Nancy Warren Mini-U Presentation March 2014
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Transcript of Nancy Warren Mini-U Presentation March 2014
NANCY WARREN, MPHCURAMERICAS GLOBAL
MARCH 7, 2014
Integration of Family Planning Services into MNCH
Programming in Liberia
Additional collaborators: Allen Zomonway, BSN, Ganta United Methodist Hospital;
Jean Capps, MPH, BSN
Liberian Context
Total population: 3,989,703Over 14 different ethnic
groupsMedian age is 17.9 yearsTotal Fertility Rate (TFR): ~5
children/womanMaternal mortality:
770/100,000 live birthsInfant mortality: 71/1,000 live
birthsFP Unmet need: 36%
Overview of Nehnwaa Child Survival Project
Nehnwaa – “struggle of the child”USAID-funded for five years (2008 – 2013)Local partner: Ganta United Methodist Hospital (GUMH)Located in Nimba County, LiberiaTargeted WRA, U2 mothers, and U5 childrenSix intervention teams:
Maternal and Newborn Care (MNC) HIV/AIDS Immunizations (EPI) Water and sanitation (WatSan) Integrated Mgmt of childhood illnesses (IMCI) Community Support Services (CSS)
Overview (continued)
Program Design combines the Community-Based Impact-Oriented Methodology (CBIO) and Care Groups to provide community-based primary health care servicesOver five years, 120 general Community Health Volunteers (gCHVs) and 120 Trained Traditional Midwives (TTMs) trained One gCHV and one TTM
per community
Introduction of Family Planning Services
In 2011, introduced 1-year FlexFund award for Community-Based Family Planning Services
Hired additional FP staff to establish Community Depot at GUMH and integrate FP into community visits (additional intervention team)
Trained all staff, gCHVs, and TTMs for community-based distribution and counseling
Established supply chain and procurement system for MOH-provided family planning commodities
Integration Process and Procedure
After funding ended in August 2012, FP services were integrated into the original Nehnwaa structure as a part of EPI service provision
EPI staff were fully trained in counseling and service provision, including administration of Depo Provera
EPI staff were trained in supply chain management, reporting, and recordkeeping
Integration Process and Procedure
While technically FP/EPI integration, family planning became a topic of most intervention teams: HIV team counseled on safe sex and provided condoms MNC and IMCI teams counseled on LAM and birth
spacing CSS team trained and mentored gCHVs on counseling,
distribution, and recordkeeping of FP services
Description of Family Planning Clients
Between September 2012 and January 2014, 3,866 office visits
2% male and 98% female Male clients range from 18 to 50 years oldFemale clients range from 13 to 50 years old
10-14 yrs
15-19 yrs
20-30 yrs
31+ yrs
Female 11 802 2128 850
Male 0 5 25 45
Family Planning-Specific Outputs
Key Result Objectives Baseline
(2008)
June 2011
July 2012
Final (2013)
Increase the percentage of Contraceptive Prevalence Rate among WRA
2.0%15.20
%61% 61%
Decrease the percentage of Unmet Need among WRA
--67.90
%22% --
Increase the percentage of WRA who report discussing family planning with a health or family planning worker or promoter
-- 25.3% 97% 97%
Indirect Improvements - Additional Indicators
Improvements in other indicators may be influenced by integration of family planning services:Indicator Baseline
(2008)Final (2013)
Exclusive Breastfeeding 39.4% 52.9%
At least 4 ANC visits 24.7% 73.9%
Postpartum visit for mother
9.3% 58.1%
Children with PENTA1 vaccine
40.1% 100%
Children with PENTA3 vaccine
24.5% 99%
Children with Measles vaccination
45.3% 97%
What was the difference maker?
Family Planning counseling and service provision made possible by network of community health volunteers
Increase in peer education and social acceptability
Supply is able to meet demandClient has options
Community v. facility Wide variety of commodities
Trust and rapport with Nehnwaa StaffInvolvement of men in BCC programming
Limitations with Survey Data
All data is self-reportedUrban biasSample size less than 5% of beneficiary poolRecall biasInterviewer bias: beneficiary wanted to please
the interviewerFP indicator may be related to availability of
commodity
Conclusion: Benefits to Integration
Cost effective - utilizes existing staff and resources
Scaling up of comprehensive service provisionSynergy of effortsMeets demands for servicesPotential continuum of FP service provision by
current implementing partnerUtilizes a robust community mobilization &
intervention system
Conclusion: Challenges to Integration
Increased workload of all staff, particularly EPICombining FP & EPI data collection &
reporting tools LogisticsCommodity Stock-outs
Lessons Learned
FP integration into MNCH community outreach activities is feasible
FP/EPI integration reaches multiple types of beneficiaries
BCC messaging should apply to the spectrum of FP users
All CBPHC teams should modify the service provision setting to address confidentiality
Clarify return-to-clinic dates (particularly with EPI and FP service provision)
Looking Forward
Currently, post-funding, GUMH has scaled back their FP services to Facility service provision and minimal CBD by community volunteers and staff
GUMH continues to regularly receive commodities from MOH despite national restructuring of distribution
New agreement with Planned Parenthood Association of Liberia (PPAL) to provide community SRH services
Continued external support from private donors to fill gaps as needed
Questions?
For more information on
FP/EPI integration, visit:
http://www.k4health.org/toolkits/family-
planning-immunization-
integration
Thank you!