Transcript in Jordan Contraceptives Logistics System

Improving Access to Long-Acting
Contraceptives in Jordan
Situation, Issues, and Recommended
Actions
Dr Ruwaida Rashid
MOH / WCHD Director
2011
Topics
1. Situation of family planning methods use in Jordan.
2. Interventions to improve access to long acting
contraceptives in Jordan.
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Jordan Contraceptives Logistic System.
Improving Access to IUDs at MCH Centers.
Introducing Long Acting Hormonal Methods (Implants)
in the Jordan Contraceptives Logistic System.
Family Planning Sentinel Surveillance at MCH Centers.
3. Recommended Actions.
1. Situation of family planning
methods use in Jordan.
Current Use of Family Planning
Methods and Method Mix / 2009
Trends in the Use of Modern
Family Planning Methods(%)
Trends in Current Use of Family
Planning Methods
Percentage of
currently married
women 15-49
using any method
6
59
Contraceptive Discontinuation
2009
Main Reason for Discontinuation
Wanted to become pregnant
35
Became pregnant while using
17
Wanted more effective method
13
Side effects
12
Health concerns
9
Infrequent sex/husband away
4
Husband disapproved
2
Inconvenient to use
2
Impact of Changing Method Mix
on Jordan’s TFR
Scenario A
Scenario B
Current Method Mix
remains constant at
2009 level
50% of Traditional
Method users shifts to
Modern Methods (%)
Average Method Effectiveness
0.83
0.89
Modern CPR (%)
40.50
49.15
CYP
345,000
417,000
Unintended Pregnancies
82,000
50,000
Births
171,000
156,000
3.80
3.45
Indicator
TFR
Method Mix Issues in Jordan
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•
•
•
•
•
Fear of side effects
Provider bias
Provider availability (female provider)
User preferences
Availability of financial resources
Quality of counseling services (practices &
space)
2. Interventions to improve access to
long-acting contraceptives
in Jordan
Jordan Contraceptive Logistic
System (JCLS)
No Products………… No programs
►Established in 1997 at MoH. All
contraceptives were provided by USAID.
►In 2005, USAID started to phase out and
completed in 2009. MoH started to purchase
all contraceptives.
►A budget item in MoH budget is
specified for contraceptives procurement in
2011.
FP Methods Available in Jordan
Contraceptive Logistic System
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Pills (combined and estrogen only pills).
IUDs (copper T).
Injectables (3 months ).
Implant (one rod).
Male condoms.
Programs Under Jordan
Contraceptive Logistic System
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•
•
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Ministry of Health (health centers and hospitals)
Royal Medical Services.
UNRWA Clinics.
Jordan Association for Family Planning and
Protection.
Governmental universities hospitals.
Private sector clinics through PSP project .
Other NGOs
Total of 662 clinics provided with contraceptives for
free.
Method Mix at MoH-2010
3.60% 4.27%
IUDs
26.70%
Condoms
50%
Pills
DMPA
Implanon
17%
Method Mix for the whole System2010
2.60%
1.40%
IUDs
21.40%
Condoms
Pills
60%
14.60%
DMPA
Implanon
Contribution of Partners under
the System to CYP - 2010
2.50%
1%
MoH
UNRWA
22.70%
Universities
JAFPP
0.80%
59%
14%
RMS
Others
Important Issues Related to
JCLS
New choices of contraceptives methods should be added
to the system. some of the barriers are:
• Concerns regarding stock out ,over stock, when adding
different brands of combined oral pills to the system.
• Limited brands of oral pills (COCs ,POPs) and types of
contraceptives registered at JFDA.
Limited market for family planning methods in Jordan.
Long and complicated procurement procedures.
Improving Access to Intra Uterine
Devices (IUDs) at MCH Clinics
► IUD is a long term, effective, and well
accepted family planning method in Jordan.
However, access to this method is limited due
to shortage of female providers.
