postpartum family planning in cameroon: beginning with the end … · 2019-12-18 · postpartum...

Postpartum Family Planning in Cameroon:

Beginning with the end in mind

Moderator: Salwa Bitar, Senior Advisor for Scale-up, E2A Project Presenters:

• Léa Monda, Technical Advisor, MSH Cameroon/E2A Project • Gwendolyn Morgan, Deputy Director, E2A Project • Boniface Sebikali, Senior Clinical Training Advisor, IntraHealth International

Panelists

Moderator: Salwa Bitar, Senior Advisor for Scale-up, E2A Project

Léa Monda, Technical Advisor, MSH Cameroon/E2A Project

Gwendolyn Morgan, Deputy Director, E2A Project

Boniface Sebikali, Senior Clinical Training Advisor, IntraHealth International

Objectives

1. Share the process of introducing a strategy for

postpartum family planning (PPFP) in

Cameroon

2. Share how ExpandNet’s Beginning with the

end in mind contributed to the design of a

demonstration and scale-up strategy for PPFP

in Cameroon

Tools

https://www.usaid.gov/sites/default/files/documents/1864/postpartum_family_planning.pdf

http://www.expandnet.net/PDFs/ExpandNet-WHO%20-%20Beginning%20with%20the%20end%20in%20mind%20-%202011.pdf

12 recommendations:

Beginning with the end in mind

1. Engage in a participatory process involving key stakeholders.

2. Ensure the relevance of the proposed innovation.

3. Reach consensus on expectations for scale-up.

4. Tailor the innovation to the sociocultural and institutional settings.

5. Keep the innovation as simple as possible.

6. Test the innovation in the variety of sociocultural and institutional settings

where it will be scaled-up.

7. Test the innovation under the routine operating conditions and existing resource

constraints of the health system.

8. Develop plans to assess and document the process of implementation.

9. Advocate with donors and other sources of funding for financial support beyond the pilot

stage.

10. Prepare to advocate for necessary changes in policies, regulations and other

health-systems components.

11. Develop plans for how to promote learning and disseminate information.

12. Plan on being cautious about initiating scale-up before the required evidence is available.

I. Engage in a participatory process

involving key stakeholders

• Initial assessment visit conducted by E2A and

USAID/West Africa

• Initial objectives on HIV and family planning

integration developed

• PPFP and youth sexual and reproductive health

identified as focal areas by DSF/MINSANTE

• Follow up meetings and discussions held with

relevant family planning stakeholders

2. Ensure the relevance of the

proposed innovation

• High total fertility, low contraceptive prevalence, and high maternal mortality rates

• Cameroon’s National Health Development Plan (2011-2015) provides policy support for family planning among women, especially young women.

• High rate of facility-based deliveries, low uptake of family planning, and absence of PPFP services drive need for PPFP program.

• GTZ ended its support for all health programs in 2014.

• FP methods were purchased and imported by UNFPA and USAID. Standardized prices were negotiated.

3. Reach consensus on expectations

for scale-up

• Expectations were not well documented or

strategically planned.

• Consensus between stakeholders and facility

providers was achieved on the following:

– Network between the hospital and the

community

– Stakeholders’ commitment to support the

hospitals

– Donor/government commitment

– Agreement to work in the four hospitals

Collaboration on Implementation

Research with the LMG Project

LMG study:

• To evaluate the added value of a

L+M+G capacity-building intervention

(LDP+) on PPFP service delivery

within MNCH departments of

tertiary care hospitals.

• Results are forthcoming.

4. Tailor the innovation to the sociocultural

and institutional settings

Tailored PPFP strategy to Cameroon context:

• Cameroon family planning services were

implemented at a single point of contact (FP Unit).

• New PPFP strategy: Integrated PPFP at the 4 points

of contact (antenatal care, immunization, maternity &

postnatal services) at 4 facilities in Yaoundé.

• PPFP clinical guidelines: Tailored and simplified PPFP

guidelines from international and local sources.

4. Tailor the innovation to the sociocultural &

institutional settings

• Opened family planning services in some health

facilities

• Integrated IEC community activities with

referrals to hospitals for family planning services

(community as 5th point of contact)

• Trained trainers and providers in PPFP

(theoretical and clinical)

• Improved quality of services by forming quality

improvement teams, use of simple indicators,

focus on data collection tools, and use of data

for decision making.

5. Keep the innovation as simple as possible

• Built capacity of local trainers and

internal/external supervisors at the 4 hospitals.

• Focused on one intervention (PPFP).

• Strengthened routine services and engaged

existing staff in health facilities: no major costs

incurred.

• Used Ministry of Health and World Health

Organization guidelines and existing registers for

monitoring and data collection.

6. Test the innovation in the variety of

sociocultural and institutional settings where

it will be scaled up

• Selected 4 facilities (urban hospitals) to implement the PPFP

strategy in Cameroon’s Central region and planned to

test the intervention in a rural area before scaling up.

• Tested contraceptive availability and affordability of

services.

• Tested the HMIS, quality, and supervision system and

learning/restitution sessions as a platform for shared learning.

• Planned to test community outreach network with

community health workers and local NGO (RENATA).

• Testing PPFP integration at different points of contact to

decide which offers smart integration.

7. Test the innovation under the routine

operating conditions and existing resource

constraints of the health system

• Engaged existing providers and supervisors, and used

existing facilities, supplies, and infrastructure.

• Facilitated availability of contraceptives at a

standardized price (no purchase of commodities).

