NANCY WARREN, MPH
CURAMERIC AS GLOBAL
MARCH 7, 2014
Integration of Family Planning
Services into MNCH Programming
in Liber...
Liberian Context
 Total population: 3,989,703
 Over 14 different ethnic groups
 Median age is 17.9 years
 Total Fertil...
Overview of Nehnwaa Child Survival Project
 Nehnwaa – “struggle of the child”
 USAID-funded for five years (2008 – 2013)...
Overview (continued)
 Program Design combines the Community-Based
Impact-Oriented Methodology (CBIO) and Care Groups
to p...
Introduction of Family Planning Services
 In 2011, introduced 1-year FlexFund award for
Community-Based Family Planning S...
Integration Process and Procedure
 After funding ended in August 2012, FP services
were integrated into the original Nehn...
Integration Process and Procedure
 While technically FP/EPI integration, family planning
became a topic of most intervent...
Description of Family Planning Clients
 Between September 2012 and January 2014, 3,866
office visits
 2% male and 98% fe...
Family Planning-Specific Outputs
Key Result Objectives Baseline
(2008)
June
2011
July
2012
Final
(2013)
Increase the perce...
Indirect Improvements - Additional Indicators
 Improvements in other indicators may be influenced
by integration of famil...
What was the difference maker?
 Family Planning counseling and service provision
made possible by network of community he...
Limitations with Survey Data
 All data is self-reported
 Urban bias
 Sample size less than 5% of beneficiary pool
 Rec...
Conclusion: Benefits to Integration
 Cost effective - utilizes existing staff and resources
 Scaling up of comprehensive...
Conclusion: Challenges to Integration
 Increased workload of all staff, particularly EPI
 Combining FP & EPI data collec...
Lessons Learned
 FP integration into MNCH community outreach
activities is feasible
 FP/EPI integration reaches multiple...
Looking Forward
 Currently, post-funding, GUMH has scaled back their
FP services to Facility service provision and minima...
Questions
?
For more
information on
FP/EPI
integration,
visit:
http://www.k4h
ealth.org/toolkit
s/family-
planning-
immuni...
Thank you!
of 18

Nancy Warren Mini-U Presentation March 2014

Liberia PP
Published on: Mar 3, 2016
Published in: Government & Nonprofit      Health & Medicine      Business      
Source: www.slideshare.net


