NANCY WARREN, MPHCURAMERICAS 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

Liberian Context

Total population: 3,989,703Over 14 different ethnic

groupsMedian age is 17.9 yearsTotal Fertility Rate (TFR): ~5

children/womanMaternal mortality:

770/100,000 live birthsInfant mortality: 71/1,000 live

birthsFP Unmet need: 36%

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, LiberiaTargeted WRA, U2 mothers, and U5 childrenSix 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)

Overview (continued)

Program Design combines the Community-Based Impact-Oriented Methodology (CBIO) and Care Groups to provide community-based primary health care servicesOver five years, 120 general Community Health Volunteers (gCHVs) and 120 Trained Traditional Midwives (TTMs) trained One gCHV and one TTM

per community

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

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

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

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 oldFemale 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

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%

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%

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 demandClient has options

Community v. facility Wide variety of commodities

Trust and rapport with Nehnwaa StaffInvolvement of men in BCC programming

Limitations with Survey Data

All data is self-reportedUrban biasSample size less than 5% of beneficiary poolRecall biasInterviewer bias: beneficiary wanted to please

the interviewerFP indicator may be related to availability of

commodity

Conclusion: Benefits to Integration

Cost effective - utilizes existing staff and resources

Scaling up of comprehensive service provisionSynergy of effortsMeets demands for servicesPotential continuum of FP service provision by

current implementing partnerUtilizes a robust community mobilization &

intervention system

Conclusion: Challenges to Integration

Increased workload of all staff, particularly EPICombining FP & EPI data collection &

reporting tools LogisticsCommodity Stock-outs

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)

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

Questions?

For more information on

FP/EPI integration, visit:

http://www.k4health.org/toolkits/family-

planning-immunization-

integration

Thank you!