Practical FP Integration_Parveen_5.12.11
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Transcript of Practical FP Integration_Parveen_5.12.11
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