national family planning stimulus plan 2013...

National Family Planning Stimulus Plan 2013 - 2015

1

National Family Planning Stimulus Plan

2013 – 2015

Burkina Faso

Unity – Progress – Justice

MINISTRY OF HEALTH


2

Table of Contents

Abbreviations ......................................................................................................................................................... 3

Foreword by the Minister of Health ...................................................................................................................... 4

Acknowledgments ................................................................................................................................................. 5

Action plan development process ....................................................................................................................... 6

Family Planning in Burkina Faso ......................................................................................................................... 7

Plan Construction Context .................................................................................................................................. 7

Family Planning Stimulus ................................................................................................................................... 9 1. Recent Family Planning Initiatives ............................................................................................................ 9 2. Commitment of the Burkina Faso Government ......................................................................................... 9

Family Planning Challenges ..............................................................................................................................10 1. Creating demand ......................................................................................................................................11 2. Supply (product availability) .....................................................................................................................11 3. Access to Family Planning Services ........................................................................................................11 4. Monitoring and Evaluation ........................................................................................................................12

National Family Planning Stimulus Plan ........................................................................................................... 13

Stimulus Plan Objectives ...................................................................................................................................13 1. National objective .....................................................................................................................................13 2. Regional objectives ..................................................................................................................................13 3. Objectives by access route ......................................................................................................................14

Summary of priority actions and activities .........................................................................................................15 1. Creating demand ......................................................................................................................................15

1.1 Increase demand among rural populations through outreach .......................................................... 15 1.2 Increase demand among urban populations through mass media campaigns .................................. 16 1.3 Educate adolescents and young people about Family Planning....................................................... 17

2. Supply (product availability) .....................................................................................................................18 2.1 Reduce supply shortages in primary health facilities by improving information collection

and management .................................................................................................................................... 18 3. Access to Family Planning Services ........................................................................................................19

3.1 Improve quality of services in basic health facilities ....................................................................... 19 3.2 Improve coverage of suburban and rural populations through mobile units and advanced

strategies ................................................................................................................................................ 20 3.3 Improve coverage of rural populations by strengthening community-based services ..................... 22

4. Monitoring and Evaluation ........................................................................................................................23 4.1 Monitor and evaluate plan implementation ..................................................................................... 23

Stimulus Plan Budget ........................................................................................................................................24 1. Summary of Costs ....................................................................................................................................24 2. Budget Breakdown by Year......................................................................................................................26 3. Breakdown of Budgets .............................................................................................................................26 4. Presentation of the Costing Tool ..............................................................................................................30

Organization of Implementation and Monitoring ................................................................................................31 1. Principles..................................................................................................................................................31 2. Strengthening the DSME's Teams ...........................................................................................................31 3. Support for Governance of Implementation and Monitoring .....................................................................31 4. Monitoring Indicators ................................................................................................................................33

4.1 Performance indicators .................................................................................................................... 33 4.2 Process indicators ............................................................................................................................ 33

APPENDICES ....................................................................................................................................................... 34

Status and Challenges ......................................................................................................................................34 1. Creating demand ......................................................................................................................................34 2. Supply (product availability) .....................................................................................................................36 3. Access to Family Planning Services ........................................................................................................37 4. Monitoring and Evaluation ........................................................................................................................38

Breakdown of Regional Objectives by Distribution Route .................................................................................39

Breakdown of Activities and Sub-Activities ........................................................................................................45


3

Abbreviations

ABBEF: Association Burkinabé de Bien Etre Familiale [Family Wellness Association of Burkina Faso]

BURCASO: Conseil Burkinabé des ONG/ OBC et associations de lutte contre les IST/ VIH SIDA [Burkina Faso Council of NGOs/CBOs and associations combating STI/HIV AIDS]

DGISS: Direction Générale de l’Information et des Statistiques Sanitaires [Directorate General for Health Statistics and Information]

DGSF: Direction Générale de la Santé de la Famille [Directorate General for Family Health]

DRS: Direction Régionale de la Santé [Regional Health Department] or Directeur Régional de Santé [Regional Health Director]

HD: Health District

DSME: Direction de la Santé de la Mère et de l’Enfant [Maternal and Child Health Department]

PCEd: Population and Citizenship Education:

E&P: Equilibres et Populations

HF: Health facility

TFR: Total Fertility Rate

MSI: Marie Stopes International

MDG: Millennium Development Goals

WHO: World Health Organization

NGO: Non Governmental Organization

FP: Family Planning

PROMACO: Projet de Marketing social et de Communication pour la santé [Health Social Marketing and Communication Project]

PS/CONAPO: Permanent Secretariat of the Conseil National de Population [National Population Council]

UNFPA: United Nations Population Fund

URCB / SD: Union des Religieux et Coutumiers du Burkina Faso pour la promotion de la Santé et le Développement [Religion and Traditions Union of Burkina Faso for the Promotion of Health and Development]

USAID: United States Agency for International Development


4

FOREWORD BY THE MINISTER OF HEALTH

To be confirmed

Deeply convinced of the importance of Family Planning given the challenges of

population growth and reproductive health, Burkina Faso has undertaken major

initiatives. Through this Family Planning Stimulus Plan, Burkina Faso has set an even

more ambitious goal: to increase contraceptive prevalence among married women from

15% in 2010 to 25% in 2015.

In support of this ambition, the government, technical and financial partners, as well as

civil society representatives have worked together to develop a stimulus plan that

focuses on eight priority actions to be implemented immediately:

Increase demand among rural populations through outreach

Increase demand among urban populations through mass media campaigns

Educate adolescents and young people about FP

Reduce supply shortages in primary health facilities by improving information

collection and management

Improve the quality of service offered by primary health facilities

Improve coverage of suburban and rural populations through mobile units

and advanced strategies

Improve coverage of rural populations by strengthening community-based

services

Monitor and evaluate plan implementation

To facilitate the implementation of this plan, priority actions were broken down by

region, and contraceptive prevalence objectives specific to each region were set.

We recognize that achieving the objective set largely depends on the long-term

commitment of the government. We recognize our central role in the success of the

action plan, and we reaffirm the commitments made at the London Summit on July 11,

2012 before the international community.

To succeed, we will need the cooperation of all Family Planning stakeholders

[Signature of the Minister]


5

ACKNOWLEDGMENTS

The Ministry of Health would like to thank all the organizations, institutions and

individuals who contributed to the completion of this plan by participating in technical

committees, working groups and the validation of the document.

Special thanks are due to the members of the Ouagadougou partnership (French

Development Agency, Bill and Melinda Gates Foundation, Hewlett Foundation, French

Ministry of Foreign Affairs, USAID), to the other technical and financial partners (UNFPA,

WHO), NGOs and associations (ABBEF, BURCASO, EngenderHealth, Equilibres &

Populations, MSI, PROMACO, URCB), private sector representatives as well as external

consultants (including Futures Group and Futures Institute).


6

ACTION PLAN DEVELOPMENT PROCESS

The process of developing the national FP stimulus plan was defined by a Technical

Committee comprising government, technical and financial partners and civil society

representatives. A dedicated operational team developed the plan under the Technical

Committee's guidance.

This plan was developed based on a collegial, factual and operational approach.

Collegial approach

The plan was carried out in the context of a joint framework including all Family

Planning stakeholders: government, technical and financial partners and civil society.

The decisions and arbitrations were validated by all participants. The Regional Health

Directors also contributed in breaking the plan down into regional objectives and

activities.

Factual approach

The assessment of the FP situation in the country is based on factual analyses using

available data known to be substantiated, and interviews with the FP stakeholders. The

actions selected are those that showed the greatest potential impact in light of the set

objectives.

Operational approach focused on implementation

The plan includes the costs of each sub-activity, impact indicators and a monitoring

mechanism to ensure quick operationalization.


7

FAMILY PLANNING IN BURKINA FASO

Plan Construction Context

Demographic and health requirements make improving Family Planning a necessity.

From a demographic point of view, the total fertility rate remains high (6.0 children per

woman in 2010 1). However, Family Planning makes it possible to take decisive action

to bring about demographic change. Proactive development of contraceptive prevalence

(an increase of 1.5 percentage points per year) would enable the population of Burkina

Faso to be kept from exceeding 39 million by 2050. A slower progression of this

indicator (0.5 percentage points per year) would have the country's population grow to

55 million by 2050, i.e., 16 million more people2. This second scenario would result in

an excessively high proportion of young people in the population and put too much

pressure on available resources. It is therefore a major hindrance to the reduction of

unemployment and poverty, as well as access to education and health services.

