This session looks at increasing access to quality FP services. This presentation is addressing transitions in FP programs that can and should occur in post-conflict settings. And we’ll be looking at such transitions using a HSS framework.
As we all know was have many consequences. And one of these is the destruction or new destruction of health delivery systems. The slide shows what, in many places, is the starting point for system rebuilding.But this also creates an important starting point for HSS inititatives. And using systemic approaches to technical assitance that organizations such as IRH offer in post-conflict settings.
And FP is still an overlook priority health response – for reasons on the slide.
FP services are important to add in post conflict service delivery for the reasons noted on the slide. This presentation is going to focus on that last bullet – how adding FP program elements in a way that specifically addresses HSS at the same time, is a good TA approach.
What are the current gaps? Slide shows findings of two studies …IAWG global evaluation Purpose:Identify gaps and constraints in RH programs/servicesto better target resources and interventions. Challenge is moving from methods to programs during emergency transitions. In there in theory, but the evaluation indicated it is not consistently happening.Recent 2011 priority research agenda for RH in crisis held at CDC this summary identified 28 major research themes, with FP representing 7/28 researhc questions. And of these severn, most indicated a systems-strengthening focus.Need for services to address and prevent unintended pregnancies and their sequelae in emergency situationsApplicability /feasibility of community-based family planning services in humanitarian settings – to improve access to and use of contraceptivesWhat is the availability of FP methods? Level of skills and abilities of service providers?Extent humanitarian programs meet the FP needs of crisis-affected adolescents and young adultsStrengths and limitations of FP services in conflict-affected countries - budgets, logistics, training, innovative approaches for reaching populations in crisis?
Let me shift now to talk about our experiences in post-conflict settings to address issues and support transitional program and health systems shifts.Introduction of SDM is just beginning and currently have only worked/are only working in 3 post-conflict countries (DRC, Burundi, Timor Leste).We see many advantages to adding SDM to existing programs from systems and users’ perspectives.
And I imagine you have already seen these HSS building blocks of WHO, so let me also place FP efforts within a context of WHO’s HSS building blocks.Good health services are those which deliver effective, safe, qualitypersonal and non-personal health interventions to those that needthem, when and where needed, with minimum waste of resources.• A well-performing health workforce is one that works in ways thatare responsive, fair and efficient to achieve the best health outcomespossible, given available resources and circumstances (i.e. there aresufficient staff, fairly distributed; they are competent, responsive andproductive).• A well-functioning health information system is one that ensuresthe production, analysis, dissemination and use of reliable and timelyinformation on health determinants, health system performance andhealth status.• A well-functioning health system ensures equitable access to essentialmedical products, vaccines and technologies of assured quality,safety, efficacy and cost-effectiveness, and their scientifically sound andcost-effective use.• A good health financing system raises adequate funds for health, inways that ensure people can use needed services, and are protectedfrom financial catastrophe or impoverishment associated with havingto pay for them. It provides incentives for providers and users to beefficient.• Leadership and governance involves ensuring strategic policyframeworks exist and are combined with effective oversight, coalitionbuilding,regulation, attention to system-design and accountability
Pulling these different ideas into one schema, this is how I would like to talk about how FP TA if done strategically can increase access to quality FP services and aid transitions from services to programs, while strengthening HS.
Two brief case studies – One focusing on FP access and HSS while revitailizing FP services in Burundi,The other focusing on scaling up a new method, as the FP itself is going to scale in DRC
Hidden slide with numbers/context.
OPPPORTUNITY – Peace accords signed in 2001 but violence continued another 8 years. OPPORTUNITY to engage in FP program improvement/strengthening at a time was the GO B is revitalizing FP programs. Adding a new method to existing mixFHI and IRH supported introduction – testing interest in providers and users during a pilot introductionCurrently expanding district wide and working to integrate SDM into norms and standards.
HSS building blocks on left.Yes, we helped add a new method to service mix. To expand FP options.From an HSS perspective, though, How is this happening.WHO/ExpandNet framework for systems-oriented scale up – beginning with the end in mind. SO addressed bottom building blocks through end of pilot meeeting to take a systems oriented approach to planning for expansion and institutionalization.
The DRC case study show how scaling up is HSS and a much complex process than introduction on small scale. Over a multi-year period.Accompanying the MOH as is re-establishes and scale up its FP program.Scaling up requires multiple actors to take something to scale – you lose control you had in pilot efforts. And there is not functioning HIS in DRC, and DRC is now a federalized system of government with some normative authority at provincial level.So need to check on quality of scale up and its effect using project data/ secondary data sources. But it looks good.
HSSstrenthening efforts are critical for scale up.
So to conclude,Need for innovation in HSS . Interacting circles at top left show that FP program transitions and orgs that support that transition have important roles to play.Well strategized FP TA can and should contribute to rebuilding HSs.
