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Uganda Protestant Medical Bureau
Expanding the FP Method Mix with
Fertility Awareness Methods (FAM)
30th CCIH Annual Confe...
www.upmb.co.ug Health in Totality
Content of Presentation
• Why this presentation?
• Who we are
• Brief Introduction
• Pro...
www.upmb.co.ug Health in Totality
Why this presentation?
• To give an update on the project as it winds up
• To work with ...
www.upmb.co.ug Health in Totality
Who we are
• Uganda Protestant Medical Bureau (UPMB) is a Christian
national umbrella or...
www.upmb.co.ug Health in Totality
Introduction: A3 Project
Uganda Protestant Medical Bureau (UPMB)
Institute for Reproduct...
www.upmb.co.ug Health in Totality
Project Goal & Objectives
GOAL:
Expanded access to and use
of family planning, including...
www.upmb.co.ug Health in Totality
What Are Fertility Awareness Methods (FAM)?
CHWs (VHTs) demonstrate how SDM, TwoDay Meth...
www.upmb.co.ug Health in Totality
Standard Days Method®
• Identifies days 8-19 of the cycle as fertile
• Is appropriate fo...
www.upmb.co.ug Health in Totality
• Track her cycle days
• Know when she is
fertile
• Monitor her cycle
length
• Communica...
www.upmb.co.ug Health in Totality
Did I note any
secretions
today?
Did I note any
secretions
yesterday?
YES
YES
NO
NO
I ca...
www.upmb.co.ug Health in Totality
Family planning method for
postpartum women who meet
the following criteria:
 Menstruat...
www.upmb.co.ug Health in Totality
Expanding the Method Mix
To ensure women and men have access to the full
range of FP met...
www.upmb.co.ug Health in Totality
Achievements since 2014
• 31 facility-based health
workers trained in family
planning
– ...
www.upmb.co.ug Health in Totality
Baseline Vs Project Implementation (FP uptake per method)
Methods Baseline (January –
De...
www.upmb.co.ug Health in Totality
Baseline Vs Project Implementation (FP uptake per method)
Methods Baseline (January –
De...
www.upmb.co.ug Health in Totality
Statistical Report (Jan 2014 – June 2015)
Facilities No. of people
reached
FP methods (C...
www.upmb.co.ug Health in Totality
0 1000 2000 3000 4000 5000 6000
Oral Contraceptives
Female condom
Male condom
SDM
LAM
Tw...
# people
sensitized by
VHTs & RLs
FP services offered by VHTs at
community level
Project
Quarters
Female Male SDM LAM TwoD...
www.upmb.co.ug Health in Totality
0 1000 2000 3000 4000 5000
Oral Contraceptive
Female condom
Male condom
SDM
LAM
TwoDay
I...
www.upmb.co.ug Health in Totality
Challenges & Solutions
Challenges Solutions
Delayed reporting & accountability of funds ...
www.upmb.co.ug Health in Totality
Challenges & Solutions
Challenges Solutions
Myths and misconceptions about FP, including...
www.upmb.co.ug Health in Totality
UPMB’S FP work with CCIH
Activity Dialogue meeting Trainings on HTSP Community sensitiza...
www.upmb.co.ug Health in Totality
Activity 1: Dialogue meeting
GOAL:
The participants will contribute to
advancing constru...
www.upmb.co.ug Health in Totality
Activity 1: Dialogue meeting
• 46 participants participated in the two days meeting.
• D...
www.upmb.co.ug Health in Totality
www.upmb.co.ug Health in Totality
Activity 2: Trainings on HTSP
GOAL:
Develop aptitudes of Religious leaders to
enable the...
www.upmb.co.ug Health in Totality
Achievements :Trainings on HTSP
• Two trainings were
conducted
• Interfaith leaders
part...
www.upmb.co.ug Health in Totality
Activity 3: Community sensitizations using religious
leaders
GOAL:
. Reduced unmet FP ne...
www.upmb.co.ug Health in Totality
Achievements: Community sensitizations with Faith
Leaders. (March –April 2016)
• 6 Proje...
www.upmb.co.ug Health in Totality
Pending activities :
• Budget approval from CCIH
for follow on activities.(May –
Sept 20...
www.upmb.co.ug Health in Totality
Considerations
• Update HMIS and FP registers to reflect SDM, LAM, and
TwoDay Method
• S...
www.upmb.co.ug Health in Totality
Acknowledgement
www.upmb.co.ug Health in Totality
THANK YOU
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Expanding FP Method Mix with FAM Tonny Tumwesigye

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At the 2016 CCIH Annual Conference, Dr. Tonny Tumwesigye of the Uganda Protestant Medical Bureau discusses how UPMB incorporated fertility awareness methods into its Family Planning services to expand options for families.

