VIEWS: 0 PAGES: 22 POSTED ON: 2/26/2012
Community-based Distribution of Injectable Contraception Flexible Fund Partners Meeting "Tools and Approaches for Successful Community-based Family Planning Programs" Friday, June 20th, 2008 Outline Descriptionof the innovation Where this innovation is in use Data from FHI’s studies What should be in place before introduction Challenges to introduction How NGOs can implement the strategy Resources for implementation and advocacy What is community-based distribution of injectables? Where is the innovation being used? • 1970s: Bangladesh • 1990s: Latin America • Guatemala • Bolivia • Mexico • Peru • 2000s: Nepal • 2005: Uganda • 2006: Madagascar Uganda Study to Assess the Safety and Feasibility of CBD of injectables 2004-5 study to compare two groups of new clients • CBD clients (n=449) • Clinic clients (n=328) The study assessed: • Continuation • Satisfaction • Knowledge of side effects • Problems Uganda Uganda Study Results Clients who received a 2nd Injection (6 mo. continuation) 100% 96% 88% 85% 80% 60% 40% 20% 0% Pilot CBD Pilot Clinic Scale-up CBD n=415 n=242 n=169 Uganda Study Results Satisfaction with Care (“satisfied” or “very satisfied”) 100% 80% 60% 40% 20% 95% 93% 98% 0% Pilot CBD Pilot Clinic Scale-up CBD n=449 n=328 n=188 Uganda Study Results Injection Site Problems Infections / 0.0% Abscesses 0.0% Very painful 0.7% injection 0.0% Clinic Clients CRHW Clients Temporary 0.7% numbness 0.3% 0% 20% 40% 60% 80% 100% Uganda Study Results Client Knowledge of Common Side Effects Irregular bleeding Heavy bleeding Spotting Pilot CBD Clients Amenorrhea Pilot Clinic Clients Scale-up CBD Clients Headache Weight gain 0% 20% 40% 60% 80% 100% Madagascar Study 61 CBD workers from 13 communes Collaboration of 3 NGOs supported by SanteNet The study assessed: • Quality of services • Effect on uptake of FP • The system’s ability to support the innovation • Acceptability Madagascar Study Results High levels of competency were demonstrated Increased uptake of FP in communities Management systems sustained the innovation Overall the innovation was acceptable Madagascar Study Results Contraceptive History of DMPA Acceptors (n=303) N ew to F P Ever 28% Us e d DM P A 47% N ew to DM P A 25% Madagascar Study Results Clients' Reports of Service Quality (n=303) % CBD worker asked if menstruating 93 Satisfied with injection technique 100 Received injection on buttock 99 No problem with injection site 97 CBD worker friendly 97 Trust CBD worker with privacy 96 Client was counseled on side effects 70 Client correctly recalled duration of 88 pregnancy protection Madagascar Study Results Clients’ Reports on Satisfaction (n=303) Satisfied with DMPA method No morbidity at injection site Plan to receive re-injection from CBD worker Would recommend to friends 0 20 40 60 80 100 % of clients Where is there demand for the innovation? Kenya Nigeria Rwanda Zambia Ethiopia, Mali, Malawi, Senegal and Ecuador What should be in place? Government support is essential An active, strong CBD program Existing demand for DMPA State-of–the art service guidelines Effective commodity logistics system Challenges to introduction Sustainability of supplies Ongoing monitoring and evaluation Supportive supervision Health establishment National regulations Improving counseling NGO Implementation There is guidance for implementers All contexts are unique and will need individualized planning FHI and partners can provide TA in advocacy and implementation FHI’s Technical Assistance Varies widely depending on the context, needs of partners, and resources. • South-to-south learning exchanges • In-country advocacy strategies • Coordination of a stakeholder input • Training of trainers • M&E and supervision systems Resources and Tools Advocacy strategy and briefs The Implementation Handbook DMPA Screening Checklists Key Factors for Replication Checklist Rapid assessment of CBD program Training tools Available at: http://www.fhi.org/en/Topics/CBD+of+DMPA.htm CBD of DMPA Cartoon Manual Thank You!
"Emergency Contraceptive Pills ECPs Knowledge for Health"