Practical FP Integration_Parveen_5.12.11


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Practical FP Integration_Parveen_5.12.11

  1. 1. May 12, 2011 Zambia Family Planning Integration Project: Integrating FP into MCH Programs Sadia D. Parveen CORE Spring Meeting, Baltimore, MD
  2. 2. Some Key RH Indicators in Zambia Data Source: (a) CIA, 2007; (b) UNICEF 2007; (c) WHO, 2006; and (d) Zambia DHS, 2007 45 Children with moderate to severe stunting 15 Underweight children (%) 52 Child mortality (per 1000 live births) 119 Under-5 mortality (per 1000 live births) 70 Infant mortality [under age 1] (per 1,000 live births) 34 Neonatal mortality [under 30 days] 5.39 a, d – 5.5. c Children born per woman (total fertility rate) 43 b, d Percent of births with skilled attendance 591 Maternal mortality ratio (per 100,000 live births) 41 Contraceptive Prevalence Rate (%) 7 HIV/AIDS prevalence: age 15-24 14.3 HIV/AIDS prevalence: total Statistic (data source) Indicator
  3. 3. Background of Program Area <ul><li>Total catchment population – 75,000 </li></ul><ul><li>Rural communities, in the districts of Luangwa and Mumbwa </li></ul><ul><li>Public health centers not easily accessible and lack staff </li></ul><ul><li>Several cadres of community health workers (CHW) support the public system </li></ul><ul><li>Adolescents and youth comprise 28% of the overall population, and present a huge unmet need </li></ul><ul><li>Pregnancy prevalence among 15-19 year-olds: 189/1000 </li></ul><ul><li>FP method mix dependent on short-term methods (pill, condom) </li></ul><ul><li>Strong religious influence on FP practice </li></ul>
  4. 4. Program Overview <ul><li>Objectives – </li></ul><ul><li>Increase the range of FP-RH services at the household level through community-based access to Injection DMPA </li></ul><ul><li>Strengthen role of youth in community-based reproductive health information and awareness-raising </li></ul><ul><li>Develop and test mechanisms to ensure sustainable community-based FP-RH programming </li></ul>Goal: To increase voluntary and informed use of FP-RH services and also improve access and availability
  5. 5. Program Structure: Integration Framework <ul><li>Inputs: </li></ul><ul><ul><li>Community: information and demand generation </li></ul></ul><ul><ul><li>CBDs: educate & build capacity </li></ul></ul><ul><ul><li>Providers: educate, build capacity & provide mngmt support </li></ul></ul><ul><ul><li>Facilities: ensure availability of equipment and logistics and appropriate physical infrastructure </li></ul></ul><ul><ul><li>Funds: ensure financial resources for starting and maintaining high-quality service delivery </li></ul></ul><ul><li>Processes: </li></ul><ul><ul><li>RH/FP information, education & communication for communities and providers </li></ul></ul><ul><ul><li>CBD and provider training and skills enhancement </li></ul></ul><ul><ul><li>Supervision & monitoring to improve & maintain service </li></ul></ul><ul><ul><li>Referral systems to ensure continuum of care </li></ul></ul><ul><ul><li>Follow-up for problem-solving and client satisfaction </li></ul></ul><ul><li>Outputs: </li></ul><ul><li>RH/FP integration, i.e. </li></ul><ul><ul><li>↑ FP awareness </li></ul></ul><ul><ul><li>↑ FP method acceptance </li></ul></ul><ul><ul><li>↑ service quality thru compliance to standard </li></ul></ul><ul><ul><li>↑ program efficiency (sustained logistics and commodities supply) </li></ul></ul><ul><ul><li>↓ maternal morbidity </li></ul></ul><ul><ul><li>↓ maternal mortality </li></ul></ul>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
  6. 6. Program Structure: Integration Framework (cont’d)
  7. 7. FP Integration Entry Points <ul><li>Organization level – </li></ul><ul><ul><li>Orient Board & Executive Team on impact of FP on children’s quality of life </li></ul></ul><ul><ul><li>Orient staff at HQ and Regional levels about FP and RH interventions </li></ul></ul><ul><ul><li>Train staff on specific FP-RH interventions </li></ul></ul><ul><ul><li>Develop communication, mobilization and documentation strategies for the different levels </li></ul></ul><ul><ul><li>Establish linkages with National and Regional FP-RH bodies, task forces and working groups </li></ul></ul>
  8. 8. FP Integration Entry Points <ul><li>Project level – </li></ul><ul><ul><li>Orient key NO-SMT, especially Sponsorship personnel, on FP-RH integration </li></ul></ul><ul><ul><li>Build-in Supervision and M&E framework & indicators into existing systems </li></ul></ul><ul><ul><li>Identify and train key personnel, on the technical aspects of the program, as well as communication, mobilization and documentation </li></ul></ul>
  9. 9. FP Integration Entry Points (cont’d) <ul><li>Community level – </li></ul><ul><ul><li>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 </li></ul></ul><ul><ul><li>Train Community Mobilizers in project activities related to data collection, monitoring, and identification of CBDs (from existing pool on CHWs) </li></ul></ul><ul><ul><li>Establish and maintain liaisons with local MOH personnel, esp. DHMT </li></ul></ul><ul><ul><li>Network with Neighborhood Committees and DHMT to support supervision and monitoring </li></ul></ul><ul><ul><li>Inform, educate and mobilize beneficiary population to create demand </li></ul></ul>
  10. 10. Services in which integration occurred <ul><li>Integrating FP as part of routine TBA activities in the community </li></ul><ul><li>Training of vaccinators (community workers) on FP information </li></ul><ul><li>Training of Safe Motherhood Counselors as CBD </li></ul><ul><li>Training HIV/AIDS Counselors as CBD </li></ul><ul><li>Working with MOH to ensure continued supply of contraceptive logistics to the CBDs </li></ul><ul><li>Establishing linkage with public service delivery points to ensure effective response to referral </li></ul><ul><li>Orienting Neighborhood Committees and DHMT on supervision </li></ul>
  11. 11. 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. <ul><li>Guatemala Scenario: </li></ul><ul><li>High maternal mortality - 149/100,000 live births </li></ul><ul><li>High TFR – 4.4 </li></ul><ul><li>High unmet need for FP – 28% </li></ul>
  12. 12. Additional Information: Guatemala <ul><li>Planned FP Integration Approach: </li></ul><ul><li>Community level </li></ul><ul><ul><li>Community-based distribution of contraceptives </li></ul></ul><ul><ul><li>Setting up functional supervision systems </li></ul></ul><ul><ul><li>Ensuring continuity in supply of contraceptive commodities </li></ul></ul><ul><ul><li>Ensuring user safety and appropriate waste disposal </li></ul></ul><ul><li>Facility level </li></ul><ul><ul><li>Training service providers </li></ul></ul><ul><ul><li>Ensuring contraceptive supply </li></ul></ul>
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