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Expanding FP Method Mix with FAM Tonny Tumwesigye

  1. 1. Uganda Protestant Medical Bureau Expanding the FP Method Mix with Fertility Awareness Methods (FAM) 30th CCIH Annual Conference 2016 Baltimore, Maryland 19TH June 2016 Dr. Tonny Tumwesigye EXECUTIVE DIRECTOR
  2. 2. www.upmb.co.ug Health in Totality Content of Presentation • Why this presentation? • Who we are • Brief Introduction • Project goal & objectives • What has been done • Results • Baseline Vs Current • Challenges • Briefs on Activities carried out under the CCIH grant
  3. 3. www.upmb.co.ug Health in Totality Why this presentation? • To give an update on the project as it winds up • To work with MoH & other partners to increase awareness of and access to FAM in Uganda • To seek support especially for sustainability (CycleBeads procurement, VHT training and facilitation) • To work with you to disseminate this information to all the relevant stakeholders • To get feedback on the project implementation
  4. 4. www.upmb.co.ug Health in Totality Who we are • Uganda Protestant Medical Bureau (UPMB) is a Christian national umbrella organization for Protestant, Adventist and Pentecostal Church founded member health facilities. • UPMB was founded in 1957 by a Government notice No. 672 • Currently supports 290 health facilities in Uganda affiliated to the Protestant Churches and 11 health training institutions (for nurses, midwives and laboratory cadres)
  5. 5. www.upmb.co.ug Health in Totality Introduction: A3 Project Uganda Protestant Medical Bureau (UPMB) Institute for Reproductive Health (IRH) at Georgetown University 1st January 2014 to 30th September 2015 8 sites across the UPMB network Partners Timeline Location ‐ Chrisco Hospital (Manafwa) ‐ Rugarama Hospital (Kabale) ‐ North Kigezi Health Centre IV (Rukungiri) ‐ Azur Health Centre (Hoima) ‐ Kagando Hospital (Kasese) ‐ St Paul Health Centre IV (Kasese) ‐ Rwesande Health Centre IV (Kasese) ‐ Kolonyi Hospital (Mbale)
  6. 6. www.upmb.co.ug Health in Totality Project Goal & Objectives GOAL: Expanded access to and use of family planning, including Fertility Awareness Methods (FAM), thus improving healthy timing and spacing of pregnancies Objectives: • Increase the availability of quality family planning services • Strengthen the capacity of health units to integrate simple Fertility Awareness Methods (FAM) methods into family planning services • Generate and disseminate knowledge and evidence-based tools for faith-based organizations working in family planning
  7. 7. www.upmb.co.ug Health in Totality What Are Fertility Awareness Methods (FAM)? CHWs (VHTs) demonstrate how SDM, TwoDay Method, and LAM are used during a quarterly support supervision visit to some of the implementing facilities in Kasese district. Standard Days Method with CycleBeads TwoDay Method Lactational Amenorrhea Method (LAM)
  8. 8. www.upmb.co.ug Health in Totality Standard Days Method® • Identifies days 8-19 of the cycle as fertile • Is appropriate for women with menstrual cycles between 26 and 32 days long • Helps a couple avoid unplanned pregnancy by knowing which days they should avoid unprotected sex • >95% effective with correct use; 88% effective with typical use • Used with CycleBeads® [Source: Arevalo M., V. Jennings and I. Sinai. 2002. "Efficacy of a new method of family planning: the Standard Days Method.“ Contraception: (65):333-338]
  9. 9. www.upmb.co.ug Health in Totality • Track her cycle days • Know when she is fertile • Monitor her cycle length • Communicate with her partner CycleBeads help a woman to:
  10. 10. www.upmb.co.ug Health in Totality Did I note any secretions today? Did I note any secretions yesterday? YES YES NO NO I can get pregnant today. I can get pregnant today. Pregnancy is not likely today. • Uses cervical secretions as the indicator of fertility • Women check everyday for the presence of secretions • If a woman notices any secretions today or yesterday, she considers herself fertile today and avoids unprotected sex today to prevent pregnancy • Can start using the TwoDay Method at any time, regardless of where she is in her menstrual cycle • >96% effective with correct use; 86% with typical use [Source: “Efficacy of a new method of family planning: the TwoDay Method” Fertility and Sterility, 2004] TwoDay Method®
  11. 11. www.upmb.co.ug Health in Totality Family planning method for postpartum women who meet the following criteria:  Menstruation has not returned  Mother is only breastfeeding  Baby is less than 6 months Lactational Amenorrhea Method LAM is >98% effective as a temporary method of family planning.