Family Planning Systems Strengthening: Expanding Access in Recently Post-conflict Settings in the Great Lakes Region of Africa
Family Planning Systems Strengthening: Expanding Access inRecently Post-conflict Settings in the Great Lakes Region of Africa Susan Igras, Marie Mukabatsinda, Arsene Binanga Institute for Reproductive Health Georgetown University Dakar, Senegal, November 2011 EXPANDING FAMILY PLANNING OPTIONS
Challenges Facing Health Systems in Conflict and Post Conflict-affected Settings• Infrastructure• Lack of equity in the provisionof health services•Lack of appropriate policyenvironment• Limited management capacity• Weak availability and distribution of Photo CICRcommodities•Difficulties in financing health programs andreallocation of funds• Overall insecurity
Family Planning- an Overlooked Priority Resources allocated to urgent priorities Security Reconstruction Water/sanitation General health Shelter CICR Photo CICR Focus is on saving lives with limited resources given to FP services and products Resulting insecurity in FP personnel, goods, and services
Importance of FP in Conflict- affected Environments• Offering family planning saveslives• Women can gain autonomyin the context of disrupted lives• Introduction/scaling up offamily planning provides anopportunity for systemsstrengthening duringtransitions from emergency to CICRmore stable conditions
Gaps in Family Planning ServicesResults from IAWG global evaluation of RHservices in conflict/post-conflict settings (2004)• FP methods were available - Nearly all visited sites reported offering at least one FP method, most common were OCs, condoms, injectables• But notable FP service and program gaps – • Transition planning from emergency to comprehensive FP services • Limited efforts to improve access to and quality of FP services2011 priority research agenda for FP calls for asystems-strengthening focus
FP for Transitional Service Settings Since 2002, Standard Days Method (SDM) has been integrated into programs in more than 30 countries, including 2 recently post-conflict countries in Africa For recovering health systems: Easily expands modern FP options. Effective. Low skilled providers can offer. Easy to access. Inexpensive. One-time- distribution commodity. For women: No resupply. No provider absence & stock-out worries. Limits health center visits during insecure periods. Source: RHInterchange
Introducing a New FP MethodStrengthens Recovering Health Systems Systems strengthening (focus on building blocks) Moving from Adding a new FP methods & different to FP method option programs
Introducing and Scaling up FAM in Recently Post-conflict Environments Case studies of Burundi and the DRC Systems strengthening (focus on building blocks) Moving from Adding a new FP methods & different to FP method option programs
Case Study Burundi – 2009/2010Introducing a new FP method, building evidence, and positioning for expansion• Context: Peace accords in 2001. MOH starting to focus more on FP, eg, norms being updated.• SDM pilot with MOH and FHI360 – 6 months delivery in 4 sites - indicated significant interest: 3.3% contribution to new-user method mix• Clients and providers liked the new method 96.4% of interviewed users were happy with SDM Easy to use/ Does not demand multiple center visits / No secondary effects / Learn about how body/cycle works / Increases couple understanding / Couple manages fertile days as they wish
How Introduction Process Strengthens Health System - BurundiQualityservices Training district trainers and center providers in offering and integrating SDM into FP servicesPerforming workforce FP counseling skills refresher/ reminderFunctioning FP /HIS Allow mixed MOH and FBO services to offer FP servicesEquitablemethod access Strong stakeholder participation from the beginningAdequate health At end of pilot period, systems-oriented reflection onfinancing expansion – planning integration into HIS, trainingStrong curriculum, procurement and supply chainleadership &governance
Case Study DR Congo 2006/2011 Accompanying MOH and partners to take FP/SDM services to scale• Opportunity: Strong GoDRC support for FP for national development, post 2003 Peace Accords • MOH re-establishing FP services as Health Zones are being rebuilt (255 of 315 HZ by 2012)• Strong political support for scale up• In absence of centralized FP data, evidence from project surveys: • 2007 GTZ/MOH CBD pilot evaluation in Bandundu Province showed SDM contributing 33% to new-user method mix. • ASD/MOH/IRH multi-site study showed SDM contributed 1,772 CYPs followed by Implants (1,512 CYPs) and Depo (1,314 CYPs) and was offered with quality
How Scale up Process StrengthensHealth Systems - DRCQuality As one set of partners builds training and serviceservices capacity, move to a new set for quality service expansionPerforming workforce Resource realities: Project-by-project TA Donor / resource equity over timeFunctioning FP /HIS Systematically coordinating with MOHEquitable Strong stakeholder engagement in FP/SDM introductionmethod access In-country IRH staff advocates and provides support toAdequate health MOH which guides expansionfinancing -TA to FP partners during expansion, -Revising HMIS / FP province by province,Strong -Supporting pre-service FP nursing curriculaleadership & revision,governance -TA for procurement planning and ordering
Systems strengthening (focus on building blocks) Need for Innovation inMoving fromFP methods Adding a new & different Systems Strengthening to FP programs method option Respond to post-conflict challenges through the introduction of an easy-to-use & easy-to-offer FP method Introducing a new method with health systems strengthening in mind addresses gaps in transition from emergency to stable system contexts Experience with SDM suggests it is appropriate for recently post-conflict settings, offers some unique advantages, and – when introduced strategically – can contribute to strengthening health systems in transition.