FEATURE

The RCOG’s Leading Safe Choices (LSC) programme was set up, thanks to an anonymous donor, to strengthen the competence

and raise the standing of family planning and abortion care professionals in South Africa and Tanzania.

One of the practical elements to come out of this programme is three Best Practice Papers (BPPs)– on postpartum family planning, abortion care and postabortion care. These are fully peer-reviewed and summarise evidence set out by the Faculty of Sexual and Reproductive Healthcare, the RCOG and the World Health Organization. The papers are

easy-to-use tools designed for frontline healthcare professionals of varying cadres, responsible for providing routine services, including in under-resourced settings.

As part of the LSC programme, RCOG worked remotely to adapt and endorse the BPPs in fi ve additional countries: Bangladesh, Kenya, Pakistan, Zimbabwe and Zambia.

In 2017, the RCOG put out a call for Best Practice Champions to lead the adaptation process. The chosen fi ve worked with local stakeholders to adapt the papers so that they were relevant and available to family planning and abortion care providers in their countries. Here, the fi ve champions tell us how they made it happen.

“To provide women with the best service, the adaptation of protocols and guidelines from other nations is imperative”

Sharing informationLocal champions in five countries have helped to adapt the RCOG’s Best Practice Papers to expand the reach of the Leading Safe Choices programme

Over 1,000 healthcare

professionals trained in

postpartum family planning

and postpartum family

planning counselling

PROGRAMME HIGHLIGHTS

10 O&G WINTER 2019 @rcobsgyn

BEST PRACTICE

Fawzia HossainProfessor of obstetrics and gynaecology, Bangabandhu Sheikh Mujib Medical University, Bangladesh

In my initial years after

becoming a doctor, my

approach to abortion

services was very

conservative. I used to

think the law should make

abortion a crime.

Though I knew the

procedure, I never

practised it. I referred

women to other clinicians

who performed abortion

services. But after

18 years, when I saw

adolescents and other

women die from unsafe

abortion, my values

transformed and clarifi ed.

I was treating women

with perforations, septic

induced abortions and

other life-threatening

complications. I decided

I wanted to be a part of

safe abortion services.

I wanted to become a

BPP champion because

women in my country are

neglected particularly

in the sector of abortion

services. To provide them

with the best service, the

exchange of knowledge

and adaptation of

protocols and guidelines

from other nations is

imperative. As a Member

of the RCOG, I felt it

would be my fi rst step to

opening a new horizon of

dissemination.

We involved the O&G

faculty of our country

and representatives from

the Directorate General

of Health services, the

Directorate General of

Family Planning Division,

as well as stakeholders

such as [the abortion and

contraception charity]

Ipas, the United Nations

Population Fund, WHO

and other NGOs. We held

several small meetings

and divided them into

groups for each paper.

The editing and upgrading

was done by myself

after the end of each

group work. It was later

sent to the RCOG for

approval. We also sent

the fi nal paper to North

Carolina University O&G

consultants who are

associated with Ipas, for

editing and upgrading.

Bangladesh has an

intricate, well established

health infrastructure so,

once the protocol and

training is developed,

it can be disseminated

easily. Adapting the BPPs

in our own country context

will be immensely helpful

for us, the healthcare

providers and our women.

PPFP & CPAC

BANGLADESH

KENYA

ZAMBIA

PAKISTAN

BANGLADESH

ZIMBABWE

RCOG Best Practice

Papers adapted and

endorsed as national

clinical guidelines

by respective

governments in

Bangladesh, Kenya,

Pakistan, Zambia and

Zimbabwe

PROGRAMME HIGHLIGHTS

rcog.org.uk WINTER 2019 O&G 11

JOB MWANZA

TSUNGAI CHIPATO

RUBINA HUSSAIN

JOHN NYAMU

FAWZIA HOSSAIN

12 O&G WINTER 2019 @rcobsgyn

FEATURE

Job Mwanza

John Nyamu

District health director (and doctor), Siavonga, Zambia

Director of the Reproductive and Maternal Health Consortium, Kenya

I got to know about RCOG

during my masters in public

health training at Cardiff

University in 2015-16. My

dissertation was on the use

of long-acting reversible

contraceptives to reduce

the high maternal mortality

rate in Sub-Saharan Africa.

I met the clinical lead of

Leading Safe Choices,

Professor Alison Fiander,

and she was interested in

my dissertation. Zambia

has a high maternal

mortality rate – 398 per

100,000 live births at that

time – and the aim of my

dissertation was ultimately

to help Zambia tackle this.

Professor Fiander indicated

to me the work she was

doing with the RCOG in

Tanzania and South Africa

and I expressed an interest

to champion similar work

in my country. I could see

the BPPs would be a great

opportunity for staff to get

useful information.