  12. 12. www.upmb.co.ug Health in Totality Expanding the Method Mix To ensure women and men have access to the full range of FP methods, FAMs were added to the basket of options which UPMB was already providing (e.g. pills, injectable, IUD, etc.)
  13. 13. www.upmb.co.ug Health in Totality Achievements since 2014 • 31 facility-based health workers trained in family planning – Refresher on all FP methods, introduction to FAM • 117 VHTs trained in family planning – Offering pills, condoms, SDM, TwoDay, LAM; refer clients to facility for all other methods • 80 religious leaders participated in sensitization workshops on family planning • Over 5000 awareness raising events conducted by VHTs and religious leaders • Over 50 radio spot messages on FP • Zero stock-outs of FP commodities, including CycleBeads
  14. 14. www.upmb.co.ug Health in Totality Baseline Vs Project Implementation (FP uptake per method) Methods Baseline (January – December 2013) Project Implementation (Jan 2014 – June 2015) Injectable 1,446 1,961 IUDs 269 586 Natural 42 SDM – 3,445 LAM – 1,635 TDM - 376 Total 42 5,456
  15. 15. www.upmb.co.ug Health in Totality Baseline Vs Project Implementation (FP uptake per method) Methods Baseline (January – December 2013) Project Implementation (Jan 2014 – June 2015) Condoms 2,695 82,880 Pills 580 1,919 Implants 1,270 951 Permanent 146 38
  16. 16. www.upmb.co.ug Health in Totality Statistical Report (Jan 2014 – June 2015) Facilities No. of people reached FP methods (CHWs & Facility) Female Male SDM LAM TDM Injectable Condoms Kagando 7939 3827 506 101 28 1135 23563 Rwesande 9199 3984 270 171 53 247 7119 St Paul’s 6884 3287 1008 760 270 72 5709 TOTAL 24022 11098 1784 1032 351 1454 36391
  17. 17. www.upmb.co.ug Health in Totality 0 1000 2000 3000 4000 5000 6000 Oral Contraceptives Female condom Male condom SDM LAM TwoDay Method Injectable IUD Implant Tubal Ligation Vasectomy TOTAL Comparison of FP uptake at baseline vs. Year 1 2014 2013
  18. 18. # people sensitized by VHTs & RLs FP services offered by VHTs at community level Project Quarters Female Male SDM LAM TwoDay Method Condom Pills Referrals Quarter 1 (project start up) 0 0 0 0 0 0 0 0 Quarter 2 1766 1092 266 167 79 1277 322 62 Quarter 3 14172 5777 1109 409 74 22580 647 502 Quarter 4 11116 6312 676 520 89 23102 129 205 Quarter 5 19694 6227 923 316 90 29384 550 198 Quarter 6 7488 3124 471 223 44 6537 271 194 TOTAL 54236 22532 3445 1635 376 82880 1919 1161
  19. 19. www.upmb.co.ug Health in Totality 0 1000 2000 3000 4000 5000 Oral Contraceptive Female condom Male condom SDM LAM TwoDay Injectable IUD Implant Tubal Ligation Vasectomy Total Facility uptake v. Community uptake in 2014 CHW Facility
  20. 20. www.upmb.co.ug Health in Totality Challenges & Solutions Challenges Solutions Delayed reporting & accountability of funds from the facilities Close monitoring by UPMB central level Lack of male involvement (leading to clandestine FP use, difficulty negotiating condom use and some FAM) Targeted sensitization conducted with men by VHTs, nurses, and religious leaders VHTs are not volunteers but need motivation to do their work Offering small stipends to turn in monthly reports and attend supervision meetings
  21. 21. www.upmb.co.ug Health in Totality Challenges & Solutions Challenges Solutions Myths and misconceptions about FP, including new FAM options Conducting sensitization through VHTs, religious leaders, and radio Weak commodities supply chain – particularly with CycleBeads which are not yet available in the national pharmacy UPMB intervened at central level to ensure sufficient supply of commodities for facilities AND community level, IRH donated CycleBeads for project sites Reporting and integration of data into HMIS particularly for FAM options MoH to integrate data on FAM into HMIS including the FP register at facilities.
