Transcript PSI/Tanzania Presentation Private sector role in Family
PSI/Tanzania Presentation
Private sector role in Family Planning By Dr. Nguke Mwakatundu,RH Director
Some Abbreviations
• CPR: Contraceptive Prevalence Rate • CYP: Couple Years of Protection • FP: Family Planning • IPC: Interpersonal Communication • IUCD: Intrauterine Contraceptive Device • LTM: Long Term Method • MWRA: Married Women of Reproductive Age • OC: Oral Contraceptive • PA: Public Announcement
Zonal Offices Regional Offices
Background and Geographical Coverage-RH Program
• Familia RH program was initiated in 2007,and started services provision in January 2009 • Sales of RH products cover the whole of Tanzania with exception of IUCDs and Implants which cover 13 regions in Tanzania.
• PSI/Tanzania distributes six FP products and offers service delivery in 17 regions of mainland Tanzania (Network facilities in 13 regions and outreach activities in 12 regions).
• Distributes one safe motherhood product and will start limited distribution of another one in Q2 2013
RH Program Objectives
• Family Planning To contribute towards increase of national CPR target (target 60% use among MWRA by 2015) and reducing total fertility rate from 5.4 to 3.1 by 2015 To promote usage of FP methods especially long-term methods (Implants and IUCD’s).
• Maternal mortality To contribute towards reducing maternal mortality to 193/100,000 live births by 2015(Currently at 454/100,000) To reduce haemorrhage misoprostol.
maternal (PPH) deaths and due incomplete to post abortions partum using To increase access to safer delivery -Clean delivery pack
Program Components
• Product procurement, packing and distribution • Social marketing of 6 FP products,1 safe motherhood product, and another safe motherhood product from Q2 2013 • Distribution at national and regional level in all authorized outlets.
• Increased access to services (esp LTM) • Comprehensive partnership with private sector facilities • Service provision through outreach teams • Behaviour Change Communication • Inter Personal Communication in communities • Medical detailing to health facilities and pharmacies • Community events • Public Announcements
Program Components
• Supportive environment • Curriculum revision • TOT’s • Working with universities, professional associations (e.g. AGOTA) • Working with the Ministry of Health at national and local level to improve the environment for better access to FP and safe motherhood services • Integration • FP / HIV : Counselling, referral for testing and free condom distribution • Treatment of Incomplete abortion / FP • Postpartum FP
Familia Products Range
• Family Planning Products: IUCD’s Implants Condoms(male and female) Injectables Oral Contraceptives Emergency contraceptives(supplier brand) • Safe Motherhood Products Misoprostol (supplier brand) Clean Delivery Pack
PSI/Tanzania Current distribution model
District/Rural Centers wholesaling outlets Pharmaceutical Regional Distributor Urban wholesaling outlets MDCs Institutions, NGOs, CBOs etc Rural retailer Urban retailer Health facilities Clinics, VCT, HBC, CHWs, Peer educators
page 10
Behavioural Change Communication Activities
• IPC activities: Household Visits, Neighbourhood Meetings, Clinic meetings • Women groups meetings : Markets places, Saloon s visits, kitchen parties • IEC materials: posters, brochures • Public Announcements (PA) • Mass media: radio spots, newspapers page 11
Private Sector Partnership Service Delivery
Approach
• Social franchising model • Selection of health facilities based on specific criteria • Signature of MOU • Comprehensive training in clinical skills for LTM • Equipment for LTM provision • Access to products, expendables and job aids • Monthly event days post-training for capacity building • On going coaching and mentoring for quality • Branding and local promotion of services through posters, wall paintings, PAs • Referral system to facility using IPC agents
Branding of Facilities
Wall Paintings
Public Sector Approach
• 10 outreach teams supporting the public sector in 12 regions.
• Each team is of 2 nurse midwives partnering with public sector providers trained in LTM • Selection of location / health facilities driven by district authorities • Demand creation prior to the event using posters; public announcements; local leaders; facility providers • Equipment, supplies and IP material brought by PSI team • All FP clients are screened for HIV and referred for testing if they are at risk • Free condoms offered to all clients in need
Major Achievements in 2012
• More than doubling in provision of LTM’s(102,778 insertions in 2012 Vs 48,518 in 2011) • Increased provision of LTM’s in private sector by 92%(58327 combined IUCD’s and Implants Vs 30446 in 2011) • Increased provision of LTM’s in the public sector by 145%(44451 combined IUCD‘s and Implants Vs 18072 in 2011) • Over 317 providers in the private sector network as of Dec 2012 from 255 at end of 2011, 24% increase in number of providers in the private sector network.
• 250 IPC workers supporting the private sector network as of Dec 2012 • Over 300,000 women reached through IPC in 2012
Major Achievements cont.
• Increase in number of outreach teams from 5 to10 teams supporting the public sector in 12 regions.
• Increase in number of women counselled for HIV during FP counselling by 55% (82,891 in 2012 from 53,593 in 2011) • Increase in number of women referred for testing for HIV by 66%(16,849 in 2012 from 10,134 in 2011) • Increase in number of free condoms distributed by 98%(486,315 in 2012 from 245,541 in 2011)
LTM’s Insertions-Private Sector
45000 40000 35000 30000 25000 20000 15000 10000 5000 0 14700 3677 2009 12578 3650 2010 21833 8613 2011 40741 17586 2012 IUCD insertions Implant insertions
LTM’s Insertions-Outreach
30000 28459 25000 20000 15992 15000 10000 5000 12911 5161 0 994 2010 239 2011 2012 IUCD insertions Implant insertions
IUCD’s and Implants Distribution
30000 27155 25000 21370 20000 15418 15000 IUCD's distributed Implants distributed 10235 10000 4400 5000 0 400 2009 0 2060 2010 2011 2012
OC’s distribution
OC's Sales
1600000 1400000 1200000 1000000 800000 600000 400000 200000 0 525072 718092 663552 2009 2010 2011 1428336 2012 OC's Sales
Injectables distribution
Injectables sales
180 000 160 000 140 000 120 000 100 000 80 000 60 000 40 000 20 000 0 4 100 2010 18 090 2011 170 650 2012 Injectables sales
Familia condoms distribution
Familia condoms distribution
25 000 000 20 000 000 15 000 000 10 000 000 5 000 000 6 785 032 20 088 720 4 262 400 10 929 600 Familia condoms distribution 0 2009 2010 2011 2012
Misoprostol distribution
350000 300000 250000 200000 150000 100000 50000 0 191710
Misoprostol distributed
310 408 172080 177960 2009 2010 2011 2012 Misoprostol distributed
CYP’s growth
1 400 000 1 200 000 1 000 000 800 000 600 000 400 000 200 000 0 2009 2010 2011 2012 CYP's other FP methods CYP's condoms
PSI 24%
National CYP Contribution, Jan-Dec 2011 by organisation
T-MARC 7% MoHSW 69%
2013 Priorities
• Integrating other services to be delivered in the Familia social franchise • Increasing productivity of private network providers and IPC workers • Increasing sales of FP products • Introducing Clean Delivery Pack