Figure 1. Estimated population in Burkina Faso according to the evolution of contraceptive

prevalence

From a health point of view, Burkina Faso has a high maternal mortality rate (341 per

100,000 live births in 20103) and neonatal mortality rate (28 per 1,000 live births4).

However, 30% of maternal deaths could be prevented by improving Family Planning5.

1 2010 DHS (preliminary results)

2 Benefiting from the demographic dividend (Burkina Faso country profile/preliminary), 2011, Initiatives Conseil International

(International Initiatives Council), Agence Française de Développement (French Development Agency, AFD)



5 Plan to Accelerate the Reduction of Maternal and Neonatal Mortality in Burkina Faso, Ministry of Health, 2006

Population (millions)

39

2816

55

30

16

0

10

20

30

40

50

60

205020302010

-16

Trend evolution of

prevalence (+0.5 pp/year)

Proactive evolution of

prevalence (1.5 pp/year)

SOURCE: Benef iting f rom the demographic dividend (Burkina Faso country prof ile/preliminary), 2011, Initiatives Conseil International

(International Initiatives Council), Agence Française de Développement (French Development Agency, AFD)

An additional percentage point of contraceptive prevalence per year will slow population growth by 16 million by 2050


8

Figure 2. Evolution of maternal mortality in Burkina Faso

Family Planning indicators suggest there is significant room for improvement:

The level of unmet needs remains high (23.8% in 20106)

The increase in contraceptive prevalence has been moderate in recent years,

rising from 8.6% in 2003 to 15.0% in 2010, which is an annual increase of 0.9

percentage points7

There are significant disparities depending on a woman's level of education,

geography or place of residence. Thus, in 2010:

- Contraceptive prevalence is 44.2% among women with a secondary level of

education or higher, versus 11.2% for those with no education8

- Contraceptive prevalence ranges from 6.9% in Sahel to 31.2% in the Central

region9

- Contraceptive prevalence is 30.8% in urban areas, versus 10.8% in rural areas10






SOURCE: Plan to Accelerate the Reduction of Maternal and Neonatal Mortality in Burkina Faso, Ministry of Health, October

2006; Trends in Maternal Mortality: 1990 to 2020, WHO, UNICEF, UNFPA, and the World Bank Estimates’

300

370

450

560

700

1990 1995 2000 2005 2010

700

500

300

100

0

121

-60 %

1990-2010, per 100,000 live births

Objective of the

plan to accelerate

the reduction of

maternal and

neonatal mortality

(2015)

30% of maternal deaths could be prevented by FP1

1 Plan to Accelerate the Reduction of Maternal and Neonatal Mortality in Burkina Faso, Ministry of Health, October 2006


9

Figure 3. Currently married women using a modern method of contraception

Family Planning Stimulus

1. Recent Family Planning Initiatives

Measures to improve Family Planning in Burkina Faso have already been undertaken:

Adoption of a law on Reproductive Health in 2005

Implementation of the Strategic Plan for Securing Reproductive Health

Products for the 2009-2015 period

Repositioning FP as a priority of the 2011-2020 National Plan for Health and

Social Development (NPHSD)

Improving access to FP services

- Providing FP services free of charge

- Subsidizing contraceptives

- Community-based distribution of contraceptives with support from NGOs and

associations (contracting)

More recently, in February 2011, Burkina Faso hosted the Ouagadougou Conference

where eight governments in the sub-region, international donors and civil society

committed to improving access to information and to quality FP services.

Moreover, a strong country delegation participated in the Dakar International

Conference on Family Planning (ICFP): "Family Planning research and best practices"

in November 2011. The delegation was able to share and learn about the experiences of

other countries in improving FP.

2. Commitment of the Burkina Faso Government

The Burkina Faso government also raised its commitment to the highest possible level

at the Family Planning Summit in London in July 2012. At that time, the First Lady

reaffirmed the importance of Family Planning. This unconditional support from the

Burkina Faso government is reflected in three lines of action:

By locationBy level of education

SOURCE: Demographic and Health and Multiple Indicator Cluster Survey (preliminary), Measure DHS ICF Macro, 2010 Statistical Yearbook of Health

DGISS, 2011 (ongoing) Direc,

Ø 15,0

Sahel

6.9

East

Central

9.0

North

Central

9.3

West

Central

9.610.0

North

10.4

East

10.8

Boucle

de

Mouhoun

11.4

Plateau

Central

14.2

South

16.3

Casca.

