 68,000/yr women die unnecessarily from unsafe abortions (13% of all maternal deaths):abortions (13% of all maternal deaths): Africa: 650 deaths per 100,000 unsafe abortionsAfrica: 650 deaths per 100,000 unsafe abortions Developed regions: 10 deaths per 100,000 unsafe Developed regions: 10 deaths per 100,000 unsafe

abortionsabortions

Page 37: Integrating Family Planning Into CSHGP and MCH Programs

Mobile ServicesMobile Services

Methods: implants, IUD insertions, male and Methods: implants, IUD insertions, male and female sterilizations, male circumcisionfemale sterilizations, male circumcision

Community-level Tasks: scheduling services, Community-level Tasks: scheduling services, preparing sites, inform client base, creating preparing sites, inform client base, creating monitoring plan, and follow-up.monitoring plan, and follow-up.

Mobile Team Tasks: appropriate team of trained Mobile Team Tasks: appropriate team of trained providers, securing commodities, ensuring providers, securing commodities, ensuring quality services and follow-up plan. quality services and follow-up plan.

FP services provided by a mobile team of trained FP services provided by a mobile team of trained providers in an area with limited or no FP services.providers in an area with limited or no FP services.

Page 38: Integrating Family Planning Into CSHGP and MCH Programs

Community Actions to Establish Community Actions to Establish Mobile ServicesMobile Services

Conduct needs assessment to determine Conduct needs assessment to determine demand for mobile servicesdemand for mobile services

Establish partnerships with local Establish partnerships with local organizations that perform mobile services organizations that perform mobile services in your program areain your program area

Negotiate with public sector facilities to Negotiate with public sector facilities to periodically bring services to a lower level periodically bring services to a lower level facilityfacility

Page 39: Integrating Family Planning Into CSHGP and MCH Programs

Abortions Result in Lost LivesAbortions Result in Lost Lives

Legal restriction do not affect Legal restriction do not affect abortion incidence: abortion incidence:

Africa abortion is illegal – Africa abortion is illegal – abortion rate is 29 abortion rate is 29

Europe abortion is legal – Europe abortion is legal – abortion rate is 28 abortion rate is 28

Causes of death due to unsafe Causes of death due to unsafe abortions:abortions:

HemorrhageHemorrhage InfectionInfection poisoning from substances poisoning from substances

used to induce abortionused to induce abortion

Dangerous Abortion Practices

• Drinking turpentine, bleach or tea made with livestock manure

• Inserting herbal preparations into the vagina or cervix

• Placing foreign bodies, such as a stick, coat hanger or chicken bone, into the uterus

• Jumping from the top of stairs or a roof

Page 40: Integrating Family Planning Into CSHGP and MCH Programs

Abortion Prevention and PACAbortion Prevention and PACLife-Saving Community-based ActionsLife-Saving Community-based ActionsPrevention:Prevention: Increase access to FPIncrease access to FP to address the unmet need for FP and to address the unmet need for FP and

reduce unintended pregnancies reduce unintended pregnancies Inform men and WRA of dangerous unsafe abortion practices Inform men and WRA of dangerous unsafe abortion practices Provide messages to promote care-seeking behaviors for danger Provide messages to promote care-seeking behaviors for danger

signs following an abortion signs following an abortion

Post Abortion Care:Post Abortion Care: Advocate for availability of PAC at the community level (emergency Advocate for availability of PAC at the community level (emergency

treatment and FP)treatment and FP) Counsel patients to seek care immediately following abortions*Counsel patients to seek care immediately following abortions* Mobilize transport to facilities for emergency careMobilize transport to facilities for emergency care Provide FP counseling and methods immediately following abortionProvide FP counseling and methods immediately following abortion Counsel women wanting pregnancy to wait six months before Counsel women wanting pregnancy to wait six months before

becoming pregnant after an abortionbecoming pregnant after an abortion

Page 41: Integrating Family Planning Into CSHGP and MCH Programs

Danger Signs Following an Abortion

Heavier than normal bleeding Monthly bleeding Fever Dizziness or fainting Severe stomach or abdominal pains Bad smelling discharge from their vagina

Immediately refer women to the clinic that has PAC services if they have:

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http://info.k4health.org/PAC

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Youth Programming at Youth Programming at the Community Levelthe Community Level

Addressing Health Care Needs of Addressing Health Care Needs of Youth in MCH ProgramsYouth in MCH Programs

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Why are Youth Important?Why are Youth Important?

1.5 billion youth aged 10-24 1.5 billion youth aged 10-24 1.3 youth are living in developing countries1.3 youth are living in developing countries

Youth Bulge of TodayYouth Bulge of Today The largest generation to transition to adulthoodThe largest generation to transition to adulthood Impact national security and civil conflictImpact national security and civil conflict Results in poverty, urban sprawl and slums Results in poverty, urban sprawl and slums

Values and decisions are impacted by norms, Values and decisions are impacted by norms, expectations, peers, parents and other adultsexpectations, peers, parents and other adults

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Integrating Youth Issues into MCH Integrating Youth Issues into MCH ProgramsPrograms

Clinic Services: Clinic Services: Advocate for clinic services that meet Advocate for clinic services that meet

the health care needs of youththe health care needs of youth CHW/Vs: CHW/Vs:

Sensitize CHWs to serve youthSensitize CHWs to serve youth Disseminate messages on SRHDisseminate messages on SRH

Behavior Change EffortsBehavior Change Efforts Design custom messages for youthDesign custom messages for youth Involve religious leaders and other adults to Involve religious leaders and other adults to

share accurate information and discuss share accurate information and discuss RH/FP issuesRH/FP issues

Engage youth in community mobilization Engage youth in community mobilization Systems: Systems:

Include indicators for youth in monitoring Include indicators for youth in monitoring systems to measure progresssystems to measure progress

Health Care Needsof Youth

• PrivacyPrivacy• ConfidentialityConfidentiality• Supportive health Supportive health

care providerscare providers• Range of quality Range of quality

services services (FP/RH, MCH, (FP/RH, MCH, PAC, STI, HIV VCT, PAC, STI, HIV VCT, treatment and care)treatment and care)

• Customized messages on Customized messages on FP/RH (delay sexual FP/RH (delay sexual debut and first debut and first pregnancy)pregnancy)