Ministry of Health, Ministry of Information/SIS IEC Center, & USAID/EGYPT
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1 Effects of an Integrated Family Health Program International Conference on Family Planning: Research & Best Practices Ministry of Health, Ministry of Information/SIS IEC Center, Johns Hopkins University/ HCP & USAID/EGYPT
2 Outline of Presentation 1. Goals 2. Life Cycle Strategy t 3. Communication Interventions 4. Results: National and Community 5. Conclusions
3 COMMUNICATION FOR HEALTHY LIVING (CHL) Goals Improve health in the areas of: Family Planning/ RH Maternal and Child Health Infectious Disease (AI, Viral-Hep., Inf.Control) Other: Breast Cancer, FGC, Anti-smoking, diet, etc. Increase sustainability of Health Communication Increase sustainability of Health Communication programs in the public, private and NGO sectors
4 Life-stage Approach Young Married Older Men, Women Birth spacing, Safe Motherhood Nutrition Nutrition STIs High fertility Healthy Lifestyles Unmarried Youth (15-24) Nutrition/Performance Smoking cessation Healthy Lifestyles HIV/AIDS HOUSEHOLD AS PRODUCER OF HEALTH School Age (6-14) Nutrition FGC Healthy Lifestyles Early Childhood (<6yrs) 14 Immunization yrs status 49 Nutrition yrs ARI, CDD
5 Young Family Cohort Post-partum & FP Initiation FP & Birth Spacing Medically- assisted Delivery Reproductive Life Cycle Antenatal Care Newlywed
6 STRATEGY: MABROUK CONGRATULATIONS INITIATIVE Situation: Youth population size (> 40% of the population) Almost 800,000 marriages; 1,700,000 deliveries per year in Egypt Key entry point for FP/MCH messages Healthy beginnings yield long-term healthy practices Positive repositioning of family planning, family health Audience: Young couples and families (<30yrs) Communication Objectives: Improve Newlywed, ANC, Delivery, PP, and Family Planning Initiation & Spacing Practices
7 National Program Partners & Delivery Systems Ministry of Information Mass media plus 64 LICs Ministry of Health & Population 5000 PHCs 17,000 MOH Raedat Riffayet Private Sector ~30,000 Private Pharmacies Private Hospitals Media & Workplace partners NGOs/CDAs Save the Children as a main Partner ~ 150 NGOs/CDAs (CHL, Takamol) Caritas, CEOSS, and Red Crescent, Scouts
8 Communication Highlights TV / Radio/ Press Signature Message, Your Health is Your Wealth TV Spots air at avg. 66% Reach (FY 08) TV radio programs, edutainment Press popular magazines/news National Outreach Community Health Educators Publicity Events, Celebrities, theatre Workshops for media, religious and community leaders P&G Hospital program (10% deliveries) Service Support Pre-marital, Postpartum Protocols Counseling Materials
9 National Set of Materials Produced by SIS & MOH Message Consistency National Distribution system Consumer & Provider Materials
10 Results: Sources of data EDHS 2000, 2005, 2008 (national, sub-national comparisons) Egypt Health Communication Survey (EHCS) 2005, 2006, 2008 (national) Sales & Monitoring PARC, IMS, Sales, Omnibus Surveys (national) Village Health Survey (VHS) 2004, 2005, 2008 (intervention areas) Focal village M&E 2004 onward (intervention ention areas)
11 National Level Indicators
12 MORE WOMEN ARE HAVING 4+ ANTENATAL VISITS Perce entage Percentage of women in Young Family Cohort By number of ANC visits for most recent birth, Among married women <30 years old with a birth in last 5 years (n=4,196) 2000 (n=4,234) 2005 (n=5,480) 2008 (n=4,619) Sources: EDHS 1995, 2000, 2005, 2008 None
13 MORE WOMEN ARE HAVING MEDICALLY ASSISTED DELIVERIES Percent tage Percentage of women in Young Family Cohorts By type of delivery assistance at most recent birth Among married women <30 years old with a birth in last 5 years (n=4,200) 2000 (n=4,235) 2005 (n=5,456 ) 2008 (n=4,617 ) Doctor Trained nurse/midwife Daya Relative/other No one Sources: EDHS 1995, 2000, 2005, 2008
14 MORE WOMEN IN YOUNG FAMILIES ARE INITIATING FP AFTER BIRTH OF FIRST CHILD Sources: EDHS 1995, 2000, 2005, 2008
15 Timing of Use after Delivery (Among Users) Source:EDHS 1995, 2000, 2005, 2008
16 Trend: INCREASE IN EVER USE YOUNG FAMILY COHORT WITH BIRTH IN PAST 5 YEARS Source:EDHS 1995, 2000, 2008
17 MORE WOMEN HAVING BIRTH INTERVALS OF 33 months or more (Young Family Cohort) Percen ntage Percentage of women in Young Family Cohorts by birth interval for most recent two births Among married women <30 years old with a birth in last 5 years (n=3,052) 2000 (n=2,898) 2005 (n=3,649) 2008 (n=3,033) <24 months months 33+ months Sources: EDHS 1995, 2000, 2005, 2008
18 NGO/CDA Sector: CHL Community Health Program Program Coverage 206 Villages in three Governorates 113 Health Units 1,000,000 Est. Population Program Structure CDA, Village Health Committee / Board Leadership: Dawar & AWSO Family Health Package
19 Community Level Indicators
20 Antenatal Care Any ANC 4 visits it & More % of Anemia Source of Data: M&E System
21 Safe Delivery % Medically-assisted births by Physician or Nurse Source: M&E Sysytem
22 Spacing Interval among women delivered 1.5 years ago <24 months 24 months-33 months >33 months Never pregnant since last birth Source: Monitoring System
23 Postpartum care & Family Planning Percentage of family planning practice within 2 months of delivery among women having postpartum visits Source: Monitoring system
24 Conclusions There are gateway effects for MCH behaviors on FP use: Health practices at one stage predict health practices at the next, creating a virtuous cycle for good health Communication influence these effects? The norm thus created have a positive The norm, thus created, have a positive effect on the practice in the population over time
25 Synergistic effect of early behavior change Increased likelihood of low parity FP use in 2008 as a function of early family lifestage behaviors (practices around first birth) All currently married women Practices around Birth of 1 st child UNIVARIATE ANALYSIS OR n p 4+ ANC visits Medically assisted delivery Child received PPC care within 2 months Mother received PPC within 2 months Six month exclusive breastfeeding Any exposure to FP messages Source: EDHS 2008 (n=3446 CMWRA)
26 Thank you
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