Jhpiego shared the following update on progress in achieving its FP2020 commitments:
Jhpiego has contributed to advocacy for task-shifting to improve access to long-acting family planning methods by contributing to the global evidence in support of lower level health cadres to provide contraceptive implants.
- As part of the Targeted States High Impact Project (TSHIP) funded by the United States Agency for International Development (USAID), Jhpiego and the State Primary Health Care Development Agency (SPHCDA) implemented a pilot intervention to increase access and utilization of long-acting reversible contraception (LARC) services among rural community members in Nigeria’s Bauchi and Sokoto states. The intervention focused on strengthening the capacity of Community Health Extension Workers (CHEWs) to insert implants and document the services provided through training and supportive supervision. The intervention also sought to improve commodity security and logistics systems, create demand, improve access to quality implant services, and strengthen the referral system. Evaluations of this intervention documented high quality of service provision and statistically significant increases in counselling skills for all methods by trained CHEWs. With proper training and continuous supportive supervision, Jhpiego’s work has demonstrated that CHEWs in Nigeria are able to administer contraceptive implants and provide adequate counseling for various contraceptive methods. A journal article highlighting the findings from this intervention has been accepted in the Global Health: Science and Practice Journal and will be published in an upcoming issue.
- Through the Maternal and Child Health Integrated Program (MCHIP) and Maternal and Child Survival Program (MCSP) funded by USAID, Jhpiego has supported the Ministry of Health of Mali to demonstrate the feasibility of matrones (auxiliary midwives) inserting contraceptive implants at rural community health centers. Evaluated through observation checklists for skills quality, the study demonstrated that matrones can insert implants satisfactorily up to one year after training. This study provides supporting evidence that matrones can be a key link to facilitate access of LARC services, especially for rural populations. The study results have been presented at a national event presenting best practices in maternal, newborn, and child health in 2014.
Jhpiego has continued to support with training matrons or auxiliary midwives to provide implants in these settings.
- As part of the TSHIP program in Nigeria, Jhpiego in partnership with SPHCDA trained 166 CHEWs in Sokoto and Bauchi states from September to December, 2013. Supportive supervision was conducted for nearly all trainees (95%; n=145). At the endline assessment six months later, a total of 3588 implants were inserted at 151 health facilities, and over 10,088 couple years of protection (CYP) were generated through implant insertion over a period of six months. In addition, the average number of family planning visits during the six months prior to the survey increased from 23 (n=157) to 28 (n=147) clients per month.
- In Mali, between August 2012 and February 2014, a total of 173 matrones across 160 sites in Diema, Kita, Sikasso districts were trained to insert implants. Between August 2013 and May 2015, 2362 clients received implants and 5020 clients were counseled and educated about Healthy Timing and Spacing of Pregnancy (HTSP).
- Of note, all of these lower level health workers were trained in implant insertion but not removals. Removals in both of these countries are referred to higher level health cadres.
Jhpiego’s initial commitment of $200,000 at the London Summit on Family Planning in July 2012 has turned into more than $7 million to increase the availability and utilization of postpartum family planning (PPFP) and postpartum intrauterine devices (PPIUDs) in Burkina Faso. In collaboration with Burkina Faso’s Ministry of Health, and after a review of the government’s revised strategy on FP, Jhpiego identified PPIUD services as a key entry point for increasing contraceptive use, along with integrating maternal health care and FP services.
To start off the initiative, Jhpiego supported two complementary skill-building courses in five public hospitals in March 2013. These activities aimed to contribute to the MOH’s goal of increasing contraceptive prevalence from 15% in 2010 to 25% by the end of 2015. Fifty health care providers from antenatal care and maternity services participated in the first course on PPFP counseling, which emphasized promoting contraception in the postpartum period for healthy timing and spacing of pregnancies. Thirty physicians and midwives who had participated in the counseling course then completed the second course on PPIUD insertion techniques.
Facilities received instrument kits, data collection tools, counseling materials and an initial supply of consumables and infection prevention materials. Supportive supervision was also carried out by the trainers to assist health care providers to put to use the new skills and services in their facilities. As part of the PPIUD training, providers were also oriented on accurate collection, reporting and use of data.
The success of this pilot of PPIUD services at the five facilities leveraged additional resources from UNFPA Burkina Faso for Jhpiego to extend PPIUD service delivery to 20 additional sites, beginning in October 2013. The first phase of the extension reached nine new sites between October and December 2013, and the second phase reached 11 more sites in early 2015. In the first nine new sites, 50 providers participated in the FP refresher training and 30 providers in the PPIUD insertion course. In the 11 additional sites, 55 providers participated in the FP refresher training and 34 providers in the PPIUD insertion course.
With a total of 155 health care workers providing PPFP counseling and 94 health care workers able to provide PPIUDs, these services are now available in 25 hospitals and health centers across six of Burkina Faso’s 13 regions. During the second phase of the extension, Jhpiego also qualified a pool of 15 local trainers who will be able to support further scale-up. Activities are continuing for in-service training of providers.
Between April 2013 and March 2014, 657 women out of the 13,174 women delivering at the first five sites chose to have a PPIUD inserted, for a rate of 4.9% among women delivering in a facility. In seven of the additional nine sites, 163 women of the 2,499 who delivered chose immediate PPIUD insertion, for a rate of 6.5% among women delivering in a facility. By comparison, prior to these interventions, postpartum insertion of the IUD was not specifically tracked, but with few providers familiar with postpartum insertion, the numbers were likely small among the approximately 10,000 IUDs inserted in 2013 (2013 Annuaire Statistique, MOH).
From the relatively small initial investment, to additional funding from UNFPA, the project continues to make great strides. As of April 2015, Jhpiego is launching a new, three-year, $6.8 million project, funded by an anonymous donor, which will further support scale-up by endorsing integration of PPFP and PPIUD with pre-service education of midwives and ob/gyns and support new graduates as they take up their first posts—giving even more women the opportunity to plan for the future of their families and ensure that they thrive.
