Sexual and reproductive health care: A comparison of providers and delivery points between the African Region and other regions

Transcription

1 Core competencies in primary care: Supplement 2 Sexual and reproductive health care: A comparison of providers and delivery points between the African Region and other regions The Core competencies in primary care is available online at publications/health_systems/ Sexual and reproductive health Core competencies in primary care The competencies have been developed through a technical consultation of SRH experts in research, education, policy and service, over more than two years. The consultation included two workshops and many rounds of review in a Delphi-research-style process. A survey on the role of PHC providers in SRH was also undertaken to inform the competency definitions. ATTITUDES KNOWLEDGE ETHICS HUMAN RIGHTS LEADERSHIP MANAGEMENT TEAMWORK COMMUNITY WORK EDUCATION COUNSELLING CLINICAL SETTINGS SERVICE PROVISION

2 Acronyms AFRO AMRO CHWs D2D EMRO EURO FP IUD RHR SEARO STIs/RTIs VCT WPRO WHO African Region WHO Region of the Americas community health workers door-to-door visits WHO Eastern Mediterranean Region WHO European Region family planning intrauterine device WHO Department of Reproductive Health and Research WHO South-East Asia Region sexually transmitted and reproductive tract infections voluntary counselling and testing WHO Western Pacific Region 1

3 Contents 1. Introduction The questionnaire and survey Survey results Where SRH is delivered Duration of CHW training Activities Conclusion...7 Appendix...8 Response to questionnaire...8 Activity rating for all seven sections, by Region and Overall based on 67 countries...10 Activity rating for selected items, by Region and Overall based on 67 countries

4 1. Introduction A global survey was undertaken in mid 2009 by the WHO Department of Reproductive Health Research (RHR), to identify what sexual and reproductive health (SRH) provision is actually offered in primary health care (PHC), the delivery points and which health workers are providing this. The survey provides supporting information about the human resources who will deliver those SRH competencies which were presented to the Scientific and Global Advisory Group in Geneva on the 18 March A few results of the survey especially relevant to the African Region are shown in this supplement. 2. The questionnaire and survey The questionnaire identified the services provided by different levels of staff and where the service was provided. Specific questions were asked about seven technical areas: antenatal; childbirth; newborn; family planning and infertility; abortion, STIs/RTIs (including HIV and VCT) as well as screening for sexual violence and cancers; and sexual health education and counselling. The questionnaire was distributed to SRH technical staff attached to WHO in 27 countries in the African Region and a total of 90 countries around the world. The in-country focal persons were expected to respond to the questionnaire themselves and also possibly collect responses from managers in their ministry of health, from SRH service programme managers in PHC, and also from providers of SRH services. 3. Survey results The largest number of responses was from the African Region with 25 out of 27 countries. A total of 67 (out of 90) countries completed the questionnaire. The following countries responded in the African Region: Angola, Botswana, Burkino Faso, Burundi, Cameroun, Cap Vert, Comoros, Côte d Ivoire, Democratic Republic of the Congo, Lesotho, Liberia, Madagascar, Mali, Mauritiana, Mozambique, Niger, Nigeria, Rwanda, South Africa, Senegal, Togo, Uganda, Untied Republic of Tanzania, Zambia, Zimbabwe In this paper we compare the African Region with all other responding countries 4. Where SRH is delivered Figure 1 shows where SRH care is provided and by which health worker. Of the African Region respondents, 28% of countries have community health workers (CHWs) who provide SRH care through door to door (D2D) visiting. There is though a wide variation within and across the region and across all countries, with CHWs in 38% of all non the African Region countries doing D2D visiting. Nevertheless, the D2D visiting by health professionals is only 4% in the African Region which is very much lower than the 31% in non-african Region countries. The graph also shows that 100% or all the African Region countries in the survey offer SRH in health centres and 80% offer SRH services by health professionals in health posts, which is marginally higher than any other region. In the African Region, in 28% of countries CHWs offer SRH services in health posts, which is similar to that of other countries. 3

5 Percent AFRO Non AFRO Overall CHW D2D Professional D2D CHW Health Post Professional Health Post Health Centre Figure. 1. Delivery points of SRH in PHC in the African Region. 5. Duration of CHW training Clearly, CHWs are making a substantial contribution to SRH services. Figure 2 shows the length of preparation or training that CHWs have. The African Region countries offer a similar length of CHW training as all other countries in other regions. Interestingly, 48% of the African Region countries offer 3 4 weeks (20% and 28% respectively) which is a little higher than the 43% (11% and 32%) in non- African Region countries. CHWs are usually the people with some health knowledge closest to the women, men, children and adolescents in the community and, as shown in Figure 1, they carry out most D2D visiting in the African Region and they also have an important role in health posts Percent AFRO Non AFRO Overall 1-5 days 1-2 w eeks 3-4 w eeks 4++ w eeks Figure 2. Duration of CHW training in the African Region compared with all WHO Regions. 4