Transcripts - Nancy Warren Mini-U Presentation March 2014

  • 1. NANCY WARREN, MPH CURAMERIC AS GLOBAL MARCH 7, 2014 Integration of Family Planning Services into MNCH Programming in Liberia Additional collaborators: Allen Zomonway, BSN, Ganta United Methodist Hospital; Jean Capps, MPH, BSN
  • 2. Liberian Context  Total population: 3,989,703  Over 14 different ethnic groups  Median age is 17.9 years  Total Fertility Rate (TFR): ~5 children/woman  Maternal mortality: 770/100,000 live births  Infant mortality: 71/1,000 live births  FP Unmet need: 36%
  • 3. Overview of Nehnwaa Child Survival Project  Nehnwaa – “struggle of the child”  USAID-funded for five years (2008 – 2013)  Local partner: Ganta United Methodist Hospital (GUMH)  Located in Nimba County, Liberia  Targeted WRA, U2 mothers, and U5 children  Six intervention teams:  Maternal and Newborn Care (MNC)  HIV/AIDS  Immunizations (EPI)  Water and sanitation (WatSan)  Integrated Mgmt of childhood illnesses (IMCI)  Community Support Services (CSS)
  • 4. Overview (continued)  Program Design combines the Community-Based Impact-Oriented Methodology (CBIO) and Care Groups to provide community-based primary health care services  Over five years, 120 general Community Health Volunteers (gCHVs) and 120 Trained Traditional Midwives (TTMs) trained  One gCHV and one TTM per community
  • 5. Introduction of Family Planning Services  In 2011, introduced 1-year FlexFund award for Community-Based Family Planning Services  Hired additional FP staff to establish Community Depot at GUMH and integrate FP into community visits (additional intervention team)  Trained all staff, gCHVs, and TTMs for community- based distribution and counseling  Established supply chain and procurement system for MOH-provided family planning commodities
  • 6. Integration Process and Procedure  After funding ended in August 2012, FP services were integrated into the original Nehnwaa structure as a part of EPI service provision  EPI staff were fully trained in counseling and service provision, including administration of Depo Provera  EPI staff were trained in supply chain management, reporting, and recordkeeping
  • 7. Integration Process and Procedure  While technically FP/EPI integration, family planning became a topic of most intervention teams:  HIV team counseled on safe sex and provided condoms  MNC and IMCI teams counseled on LAM and birth spacing  CSS team trained and mentored gCHVs on counseling, distribution, and recordkeeping of FP services
  • 8. Description of Family Planning Clients  Between September 2012 and January 2014, 3,866 office visits  2% male and 98% female  Male clients range from 18 to 50 years old  Female clients range from 13 to 50 years old 10-14 yrs 15-19 yrs 20-30 yrs 31+ yrs Female 11 802 2128 850 Male 0 5 25 45
  • 9. Family Planning-Specific Outputs Key Result Objectives Baseline (2008) June 2011 July 2012 Final (2013) Increase the percentage of Contraceptive Prevalence Rate among WRA 2.0% 15.20% 61% 61% Decrease the percentage of Unmet Need among WRA -- 67.90% 22% -- Increase the percentage of WRA who report discussing family planning with a health or family planning worker or promoter -- 25.3% 97% 97%
  • 10. Indirect Improvements - Additional Indicators  Improvements in other indicators may be influenced by integration of family planning services: Indicator Baseline (2008) Final (2013) Exclusive Breastfeeding 39.4% 52.9% At least 4 ANC visits 24.7% 73.9% Postpartum visit for mother 9.3% 58.1% Children with PENTA1 vaccine 40.1% 100% Children with PENTA3 vaccine 24.5% 99% Children with Measles vaccination 45.3% 97%
  • 11. What was the difference maker?  Family Planning counseling and service provision made possible by network of community health volunteers  Increase in peer education and social acceptability  Supply is able to meet demand  Client has options  Community v. facility  Wide variety of commodities  Trust and rapport with Nehnwaa Staff  Involvement of men in BCC programming
  • 12. Limitations with Survey Data  All data is self-reported  Urban bias  Sample size less than 5% of beneficiary pool  Recall bias  Interviewer bias: beneficiary wanted to please the interviewer  FP indicator may be related to availability of commodity
  • 13. Conclusion: Benefits to Integration  Cost effective - utilizes existing staff and resources  Scaling up of comprehensive service provision  Synergy of efforts  Meets demands for services  Potential continuum of FP service provision by current implementing partner  Utilizes a robust community mobilization & intervention system
  • 14. Conclusion: Challenges to Integration  Increased workload of all staff, particularly EPI  Combining FP & EPI data collection & reporting tools  Logistics  Commodity Stock-outs
  • 15. Lessons Learned  FP integration into MNCH community outreach activities is feasible  FP/EPI integration reaches multiple types of beneficiaries  BCC messaging should apply to the spectrum of FP users  All CBPHC teams should modify the service provision setting to address confidentiality  Clarify return-to-clinic dates (particularly with EPI and FP service provision)
  • 16. Looking Forward  Currently, post-funding, GUMH has scaled back their FP services to Facility service provision and minimal CBD by community volunteers and staff  GUMH continues to regularly receive commodities from MOH despite national restructuring of distribution  New agreement with Planned Parenthood Association of Liberia (PPAL) to provide community SRH services  Continued external support from private donors to fill gaps as needed
  • 17. Questions ? For more information on FP/EPI integration, visit: http://www.k4h ealth.org/toolkit s/family- planning- immunization- integration
  • 18. Thank you!

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