  22. 22. www.upmb.co.ug Health in Totality UPMB’S FP work with CCIH Activity Dialogue meeting Trainings on HTSP Community sensitizations by Religious leaders Dates May 2015 October 2015&November 2015 Jan-March 2016 Target/ Coverage Selected Faith leaders(all denominations) Faith leaders who participated in the dialogue meeting 4 UPMB facilities 2 UMMB facilities
  23. 23. www.upmb.co.ug Health in Totality Activity 1: Dialogue meeting GOAL: The participants will contribute to advancing constructive dialogue about family planning within faith communities and/or organizations. Objectives: • Raise awareness of the health challenges facing women and families in Uganda and discuss how faith communities can address them. • Explore the role of faith leaders and their communities in promoting healthy families • Identify opportunities for a continued dialogue and the interest of faith leaders in addressing these challenges
  24. 24. www.upmb.co.ug Health in Totality Activity 1: Dialogue meeting • 46 participants participated in the two days meeting. • Dialogue meeting held in May 10th-11th 2015. • Participants signed commitments to promote HTSP/FP
  25. 25. www.upmb.co.ug Health in Totality
  26. 26. www.upmb.co.ug Health in Totality Activity 2: Trainings on HTSP GOAL: Develop aptitudes of Religious leaders to enable them promote healthy Timing and spacing of pregnancies and FP Services so as to maximize availability, accessibility of FP services at communities. . Objectives: • Explain key HTSP messages and understand their links to family planning • Identify and clarify rumours about contraception • Identify the family planning methods available in the local context and where to receive them • Support couples to improve communication and shared decision- making
  27. 27. www.upmb.co.ug Health in Totality Achievements :Trainings on HTSP • Two trainings were conducted • Interfaith leaders participated • 39 interfaith leaders were trained on HTSP. • Participants drafted their post training tasks R promoting HTSP..
  28. 28. www.upmb.co.ug Health in Totality Activity 3: Community sensitizations using religious leaders GOAL: . Reduced unmet FP needs and improved maternal and child health outcomes in the catchment area of the program implementation Objectives: • The capacity of faith-based health networks and workers is strengthened to provide high quality, sustainable FP information, counseling and services. • The capacity of religious leaders and other community stakeholders is built and strengthened to increase demand for FP
  29. 29. www.upmb.co.ug Health in Totality Achievements: Community sensitizations with Faith Leaders. (March –April 2016) • 6 Project sites identified, assessment done ( 4-UPMB & 2 UMMB) • Baseline data collected and report compiled. • Project Reporting tools reviewed and finalized and shared with facilities. • Debriefs with UMMB and Mityana diocese held with CCIH’s Mona. • UPMB held planning meeting with CCIH’s Mona. • Activity list (work plan)drafted (May-Sept 2015) • Budget drafted and submitted for approval .
  30. 30. www.upmb.co.ug Health in Totality Pending activities : • Budget approval from CCIH for follow on activities.(May – Sept 2016) • To conduct trainings for other community based providers such as VHTs & Faith leaders • Create, translate and disseminate simple IEC materials with factual messages on FP • Community outreaches by VHTS • Community sensitizations by Religious leaders • Reporting on activities carried .
  31. 31. www.upmb.co.ug Health in Totality Considerations • Update HMIS and FP registers to reflect SDM, LAM, and TwoDay Method • Strengthen training for health workers in permanent methods • Procure Cycle Beads alongside other family planning commodities • Develop an FP curriculum and service protocols for VHTs allowing them to offer a wide range of FP methods to clients • Involve religious leaders in FP/HTSP sensitization and encourage their participation as champions • Improve male involvement in FP programs
  32. 32. www.upmb.co.ug Health in Totality Acknowledgement
  33. 33. www.upmb.co.ug Health in Totality THANK YOU

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