18.0

Hauts

Bassins

26.8

Central

31.2

South

West

By region

0.40 0.420.82 2.210.41 2.24

-Weight of each segment of married women

aged 15 to 49, 2011, million

0.38

%, 2010, 15-49 years old

Ø 15.0

Rural

10.8

Other

cities

29.2

Urban

areas

30.8

Ouagadou-

gou

32.6

11.2

25.2

44.2

No

Schooling

PrimarySecondary

or higher

0.45 0.33 0.130.12 0.15 0,28 0.25 0.24 0,13 0.26 0.25 0.24 0.20


10

Financially

The budget line for the purchase of contraceptives, created in 2008 (500 million CFA

francs/1 million US Dollars), will be maintained.

In terms of health policies

Efforts in terms of innovation, for example by allowing the introduction of subcutaneous

Depo-provera (Uniject), will be continued.

In terms of implementation and monitoring

Emphasis will be placed on partnering with the private sector, involving men, and

regularly and actively monitoring the availability of contraceptives

In addition, the government is committed to reaching the goals set by the plan for each

level: national, regional, district and health facilities.

Figure 4. Public budget for the purchase of contraceptives

Family Planning Challenges

Burkina Faso faces several challenges affecting the major determinants of Family

Planning: creating demand, supply (product availability), access to FP services,

monitoring and evaluating activities.

Eight challenges were identified after the diagnostic analysis that preceded the

development of the National Family Planning Stimulus Plan (see more information in

the Appendix "Status and Challenges"):

SOURCE: Ministry of Health data

668

600

500

359

20112010

3001

200920082007

CFA francs (millions)

1 Decrease due to reconstruction ef forts af ter the 2009 f loods


11

1. Creating demand

Challenge No. 1: rural demand11:

- 1.5 million women do not want to space out or limit births

- 160,000 women want to space out births but know little about FP or have a poor

understanding of it

- 280,000 women want to space out or limit births but are opposed to FP

Challenge No. 2: urban demand12:

- 280,000 women do not want to space out or limit births


understanding of it


Challenge No. 3: demand among youth and adolescents:

- 2.2 million13 girls and adolescents under 15 in 2010 will be of childbearing age

by 2020

2. Supply (product availability)

Challenge No. 4: small-scale supply shortages in primary health facilities

persist despite improvements observed since the second half of 2011:

- Less than 6% of health facilities have experienced supply shortages for the most

widely used contraceptives in 201214

- These breaks are mainly caused by deficiencies in the collection and

management of information about stocks

3. Access to Family Planning Services

Challenge No. 5: quality of service and equipment at health facilities:

- 400,000 married women do not have access to FP because of the health

facilities' poor quality of service and equipment15

Challenge No. 6: access for people living in suburban areas:

- 50,000 married women living in suburban Ouagadougou and Bobo-Dioulasso

have unmet FP needs partly due to inadequate access to health facilities16

11 2010 DHS; Technical Committee; 2012 population projection

12 2010 DHS; Technical Committee; 2012 population projection

13 Demographic projections from 2007 to 2020 by region and province from 2007 to 2020 by region and province, 2009, INSD

14 Pills, injectables and implants

15 Estimated using data from the RESPOND project; Technical Committee; 2012 population projection

16 Unmet needs for contraception in formal and informal neighborhoods of Ouagadougou, Institut National d’Etude

Démographique [National Institute for Demographic Studies], Paris, Population Sciences Higher Education Institute

(ISSP), Université de Ouagadougou [Ouagadougou University], 2011; Technical Committee; 2012 population projection


12

Challenge No. 7: rural access:

- 710,000 married women live more than 10 km from a health facility17

4. Monitoring and Evaluation

Challenge No. 8: the quality and completeness of available data can be

improved

- The frequency of collecting and monitoring key indicators does not allow for

close monitoring of the FP program

17Statistical Yearbook of Health, DGISS, 2011; Technical Committee


13

NATIONAL FAMILY PLANNING STIMULUS PLAN

Stimulus Plan Objectives

1. National objective

The national objective set consists of achieving a modern contraceptive prevalence of

25% for married women in 2015 (this figure was set at 15% in 2010). The effort to be

made between 2012 and 2015 is therefore 2.7 percentage points per year18. To achieve

this objective, 332,000 additional women must begin FP by 2015.

