Transcript Document

Reducing Maternal and Child
Mortality through Strengthening
Primary Health Care in SA (RMCH)
Contraception & Fertility Planning
Support
Dr NA Skeyile
29 January 2015
Outline of the presentation
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Background – The Mandate
What we did (with the districts)
How did we do it
What did we achieve – CFP Dashboard
What did we learn
What still needs to be done
How will we get there
RMCH in 2015
Rationale for DFID RMCH support: three strategic gaps
• Past inability to translate
national policy into action
(Knowledge to Action)
• Poor management of
public health sector
services (Leadership)
• Inadequate primary health
care (PHC) (service
delivery)
Compromising delivery of effective
MNCWH services
(access, coverage, quality and
utilization)
The Mandate
 Crisis:
< than 1 million women who fall pregnant annually,
8% are girls under the age of 18 years & these
account for 36% of maternal deaths.
(source: NCCEMD –The National Committee for the Confidential Enquires into
Maternal Deaths)
 The new National Family Planning Campaign launch –
(February 2014) – the theme “Dual Protection” for
consistent use of a condom together with another form of
contraception
 Sub-dermal implant introduced
RMCH CFP - technical assistance
Focus: 25 Priority Districts
Objectives:
1. to strengthen & accelerate the implementation of CFP policy and guidelines at
district and facility level
2. to strengthen and maximise the use of available resources, avoid duplication
of efforts and encourage sustainability
How: align to the KZN 5 Point Contraceptive Strategic Plan
 Improve HCP training and Mentoring
 Promote Integration of Contraceptive Services with other Services
 Improve Record Keeping, review implementation status and reporting
 Improving demand creation – Contraceptive awareness and access
 Post training – mentoring / monitoring & responding to upcoming grey
areas
 Strengthening FP counselling
Situational analyses and prioritization conducted
Bottlenecks identified
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Weak Integration of services
Commodities
Capacity building
Monitoring & response
Quality assurance (to improve
the quality of family planning
services – identified CFP related
problems; analysed the causes of
the problems; prioritised and
developed solutions;
implemented corrective
measures and reviewed to
respond) .
Barriers to FP uptake
 method‐related concerns
 belief that methods interfere with the
body’s normal processes
 concerns about the safety, efficacy and
side effects of modern methods
TA approach
Leadership:
 the active engagement of MNCWH coordinator + DCSTs + SRH manager at
provincial, district and sub-national levels to increase programme ownership
and involvement planning
Capacity building:
 support FP trainings to improve competency and skills
 Post training – mentoring / monitoring & responding to grey areas
Data use:
 Improve record keeping, monitoring and review implementation status in
order to determine improvement and identify barriers to better outcome and
develop appropriate interventions
TA approach
Demand creation activities – to improve awareness
and access → (Grantees & Forums already existing &
having a voice in the communities; WBOTs)
Coordination:
Collaboration and coordination – facility readiness
assessment , post training follow-up and support
supervision, advocacy within the district and province
between programmes
Facility Readiness for FP services
Four key indicators of quality CFP provision
that we used to assess the readiness of health
facilities:
 Presence of at least one midwife in the
facility
 Adequate number of the CFP methods
supplied
 The basic amenities of infrastructure
 The basic equipment for provision of most
methods
STRATEGY – TRAINING
 Identify training needs
 Establish rationale for training (What informs training? – data
and root cause analysis)
 Training pre-requisites
– Who has been trained? (how long ago)
– Where are they working?
– Where is the training going to take place?
– What is the follow up plan?
– Who is going to do the follow up?
– What tool will be used for follow up?
– How do we get the report?
Training Strategy – Sustaining CFP at a district level
Provincial
Master Trainer
• Capacitates the
districts by training
District trainers
District Master
trainer and
Champion for
CFP
Form Roving Teams
• Mentors the sub-districts and
does the monitoring, review
and responds to gaps in the
district
Each sub-district has
a Champion trained
in CFP
Meeting the Unmet Need
Link FP to other services
 prenatal care
 post-partum care/breastfeeding
 Immunization
 child health services
Achievements
Contraception and Family Planning
 Support and participation in CFP training workshops – 100% facilities are
offering CFP and have at least 1 P/N trained in CFP
 Dissemination of CFP policies and guidelines and WBOTs education
material
 Trained WBOTs team leaders in use of CFP education material
Legacy
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Improved utilization and analysis of data to plan interventions
The culture of post training follow up and mentorship
CFP tools
FP facility readiness tool
TOR for established Roving teams
Implementation status tracking tool
Post training follow up tool
SOPs for MOUs; CHCs and PHC
Family planning flipchart for WBOTs; SOPs
“Let’s Talk” song by Yvonne Chaka Chaka
I (integration of services & commodities)
Component
Challenge/Bottleneck
Commodities
Frequent stock-outs of
CFP methods leading to
clients receiving a method
based on availability
Weak
integration of CFP
into other relevant
departmental
activities (DBE;
Department of Social
Welfare etc)
Weak collaboration
between DBE & DOH
(from national through to
the district level) on
issues of introduction of
SRH interventions into
schools
Current intervention
strategy
Lesson Learned
Frequent facility-level stock-outs
have negative effect on the
service and hinder efforts to
scale-up implementation at
district level of care
Strengthening the ISHP
programme by
introducing multi
stakeholders meetings
Failure to actively partner in the
planning and implementation of
SRH interventions results in
disjointed programming and
missed opportunities for
RMCH support to the
introduction of CFP in schools
districts to strengthen
which can exacerbate Teenage
Networks of care forums pregnancy in schools. In
(multi-sectoral
addition an “opt-in” policy for
stakeholders
SRH services in schools leads to
involvement) to link with long consultative processes
schools (School based
which the service in schools
support teams)
II (capacity building)
Component
Challenge/Bottleneck Current intervention
strategy
Lesson Learned
Capacity
Building
Inadequate districtlevel personnel
dedicated to
reproductive health
(RH)
Promote capacity-building
strategies that include on-the
job training, mentorship, and
supervision
Establishment of
Roving teams
Inadequate number
Roll out of HCP training
of facility-level health in CFP
care providers
trained in SRH
Establish an in-service
training database and
evaluate training
outcomes
Pre- and in-service training
has limited impact if health
facilities are understaffed and
workers overburdened
III (Monitoring & response/ Community involvement)
Component
Monitoring
& Response
Community
awareness and
male
involvement
Challenge/Bottleneck Current intervention
strategy
Weakness in data
management
Poor demand for CFP
services by the
community
Developing
CommunityBased SOPs
Lesson Learned
HCP will not prioritize data
management unless they
recognize its usefulness to
programming). Data
management must be a Core
component of all in-service
trainings for health care
providers
Increased community
sensitization on CFP through
WBOTs and strengthening of
referral mechanisms has
helped
to overcome cultural
barriers that prevent access to
CFP
Recommendations
 Integrated MNCH services with better budget line
 Consider community based distribution of FP services (WBOTs
TL)
 Forecast of 3 - 5 years contraceptive requirement done
 Male involvement
 Youth-friendly services revisited
 FP providers’ knowledge and skills up-to-date – (on-the-jobtraining with continuous mentoring)
 Well-functioning district procurement and distribution of
commodities and supplies should be in place
 National Family Planning Implementation Plan that filters down to
the facility level
For keeping me healthy
and making my life
worth living for!