May 12, 2011

Zambia Family Planning Integration Project: Integrating FP into MCHPrograms

Sadia D. Parveen

CORE Spring Meeting,

Baltimore, MD

Some Key RH Indicators in Zambia Indicator Statistic (data source)

HIV/AIDS prevalence: total 14.3

HIV/AIDS prevalence: age 15-24 7

Contraceptive Prevalence Rate (%) 41

Maternal mortality ratio (per 100,000 live births) 591

Percent of births with skilled attendance 43 b, d

Children born per woman (total fertility rate) 5.39 a, d – 5.5.c

Neonatal mortality [under 30 days] 34

Infant mortality [under age 1] (per 1,000 live births)

70

Under-5 mortality (per 1000 live births) 119

Child mortality (per 1000 live births) 52

Underweight children (%) 15

Children with moderate to severe stunting 45

Data Source: (a) CIA, 2007; (b) UNICEF 2007; (c) WHO, 2006; and (d) Zambia DHS, 2007

Background of Program Area

• Total catchment population – 75,000 • Rural communities, in the districts of Luangwa and Mumbwa • Public health centers not easily accessible and lack staff • Several cadres of community health workers (CHW) support the

public system• Adolescents and youth comprise 28% of the overall population,

and present a huge unmet need• Pregnancy prevalence among 15-19 year-olds: 189/1000• FP method mix dependent on short-term methods (pill, condom)• Strong religious influence on FP practice

Program Overview

Objectives – • Increase the range of FP-RH services at the household level

through community-based access to Injection DMPA

• Strengthen role of youth in community-based reproductive health information and awareness-raising

• Develop and test mechanisms to ensure sustainable community-based FP-RH programming

Goal: To increase voluntary and informed use of FP-RH services and also improve access and availability

Program Structure: Integration Framework

Inputs:Community: information and demand generationCBDs: educate & build capacityProviders: educate, build capacity & provide mngmt supportFacilities: ensure availability of equipment and logistics and appropriate physical infrastructureFunds: ensure financial resources for starting and maintaining high-quality service delivery

Processes:RH/FP information, education & communication for communities and providersCBD and provider training and skills enhancementSupervision & monitoring to improve & maintain service Referral systems to ensure continuum of care Follow-up for problem-solving and client satisfaction

Outputs:RH/FP integration, i.e.

↑ FP awareness↑ FP method acceptance ↑ service quality thru compliance to standard↑ program efficiency (sustained logistics and commodities supply) ↓ maternal morbidity ↓ maternal mortality

Service Delivery System

Support Systems in Place: Needs Assessment & Planning, Implementation & Management, M & E, Training, Logistics, Quality Assurance, Community Participation, Human Resource Management, Financial Resource Mobilization (e.g.

Involvement of Child Fund Alliance), Marketing & Communication, Development of ASPs, CSPs, PDDs

Environment: i. IO and RO support and participation, including The Board and Senior Leaders; ii. MOH and DHMT Coordination, Support and Liaisons

Program Structure: Integration Framework (cont’d)

Formulate policy and raise awareness and understanding of the linkage between child protection/poverty and FP

Foster better understanding of FP among non-program departments

Conduct marketing/promotion Support funds/resource generation Develop plan of action

Support policy formulation Establish dialogue Assessment capacity Coordinate training Provide technical support Assist in fund generation Develop plan of action

Increase understanding of the need for FP programming among health and non-health sectors

Identify needs Establish MOH stakeholder liaisons Build capacity and train staff Develop systems Support implementation

Build provider & CBO capacity and train staff

Conduct surveys Establish local MOH and stakeholder

liaisons Conduct supervision and monitoring Ensure documentation

Establish linkage between child poverty & FP in strategic planning

Participate actively in integration Identify non-health programs with

possibilities for FP integration Improved awareness Ensure increases demand for and

acceptance of RH/FP Foster male participation

International Office

Community

Regional Office

National Office

Project Office

Support/monitoring Request/report

Support/monitoring

Support/monitoring

Request/report

Request/report

Request/report Support/monitoring

Location Roles and Responsibilities

FP Integration Entry Points

• Organization level –

– Orient Board & Executive Team on impact of FP on children’s quality

of life

– Orient staff at HQ and Regional levels about FP and RH interventions

– Train staff on specific FP-RH interventions

– Develop communication, mobilization and documentation strategies

for the different levels

– Establish linkages with National and Regional FP-RH bodies, task

forces and working groups

FP Integration Entry Points

• Project level – – Orient key NO-SMT, especially Sponsorship personnel, on FP-RH

integration

– Build-in Supervision and M&E framework & indicators into existing systems

– Identify and train key personnel, on the technical aspects of the program, as well as communication, mobilization and documentation

FP Integration Entry Points (cont’d)

• Community level – – Orient and get buy-in from affiliate CBOs on FP-RH intervention and its

impact on the community and the quality of life of children

– Train Community Mobilizers in project activities related to data collection, monitoring, and identification of CBDs (from existing pool on CHWs)

– Establish and maintain liaisons with local MOH personnel, esp. DHMT

– Network with Neighborhood Committees and DHMT to support supervision and monitoring

– Inform, educate and mobilize beneficiary population to create demand

Services in which integration occurred

1. Integrating FP as part of routine TBA activities in the community

2. Training of vaccinators (community workers) on FP information

3. Training of Safe Motherhood Counselors as CBD

4. Training HIV/AIDS Counselors as CBD

5. Working with MOH to ensure continued supply of contraceptive logistics to the CBDs

6. Establishing linkage with public service delivery points to ensure effective response to referral

7. Orienting Neighborhood Committees and DHMT on supervision

Additional Information: Guatemala

Existing MNH Project:

Strategy focuses on high quality maternal and newborn health service delivery at the health facility and community levels. Therefore integrating FP increases the efficiency of the program, as it supports improved maternal and newborn health by helping women delay pregnancy.

Guatemala Scenario:• High maternal mortality - 149/100,000 live births• High TFR – 4.4• High unmet need for FP – 28%

Additional Information: Guatemala

Planned FP Integration Approach:• Community level

— Community-based distribution of contraceptives— Setting up functional supervision systems — Ensuring continuity in supply of contraceptive

commodities — Ensuring user safety and appropriate waste disposal

• Facility level— Training service providers— Ensuring contraceptive supply