Although this goal seems ambitious, it remains an imperative for Burkina Faso in its

mission to manage the population and reduce maternal and child deaths.

Figure 5. Target for contraceptive prevalence in 2015

2. Regional objectives

The national objective for contraceptive prevalence was defined at the regional level by

establishing a classification of regions according to their potential (high, medium and

low). This potential was calculated based on the number of women of childbearing age

and the rate of unmet needs.

The Regional Health Directors have established regional objectives for increasing

contraceptive prevalence by between 1.0 and 3.5 percentage points per year depending

on the potential in each region.

18 Considering that the historical evolution from 2003 to 2010 continued from 2010 to 2012

1715

9

54

25

1992/93

+ 8

Target

2015

2012 1201020031998/99

Prevalence of modern contraception and

objective for 2015% women between 15 and 49 years old

Target 2015

869,000

537,000

332,000

2012

537,000

Married women using contraceptives and objective

For 2015

Women between 15 and 49 years old

SOURCE: 1992/1993; 1998/1999; 2003 and 2010 DHS; Demographic projections from 2007 to 2020 by region and province 2009,

National Institute for Statistics and Demographics (INSD)

1 Projected prevalence f rom 2010 (DHS) to 2012 based on the trend f rom 2003 to 2010

17 %

25 %

Including

50,000

women to

maintain

At 17% in

2015

#Contraceptive

prevalence


14

Figure 6. Regional contraceptive prevalence objectives

Consultation conducted with the DRSs on regional objectives has made it possible to set

a more ambitious goal of 392,000 additional women to cover by 2015 (27%

contraceptive prevalence). The difference between the regional objectives and the

national objective, i.e., 332,000 additional women by 2015 (25% contraceptive

prevalence), will create a necessary scope for action in this type of program.

3. Objectives by access route

The objective was divided among the various access routes: public health facilities, private

health facilities, community-based distribution and mobile units/advanced strategy. Public

health facilities will contribute 50% to the achievement of the objectives.

Figure 7. Distribution according to access route for additional women between now and 2015

Regions

with strongpotiential

Regions

with averagepotential

Regions

with weakpotential

4

7

18

10

9

25

23

25

25

49

56

46

94

West Central

Southwest

Cascades

Plateau Central

South Central

Sahel

North Central

North

East

East Central

Hauts Bassins

Boucle du Mouhoun

Central

Additional women

2013-2015,

Thousands of women 1Regions 2015, target

1 Married women, aged 15-49

SOURCE: Technical committee

Total

46%

25%

42%

27%

18%

21%

19%

18%

11%

24%

26%

22%

13%

27%392

2012, estimated

32%

12%

31%

11%

10%

13%

11%

10%

8%

20%

17%

19%

11%

17%

Prevalence1

Distribution of additional women by access route

Married women; 2013-2015

SOURCE: 2010 (Preliminary) DHS; Statistical Yearbook of Health, DGISS, 2011 (preliminary version); MSI; ABBEF; interviews

50%

6%

19%

25%

Total 392,000

Mobile units/Advanced strategies 99,0001

Community-Based Distribution 73,000

Private health facilities 23,000

Public health facilities 197,000

1 Including 66,000 f rom Mobile Units


15

Summary of priority actions and activities

1. Creating demand

1.1 Increase demand among rural populations through outreach

Educate national leaders about outreach activities

Each year, the most influential national traditional and religious leaders will be educated

about FP in order to gain their support in organizing outreach activities.

Monitor and coordinate outreach activities

Implementation and monitoring structures at the central, regional and district levels will

be strengthened in order to supervise outreach activities while civil society will be

widely involved in this action.

Train local leaders

Traditional and religious leaders will be trained in each district (e.g., using Religious

and Traditional RAPID advocacy tools). Individual monitoring will ensure the messages

they deliver are consistent.

Conduct educational outreach with the support of local leaders

Local leaders and facilitators will carry out joint outreach activities bringing

homogeneous groups (e.g., religious, ethnic, gender or age groups) together.