MoH Pilot Project on IUDs
Insertion by Midwives
► Objective : Improve Access to IUD Services at MoH
Primary Health Care Level.
► Started in 2003 and continued successfully until
2009.
► 182 midwives at MCH centers were trained to
offer IUD insertion service and permitted to
provide the services.
► Results :
• No significant complications were reported.
NUMBER OF HEALTH CENTERS
PROVIDING IUD SERVICES 2003-2009
200
167 175
193
175
142
150
100
182
119
100
.n
50
0
2003 2004 2005 2006 2007 2008 2009
PERCENTAGE OF IUDs INSERTED
BY MIDWIVES 2004-2010
50
42.8
37
40
46.5
39
29
30
24.8
19.8
20
.n
10
0
2004 2005 2006 2007 2008 2009 2010
► Policy Change
Recently, the Minister of Health approved adding
the “task of IUD insertion under physician’s
supervision” in job description for midwives.
Introducing Long Acting Hormonal
Methods-Implants- in Jordan
Contraceptives Logistics System
► Why Implants ??
• Effective and long acting.
• Acceptable from male physician providers.
• Expand choices of contraceptives.
►Implants was introduced in Jordan Contraceptive
Logistic system in 2006 in cooperation with
Organon in a limited scale (two training courses).
►In cooperation with HSS2, a core of 13 trainers
were trained in 2010, then several training courses
were conducted.
►Currently,
- Total number of trained physicians:
94
(from MOH, JAFPP, RMS)
- Number of health facilities providing implants: 48
(at MOH, RMS)
►Issues
• High over turn of trained health providers.
• Limited promotional activities towards
Implants.
• The need for assessment of acceptance,
side effects, and discontinuation of
implants.
Family Planning Sentinel
Surveillance
at MCH Clinics
Established in cooperation with HSS project for
discontinuation of combined pills and IUDs
using prospective study design.
Contraceptive Discontinuation Rate (%)
by Reason and Method-(2009-2010)
Reason
Discontinuation
Rate
Pills
IUDs
Method failure
1.5
1.1
Desire to become pregnant
10.2
2.2
Switched to another method
18.6
6.6
Other reasons
12.2
4.1
42
14
Total
Percent Distribution of
Contraceptive Discontinuation by
Reason
Reason
IUD
Pills
Total
Husband’s absence
%
6.2
3.5
%
4.5
4.5
%
5
4.3
Desire to become pregnant
19.5
26.2
24.3
8
9.8
9.3
Husband or others disapproval
4.4
3.5
3.8
Separation
0.9
1.7
1.5
Side effects
51.3
44.4
46.4
Other
6.2
5.2
5.5
Total
28.3
71.7
100
Method failure
Health reasons
► Issues based on the results
• High discontinuation rate especially among COCs
users (although less than national rate).
• Most of discontinuers (42%) switch to another
method mainly condom which is less effective.
• High % of IUD users (39%) switch to COCs which is
short term, while 27% of COCs users switch to IUD
which is long term.
• Side effects play a major role in discontinuation
and switching.
3. Recommended Actions
Recommended Actions
►Conduct an assessment of the feasibility and
effectiveness of introducing new brands and
varieties of pills to Jordan FP logistic system.
►Introduce new family planning methods to the
Jordan FP logistic system.
►Simplify the procurement procedure of FP
methods.
Recommended Actions
►Operationalize the Minister’s decision which
approved adding IUDs insertion to midwife job
description.
►Collect and analyze information on Implanon
discontinuation rate, side effects, and acceptance,
to be used as a tool for evidence based promotion
for service providers.
►Strengthen FP communication activities on
increasing demand for long-acting hormonal
contraceptives, decreasing demand for traditional
methods, and on birth spacing and limiting to
promote appropriate method selection.
Recommended Actions
► Conduct an assessment of the family planning
counseling services.
►Strengthen counseling services with focus on
provision of special counseling and follow up for
COCs users, and sufficient information and
counseling on side effects and on most suitable
methods for limiting and spacing.
Thank You