Reinvigorating use of family planning in Cameroon with emphasis on immediate postpartum intra-uterine devices and implants

Transcription

1 Reinvigorating use of family planning in Cameroon with emphasis on immediate postpartum intra-uterine devices and implants Presented By: Lea Monda, Technical Advisor, E2A project, Cameroon

2 Summary Cameroon overview The E2A project in Cameroon Background Program intervention tested Methodology/Best practices Results/Key findings Lesson learned Challenges

3 Cameroon Overview Population :21 million Maternal mortality:782/100,000 live births Infant mortality:122/1000 live births Low contraceptive prevalence rate: 14.4% High level of unmet need for FP: 17% HIV prevalence rate: 4.3% Men 2.9% Women:5.6% Pregnant women:7.4% Central region : 6.1% There is a clear need for PPFP in Cameroon and the E2A project is an opportunity to fill this gap

4 The E2A Project in Cameroon Title of the project: La planification familiale après l accouchement pour les jeunes femmes à Yaoundé-Cameroon Target: young/adolescent mothers; women; providers Implementation Partners: DSF/MINSANTE; RENATA Execution: E2A - MSH Duration: 02 ans (Mars 2014 Février 2016) Source of funding: USAID/West Africa Expected results: Integrated PPFP at the 4 points of contact (antenatal care, immunization, maternity & postnatal services) at 4 facilities in Yaoundé. Main activities: Training of healthcare providers in PP FP Service delivery Quality assurance Community Mobilization to increase demand for FP and HIV services

5 Significance/background: Globally, family planning is recognized as a key life-saving intervention for mothers and their children (WHO 2012b). Postpartum women are among those with the greatest unmet need for family planning (FP). Adolescent mothers who use longer-acting FP methods have higher rates of continued use and lower rates of pregnancy. Cameroon s National Health Development Plan ( ) provides policy support for family planning among women, especially young women. High rate of facility-based deliveries, low uptake of family planning, and absence of PPFP services drive need for PPFP program.

6 Significance/background (cont): Despite efforts to reinvigorate use of FP, all methods have not been widely provided during the postpartum period in Cameroon. The USAID-funded Evidence to Action (E2A) Project was invited by USAID/West Africa and the Cameroon Ministry of Health to design and implement the program: Advancing Youth, Post-Partum, and Community Family Planning Promotion and Service Delivery in Cameroon. The program s main goal is to prevent unintended and closely spaced pregnancies through the first 12 months following childbirth.

7 Program intervention/activity tested: The E2A project developed a comprehensive PPFP program that offers a full range of contraceptive options in four large hospitals in Yaounde, This program offers voluntary FP counseling and provision of contraceptive methods with a focus on immediate and extended post-partum care for young mothers. It also addresses FP needs along the continuum of care and through the reproductive health cycle for women and girls, integrating FP into other services

8 Methodology Program/Best Practice: Selection of the health Facilities Engaged existing providers and supervisors, and used existing facilities, supplies, and infrastructure Adapted postpartum intrauterine device (PPIUD), interval IUD, and implant training materials from national and international guidelines. Training in family planning counseling, youth education, and youth-friendly services. (Dec 2014) 38 providers from four selected hospitals 02 central-level staff from the Ministry of Health Conducted a six-day clinical Training of Trainers on PPIUD, interval IUD, and postpartum implants for 15 trainers (from hospitals, national and regional health officials, and partners) 24 participants (nurses/midwives): 23 from the 4 practicum hospitals and 1from the Ministry of Health, attended training on PPIUD, interval IUD, and postpartum implants. Trainers facilitated the entire PPIUD and implants training with supervision and coaching by international facilitators.

9 Praticum on anatomic models (Mama-U)

10 Methodology Program/Best Practice (cont): PPFP clinical guidelines: Tailored and simplified PPFP guidelines from international and local sources. Postpartum IUD insertion techniques (video); implant insertion (video) Ensuring the availability of data collection tools, and collecting data on new services provision (PPIUDs, PP implants). Provide Tools and consommables during trainings Supportive supervision visits for monitoring and evaluation of their performance for their competency certification (after six weeks). Facilitated availability of contraceptives at a standardized price (no purchase of commodities)

11 Minister of Health observes practicum on anatomic models

12 Results/key findings Providers Knowledge evaluation: 63.67% average (pretest), 91.16% (post-test) Since the training in PPIUD, interval IUD, and PP implants, changes have taken place in the four pilot hospitals Data from the introductory month following training (February 2015) in three of the four sites are very encouraging: 54 immediate PPIUD instersion (within 48 hours), 12 interval IUD insertions, 128 postpartum implant insertions and 15 postpartum injectable.

13 Women who received family planning, sexual & reproductive health counseling (group and individual) at 4 points of contact Number of women counseled Total Maternity ANC Family Planning Child Immunization 0 Baseline Oct - Dec 2014 Quarter 1 Jan - Mar nd Quarter Apr-Jun 2015 Time/Quarters

14 Acceptors of family planning methods All Women Number of FP acceptors Months PP Immediate PPFP 0 0 Baseline Oct - Dec 2014 Quarter 1 Jan - Mar nd Quarter Apr-Jun 2015 Time/Quarters

15 Acceptors of long-acting reversible contraceptives (LARCs) immediately postpartum Number of PPFP acceptors Total LARCs Jadelle 0 0 Baseline Oct - Dec 2014 Quarter 1 Jan - Mar nd Quarter Apr-Jun 2015 Time/Quarters

16 Acceptors of long-acting reversible contraceptives (LARCs) immediately postpartum Number of PPFP acceptors Total immediate PP LARCs Jadelle PPIUD 0 0 Baseline Oct - Dec 2014 Quarter 1 Jan - Mar nd Quarter Apr-Jun 2015 Time/Quarters

17 Results (Cont) 1000 Number of women who received group and individual FP/SRH counseling by age group and quarter Number of all women who accepted FP method by age group and quarter Oct-Dec 14 Jan-Mar 15 Apr-Jun and above years Oct-Dec 14 Jan-Mar 15 Apr-Jun 15 Number of women who accepted FP immediately after delivery by age group and quarter Oct-Dec 14 Jan-Mar 15 Apr-Jun 15

18 Lessons Learned: The re-introduction and integration of PPFP is an important step in re-invigorating the positioning and use of family planning in Cameroon. Introduction of immediate postpartum implants is also an innovation. Work with stakeholders and management to ensure their involvement and commitment early in the process.

19 Challenges Integration of PPFP strategy in the MOH strategy, clinical sexual and reproductive health standards, and development of a guideline for certification of providers in PPFP. Negative perceptions and persistent myths around IUDs insertion Increased workload of providers Expanding integration of PPIUD and PP implants to other sites and regions with support from other partners

20 Thank You Merci Me yéga Ngandak