Date/Time: Friday, November 15, 2013 Session: Poster Session 5 Contraceptive Financing, Policy, Innovation in Service Delivery, Monitoring,

Evaluation and Research

Author(s): Title of Abstract: Tsigue Pleah, Jhpiego Yolande Hyjazi, Jhpiego Suzanne Austin, Jhpiego Lessons from Guineas Integration of Family Planning (PPIUD) and Maternal Newborn Health what works? Program/Best Practices Abstract Innovations in contraceptive service delivery

Abstract Type: Topic:

Significance/background / Importance
According to the 2012 Demographic and Health Survey provisional data, contraceptive prevalence in Guinea is 7% and for IUD 0.2%. About 78% of all postpartum women will need contraceptives during the first 12 months after delivery; however, less than 10% currently use modern contraceptive methods. To address this gap, the Ministry of Public Health (MOPH) put in place a strategy to revitalize family planning (FP) prioritizing long-acting contraceptive methods, specifically the postpartum intrauterine device (PPIUD). One of the strategies to increase the use of postpartum family planning (PPFP) is to use maternal and newborn health platforms. For this strategy to work, the provision of PPIUD should be based on an integrated model for antenatal care (ANC), intra-partum care (labor and delivery) and postpartum care. To respond to the MOPHs priority, MCHIP/Jhpiego has supported the MOPH to ensure the integration of FP services, inclusive of PPIUD, with maternal health services. The interventions purpose has been to ensure the integration of long-acting reversible contraceptive (intrauterine device (IUD) methods with maternal health services to facilitate access to FP services in the postpartum period. This intervention will ensure that there are no missed opportunities and provide quality services to women who need them the most.

Program intervention/activity tested

Working with the MOPH, MCHIP/Jhpiego conducted the following activities: Advocated with all key stakeholders about healthy timing and spacing of pregnancy (HTSP) and the contribution of FP in reducing maternal and child mortality;

Facilitated the revision/adaptation of the PPIUD training kit using international standards and taking into account local context and national policy and guidelines; Assisted in Identification of service delivery sites with high caseloads of childbirth and motivated and engaged providers ( champions)- Conducted technical update of providers from ANC,, labor wards, nutrition and vaccination services in contraceptive technology with emphasis on PPFP counseling Assisted in the development of IEC materials to support counseling; Facilitated in training of providers in PPIUD insertion; Strengthened of services delivery sites through provision of equipment, job aids and health management information system tools for PPIUD services; Conducted transfer of learning , monitoring and supportive supervision for providers, collection of data and troubleshooting of issues raised during the implementation period; Facilitated the introduction of FP performance standards for pre-and postnatal care, including for the PPIUD, to standardize and ensure quality services; and, Trained national trainers to develop local capacity to expand PPIUD services to respond to the populations needs.

Methodology
To implement integrated PPIUD services in Guinea, six sites were selected: two national teaching hospitals (Donka and Ignace Deen) , and four district hospitals (Matam, Coleah, Miniere and Ratoma) in Conakry. The success of this program led to the expansion of these services to 12 additional sites, including 8 regional and prefectural hospitals and also four health centers in Conakry; all in USAID-supported regions.The data for this presentation is from April 2011-March 2013. The data sources used were: training and supervision reports, service delivery registers, individual client records, monthly and quarterly service reports and client interview records.This program targeted pregnant, in labor and immediate postpartum women. Data were collected on a monthly and quarterly basis, and cleaned, compiled and tabulated to provide the following indicators:; Number and percent of women who received PPIUD in the post-placental period (10 minutes after delivery), number and percent of women who received PPIUDs in the immediate postpartum period (within 48 hours after delivery), and number and percent of complications (infection, expulsion).

Results/key findings
To date, PPIUD services have been integrated in 18 sites; 231 providers have been trained in PPFP counseling; and among those providers 37 have been trained in PPIUD insertion. Additionally, to decentralize and expand training and service provision, the skills of eight trainers were developed.A total of 2198 clients benefited PPIUD insertion services and 1737 (79%) were seen for a follow-up visit. There were 766 (39%) women who received PPIUD during the post-placental

period; 369(18%) intra-cesarean, and 869 (43%) within 48 hours.. For 194 clients, the insertion period was not mentioned. The rate of complications was very low. 19 clients experienced expulsions (0.9%), 12 experienced missing strings (0.5%) and 4 infections were recorded (0.2%).

Program implications/lessons
Identification of champions and appropriate sites (caseload, method mix) is essential for the success of the program. Reorganizing services and addressing availability of equipment and supplies are needed to ensure quality PPIUD services. Transfer-of-learning visits and regular follow-up of providers implementing new services are also key to the programs success. Saving clients contact information (mobile phone number) facilitates follow-up. Collecting key information during service provision is an important aspect to appreciate the success/weakness of the program.