The adaptation process

began by identifying key

eligible stakeholders to

work with and review the

BPPs. Presentation to the

technical working group

on family planning under

the Ministry of Health was

also done as part of the

process. The group was

impressed with the work

and recommended to the

Permanent Secretary at

the Ministry of Health for

approval, who granted

it. We forwarded the

approved copy to the RCOG

editorial team for technical

advice and approval. After

three reviews, the BPPs

were ready for printing.

The process took close to

three months.

The content had to be

adapted to local conditions.

For example, the team

had to include the law on

abortion in Zambia and how

it was to be implemented. In

Zambia, mid-level providers

are only allowed to offer

safe termination up to the

fi rst trimester.

Personally and

professionally as a best

practice champion,

I have learnt how to

better collaborate with

other senior colleagues,

Ministry of Health and

partners (such as the

RCOG). I have become

a better communicator.

I have learnt how to

organise and conduct

a conference hosting

senior professionals.

Thank you to the team

at RCOG, the Ministry of

Health in Zambia and the

stakeholders who worked

tirelessly to ensure that we

produced quality, easy-to-

use BPPs for Zambia.

I knew that one of the arms of the

Leading Safe Choices programme

– the BPP on comprehensive

postabortion care – would interest

the Ministry of Health due to the high

number of unsafe abortions in public

health facilities. I approached the

director of medical services, who gave

the green light for the project, and

asked me to see the relevant offi cer

in the Family Health Division to start

the process. The Reproductive and

Maternal Health Consortium, of which

I am the director, was the coordinating

organisation for the project.

Our partners included the Ministry

of Health, ANMA-Kenya, Reproductive

Health Services, Ipas, Marie Stopes

and the Kenyan Obstetrics and

Gynaecological Society. The draft I

wrote was validated by stakeholders

and the Ministry of Health technical

working group. The process took

two years.

The document is now being used

to draft a national postabortion care

training manual, which will be used to

train healthcare providers in managing

unsafe and incomplete abortion

complications.

PPFP & CAC

CPAC

ZAMBIA

KENYA

rcog.org.uk WINTER 2019 O&G 13

BEST PRACTICE

Rubina Hussain

Tsungai Chipato

Professor of gynaecology and obstetrics and departmental chairperson at Ziauddin University and Hospitals, Pakistan

Lecturer in the department of obstetrics and gynaecology at the University of Zimbabwe

College of Health Sciences

I found out about this project from

the RCOG global team and website.

I discussed with people at the RCOG

and received a lot of encouragement

to carry on with it. I applied for this

work because our country has a

very high fertility rate and there is

a dire need for good contraceptive

practices over here. In Pakistan there

are a lot of myths associated with

family planning and new parents

often say no to any contraceptive

advice just after childbirth.

We engaged with the university

to carry out this work. We made

quite a few changes to the BPP.

For example, female condoms are

not available in Pakistan so we had

to remove any mention of those.

Due to the low literacy rate we

made posters in local languages.

This made it easier for the local

population to comprehend the

message behind our campaign.

This work with the posters was

piloted in one province of Sindh.

We are still following up. Due to our

work, there is increased awareness

and use of contraception in slum

areas of Sikandarabad.

The majority of the women in

our country, especially the less

educated ones, totally depend on

the decisions of their husbands.

They choose not to have a say

which can be very sad. We need to

empower our women – and work

like this could help.

We had already

updated our national

postabortion care

guidelines in 2014 –

but the RCOG’s family

planning BPP was

better presented than

ours, so I wanted to get

involved in adapting it

for our context.

The process took

about six months.

I had to convene

meetings with all

stakeholders, including

the Ministry of Health,

Zimbabwe Family

Planning Council,

colleagues from three

provinces and local

gynaecologists with

an interest in family

planning, and the

Schools of Nursing and

Midwifery. I and two

young gynaecologists

wrote the fi rst draft

and fi nal version.

The guidelines are

currently in the process

of being disseminated

alongside the national

family planning

guidelines, so it’s too

early to assess their

impact. But through

this process I’ve learnt

that it’s important to

consult all stakeholders

so they can assume

ownership.

PPFP

PPFP

PAKISTAN

ZIMBABWE

• Women going

home with a contraceptive

method of their choice

increased from 1% to

57% across 10 facilities in

Tanzania

• 20 termination of

pregnancy clinics

reopened in the Western

Cape

Leading Safe Choices Best Practice Papers can be downloaded at rcog.org.uk/bestpracticepapers

PROGRAMME HIGHLIGHTS

WINTER 2019

so they can assume

ownership.