• Strengthened collaboration between service

providers and leadership to make advocacy for

resources easier.

• Adapted postpartum intrauterine device (PPIUD), interval IUD,

and implant training materials from national and international

guidelines.

• Conducted a six-day clinical Training of Trainers on PPIUD,

interval IUD, and postpartum implants for 15 trainers (from

hospitals, national and regional health officials, and partners)

• 24 participants (nurses/midwives): 23 from the 4 practicum

hospitals and 1from the Ministry of Health, attended training on

PPIUD, interval IUD, and postpartum implants.

• Trainers facilitated the entire PPIUD and implants training with

supervision and coaching by international facilitators.

Capacity Building and Quality Improvement

Praticum on anatomic models (Mama-U)


Skill Development:

• Postpartum IUD insertion techniques (video); implant

insertion (video)

• Counseling/PPIUD insertion practices on anatomic models

• 3-day practicum (coaching) in 4 hospitals in Yaoundé

• Knowledge evaluation: 63.67% average (pretest), 91.16%

(post-test)


Minister of Health observes practicum on anatomic models


8. Develop plan to assess and document the

process of implementation

• Conducted an initial assessment on 6 hospitals and

chose 4 based on multiple criteria.

• Completed an in-depth assessment of maternal and

family planning services at the 4 facilities.

• Selected unified program targets and indicators.

• Conducted a baseline for PPFP services.

• Established ongoing supportive supervision,

monitoring, and evaluation of project activities.

• Created a system for reporting, documentation, and

dissemination of project results.

9. Advocate with donors and other sources of

funding for financial support beyond

the pilot stage

• Met with UNFPA to explore collaboration and

sustainability.

• Initiated discussion with Ministry of Health on

performance-based financing.

10. Prepare to advocate for necessary changes

in policies, regulations and other health

system components

• No policy change was required to implement the pilot phase, but E2A will continue to explore any need for policy change.

• PPFP strategy to be integrated in the Ministry of Health strategy, clinical sexual and reproductive health standards, and a guideline for certification of providers in PPFP to be developed.

• Ministry of Health has agreed to review and validate the family planning training guide.

• Ministry of Health is waiting for the results of the pilot phase before scaling up.

11. Develop plan for how to promote learning

and disseminate information

• Continuing to build capacity in supportive supervision

and quality improvement ,where teams from different

facilities and management share learning and

disseminate results.

• Planning 2 meetings, 1 national and 1 regional, to

disseminate results and advocate for scaling up.

12. Plan on being cautious about initiating

scale-up before the required evidence

is available

• Results analysis will be crucial before a strategy for scale-up

is designed.

• Will test PPFP strategy in a rural setting before developing a

scale-up strategy.

• Will test and evaluate the community outreach work and its

success in generating demand.

• Will ensure that PPFP package (training, counseling, data,

indicators) is simple and replicable at scale.

• Will ensure contraceptive availability.

Women who received family planning,

sexual & reproductive health counseling (group and individual)

at 4 points of contact

618

2650

1458

0

500

1000

1500

2000

2500

3000

BaselineOct - Dec 2014

Quarter 1Jan - Mar 2015

2nd QuarterApr-Jun 2015

Nu

mb

er

of

wo

me

n c

ou

nse

led

Time/Quarters

Total

Maternity

ANC

Family Planning

Child Immunization

Acceptors of

family planning methods

525

1110

1040

0

801

633

0

133 155

0

200

400

600

800

1000

1200




Nu

mb

er

of

FP a

cce

pto

rs

Time/Quarters

All Women

12 Months PP

Immediate PPFP

Acceptors of long-acting reversible contraceptives (LARCs) immediately postpartum

0

133

155

0

53

115

0

80

40

0

20

40

60

80

100

120

140

160

180




Nu

mb

er

of

PP

FP a

cce

pto

rs

Time/Quarters

Total immediate PPLARCs

Jadelle

PPIUD

Results

0

20

40

60

80

100

Oct-Dec 14 Jan-Mar 15 Apr-Jun 15

Number of women who accepted FP immediately after delivery by age group and quarter

0

100

200

300

400

500

600


Number of all women who accepted FP method by age group and quarter

0

200

400

600

800

1000

1200


Number of women who received group and individual FP/SRH counseling by age

group and quarter

Challenges

• Some hospital managers do not prioritize

family planning

• Low demand, high mistrust, and suspicion

of family planning in the community

• Provider turnover, heavy workloads, and low

morale and motivation

Opportunities

• Positive environment for family planning:

Early history (1990s) of strong family planning

programs/ good will under regional West Africa programs

Strong commitment from the Ministry of Health

• Availability of contraceptives with negotiated prices

between the donor, the government, and the central

warehouse

• Inputs for high-quality services are present, for example:

adequate providers, supplies, and infrastructure

Lessons Learned/Recommendations

• Work with stakeholders and management to

ensure their involvement and commitment early

in the process.

• Performance based financing may lead to higher

quality services and sustainability.

• Tailoring a global PPFP strategy to Cameroon

context at low cost improves chances of

sustainability.

• Continue documentation, dissemination, and involve

stakeholders in developing a strategy for scaling up.

Conclusion

Designing and analyzing the PPFP program

against the 12 recommendations of Beginning

with the end in mind early in the process

improves the chance of sustainable scale-up.

Thank You

Merci

Me yéga Ngandak

“

“

www.E2AProject.org

@E2AProject

postpartum family planning in cameroon: beginning with the end … · 2019-12-18 · postpartum...

Documents