6 The next two tables show the very important contribution that CHWs, nurses and midwives make to SRH care in the area of Family Planning and Fertility and also in safe abortion services. 6. Activities Table 1 shows the tasks in these two domains Tasks in family planning and infertility care Individual and couple counselling Counsel client for method eligibility Provide condoms Provide oral contraceptives Provide injectable contraceptives Insert implants Insert IUD Removal of IUD Sexually transmitted infection assessment during FP consultation Tasks in abortion care Information and counselling about options Post abortion care If complicated abortion referral Determine medical eligibility for abortion methods Surgical method of abortion Medical abortion Manual Vacuum Aspiration Counselling STI/HIV prevention Referral for further management or complication Provide emergency contraception Inform and counsel individuals and couples seeking care for fertility Referral for further investigation and treatment Table 1 Tasks in Family Planning and Fertility and Abortion Care Figures 3 and 4 below show the total activities in Table 1 in Afro Region compared with all other regions. The bar graph ratings are achieved by calculating the activity rate of service providers (CHW, nurse, midwife, doctor) for the activity, on the scale of (0 1) as an average involvement in the service provision, and then calculated as a total activity rate as a sum of all 12 activity rates (0 12) in FP and 9 activities rates (0 9) in Abortion Care. For example, in Table 3 (Family Planning) there are 12 activities, therefore the rate for a country is calculated as an average over these 12 items, and then the average is calculated over all countries in the African Region. 5

7 Family Planning & Infertility Services Rate AFRO Non AFRO Overall CHW Nurse Midw ife Doctor Figure 3 Family planning and infertility services Figure 3 shows that midwives in the African Region are the most involved in carrying out family planning and infertility services than in other regions. Nurses involvement in FP services in the African Region are also quite important: in the African Region CHWs, nurses and midwives have a bigger role in this area of care than those in the rest of the world. Safe Abortion Services Rate AFRO Non AFRO Overall CHW Nurse Midw ife Doctor Figure 4. Safe abortion services 6

8 Figure 4 shows that in all regions doctors have by far the largest responsibility for carrying out abortion activities. In the African Region, despite doctors having larger responsibility, CHWs, nurses and midwives have a more important role in this area of care than those in the rest of the world. 7. Conclusion Key results of the global survey on The Role of Primary Care Providers in Sexual and Reproductive Health have been shown in the figures and tables in this document. This information will be useful for countries when planning their strategies and policies to develop competent skills of the SRH providers. 7

9 Appendix Response to questionnaire Region African Region Region of the Americas Eastern Mediterranean Region European Region Country Number of questionnaires Angola 1 Botswana 1 Burkina Faso 1 Burundi 1 Cameroun 1 Cap Vert 1 Comoros 1 Côte d'ivoire 1 Democratic Republic of Congo 1 Lesotho 1 Liberia 1 Madagascar 1 Mali 1 Mauritanie 1 Mozambique 3 Niger 1 Nigeria 1 Rwanda 2 South Africa 1 Senegall 1 Togo 1 Uganda 1 United Republic of Tanzania 1 Zambia 1 Zimbabwe 1 Totals 25(28) Belize 1 Bolivia (Plurinational State of) 3 Guatemala 1 Guyana 1 Haiti 1 Honduras 1 Paraguay 1 Peru 1 Trinidad and Tobago 1 Totals 9(11) Iraq 1 Jordan 1 Morocco 1 Oman 1 Somalia 1 Sudan 1 Syria 1 Tunisia 1 Yemen 1 Totals 9(9) Armenia 1 Kazakhstan 1 Kyrgyzstan 1 Moldova 1 Russian Federation 1 Tajikistan 1 Uzbekistan 1 Totals 7(7) 8

10 South-East Asia Region Western Pacific Region Bangladesh 1 Democratic People s Republic of Korea 1 India 1 Indonesia 1 Maldives 1 Myanmar 1 Thailand 1 Timor Leste 1 Totals 8(8) Cambodia 1 Fiji 1 Lao People s Democratic Republic 1 Malaysia 1 Mongolia 1 Papua New Guinea 1 Philippines 1 Singapore 1 Viet Nam 1 Totals 9(9) CHW and Midwifery activity rate by duration of training 1-5 days <12 mnths 1-2 wks mnths 3-4 wks mnths 4+ wks 36+mnths CHW Midwife

11 Activity rating for all seven sections, by region and overall based on 67 countries Section Region CHW Nurse Midwife Doctor AFRO AMRO EMRO Antenatal care services EURO SEARO WPRO Overall AFRO AMRO EMRO Childbirth & immediate postpartum care services EURO SEARO WPRO Overall AFRO AMRO EMRO Newborn care services EURO SEARO WPRO Overall AFRO AMRO EMRO Family Planning and Infertility services EURO SEARO WPRO Overall AFRO AMRO EMRO Safe abortion services EURO SEARO WPRO Overall AFRO AMRO EMRO Sexual and Reproductive Tract Infection services EURO SEARO WPRO Overall AFRO AMRO EMRO Sexual Health Education & Counselling services EURO SEARO WPRO Overall AFRO AMRO EMRO Overall EURO SEARO WPRO Overall

12 Activity rating for selected items, by tegion and overall based on 67 countries Section Region CHW Nurse Midwife Doctor AFRO AMRO EMRO Selected Antenatal care services EURO SEARO WPRO Overall AFRO AMRO EMRO Selected childbirth & immediate postpartum care services EURO SEARO WPRO Overall AFRO AMRO EMRO Selected newborn care services EURO SEARO WPRO Overall AFRO AMRO EMRO Selected family planning services EURO SEARO WPRO Overall AFRO AMRO EMRO Selected safe abortion services EURO SEARO WPRO Overall AFRO AMRO EMRO Selected sexual and reproductive tract infection services EURO SEARO WPRO Overall AFRO AMRO EMRO Selected sexual health education & counselling services EURO SEARO WPRO Overall AFRO AMRO EMRO Infertility services EURO SEARO WPRO Overall