Integrate FP activities in the Community Development Plans

The communes will be encouraged and supported such that FP is included in their

community development plans.

Train facilitators of women's homes on community-based services

Facilitators at women's homes will be trained in counseling in order to add FP to their

package of activities.

Organize FP week in each district

A FP week will be organized in each district: demonstrations on using contraceptives,

theater forum, free clinical services to winners and organization of a

conference/discussion.


16

Figure 8. Implementation schedule – Increase demand among rural populations through

outreach

1.2 Increase demand among urban populations through mass media campaigns

Identify barriers to the use of FP and define target profiles

Use existing studies and conduct new surveys if necessary to determine the barriers to

using FP in order to identify target profiles.

Define the messages and channels that correspond to each profile

Messages will be designed for each profile using the analysis of barriers to using FP.

Design and test the mass media campaign

The TV campaign will then be designed and tested with the aid of "focus groups." Once

validated, the TV spots will be converted into radio spots and billboards.

Broadcast the mass media campaigns (television, radio and billboards)

TV and radio spots as well as discussion shows will be broadcast on public and private

television and radio while a billboard campaign will be organized in large urban centers.

Costs of broadcasting will be minimized thanks to a multi-year partnership with public

and private broadcasters.

Conduct an Internet campaign (particularly on social networks)

A full-time person will be responsible for disseminating messages on FP on the Internet

and in particular through social networks.

Conduct outreach at major national events

2013 2014 2015

Review

of tools


Activity

Integrate FP activities in Community

Development Plans

Conduct educational outreach

with local leaders

Train local leaders

Train facilitators of women's homeson community-based

services

Monitor and coordinate

outreach activities Implementation

of the monitoring

framework

Educate national leaders about outreach

activities Mapping

of leaders

D.1.1

D.1.2

D.1.3

D.1.4

D.1.5

D.1.6

D.1.7

Activities

Reminder/refresher activities

D.1


Schedule - Increase demand among rural populations through outreach


17

Outreach campaigns will be carried out during major national events (e.g., Panafrican

Film and Television Festival of Ouagadougou [FESPACO], Integrated Information and

Guidance Services [SIAO]).

Support the implementation and monitoring framework

Audience and impact research will assess the results of communication campaigns

which will thus be improved if necessary (frequency, messages, methods or routes).

Figure 9. Implementation schedule – Increase demand among urban populations through

mass media campaigns

1.3 Educate adolescents and young people about Family Planning

A mass media campaign specifically directed at young people will be conducted

according to the process followed for the mass media campaigns:

Identify barriers to the use of FP among young people and adolescents

Define the messages and channels that are appropriate for young people and

teenagers

Design the communication campaign

Broadcast the communication campaign

Other actions are planned:

Revitalize education about population in the formal and informal systems

A plan to extend educational activities about population will be designed after the

diagnostic analysis. Education about population will then be further strengthened in

formal and informal systems.

Train school nurses

2013 2014 2015

Conduct an Internet campaign

(particularly on social network)


Create a

Website


Audience

study

Define the messages and channels

that correspond to each profile Focus group

Audience

study

Audience

study

Identify barriers to the use of

FP and define target profiles Segmentation

study

Support the implementation and monitoring

framework

Focus group

Activity

Segmentation

study

Review of studies

on barriers

Broadcast the mass media campaign

(television, radio and billboards)

Focus Group

D.2 Schedule - Increase demand among urban populations throughmass media campaigns

SOURCE: Comit é technique

D.2.1

D.2.2

D.2.3

D.2.4

D.2.5

D.2.6

D.2.7

Activities

Segmentation

study


18

School nurses will receive specific training regarding a "young approach" intended to

give them the means to inform and guide young students.

Participate in building Listening Centers for Young People (CEJ)

CEJ facilitators will be trained in the "young approach" and center equipment will be

improved in order to reach young people in and out of school.

Figure 10. Implementation schedule – Educate adolescents and young people about FP


2.1 Reduce supply shortages in primary health facilities by improving information

collection and management

Inventory the availability of contraceptives

The annual survey on the availability of contraceptives will give a better understanding of the supply situation.

Hold national and regional workshops about the contraceptive acquisition

tables (TAC)

Backing for management of meetings for constructing TACs at central and regional levels will be supported in order to further efforts to estimate future contraceptive acquisition needs.

Strengthen coordination among health districts for redistributing contraceptives

Redistribution of stocks among the various districts will be encouraged and supported.

Complete staff training on the use of information systems

Training in the use of information systems (CHANNEL) will continue.

2013 2014 2015Activity

Participate in building Listening Centers

for young people

Train school nurses

Revitalize education about population in the

formal and informal systemsAdvocacy


Focus GroupDefine the messages and channels that are

appropriate for young people and adolescents

Segmentation

study


Focus group

Segmentation

study

Segmentation

study

Focus group

Review of studies

on barriers


Schedule - Educate adolescents and young people about FPD.3

D.3.1

D.3.2

D.3.3

D.3.4

D.3.5

D.3.6

D.3.7

Diagnosis and

planning

Implementation and monitoring

Activities


Identify barriers to the use of FP

among young people and adolescents


19

Strengthen agents' skills in data consolidation/collection and supervision

Agents' data consolidation and collection skills (SIGL) will be strengthened and

managers of health facility supplies will be monitored and supported by District

Distribution Depot teams.

Supervise managers of health facility supplies

Managers of health facility supplies will be supervised and supported by District

Distribution Depot (DRD) teams.

In addition, 5.3 billion CFA francs (9.9 million US dollars) will be needed between 2013

and 2015 to secure the supply of contraceptives.

Figure 11. Implementation schedule – Reduce supply shortages in primary health facilities

by improving information collection and management


3.1 Improve quality of services in basic health facilities

Improve training of service providers

Health facility staff will be trained in two areas: counseling and clinical FP. These initial

training sessions will also be complemented by refresher courses to ensure consistent

service quality. The training effort will be adjusted according to the identified potential

of the region.

Finish equipping Health Facilities

Health facilities will be equipped and their equipment will be regularly replaced to

ensure service continuity. The equipment selected will be appropriate for health

2013 2014 2015

trainingtrainingtrainingtraining

Inventory the availability of contraceptives Availability

study

Availability

study

Availability

study

National/

regional

TAC

National/

regional

TAC

National/

regional

TAC

Hold national and regional workshops about

the contraceptive acquisition

tables (TAC)

training

Strengthen coordination within the health district

for supplying contraceptives again

Strengthen agents' skills for data

consolidation/collection

and supervision

Complete staff training on the use

of information systems

National/

regional

TAC


training

Activity

National/

regional

TAC

National/

regional

TAC

Activities



O.1

O.1.1

O.1.2

O.1.3

O.1.4

O.1.5

O.1.6

Schedule - Reduce supply shortages in primary health facilitiesby improving information collection andmanagement


20

facilities without electricity and include sterilization equipment. The equipment

improvement effort will be adjusted according to the identified potential of the region.

Monitor and evaluate changes in service quality

A national registry of the training received by each provider will be implemented while

reproductive health officials will conduct facilitative supervision visits specifically for

FP.

Reward the best health facilities and health districts

The best health facilities and health districts will be rewarded to motivate staff working

there.

Test Uniject injectables in pilot areas

Health Districts will be selected to test Uniject injectables.

Figure 12. Implementation schedule – Improve quality of services provided by primary

health facilities

3.2 Improve coverage of suburban and rural populations through mobile units and

advanced strategies

Identify additional needs in terms of mobile units

Needs in terms of mobile units will be mapped to assess the areas that require

strengthening of these services.

Acquire infrastructure and equipment for mobile units

Vehicles, motorcycles and sterilization equipment will be acquired.

Acquire supplies for mobile units

2013 2014 2015

Implementing a

national registry

Monitor and evaluate changesin service quality

Bonus

distribution

Bonus

distribution

Reward the best Health Facilities

and health districts

Activity

Finish equipping Health FacilitiesMapping

Improve training of service providersNeeds

survey

Test Uniject injectables in pilot areasStudy

Activities



A.1.1

A.1.2

A.1.3

A.1.4

A.1 Schedule - Improve service quality in Basic Health Facilities

A.1.5


21

Each mobile unit will receive an initial supply of medical and non-medical consumables

and the supply will be replenished daily after unit deployments.

Train service providers for mobile units

Units will consist of a doctor, midwife, midwife assistant, driver and two social

marketing agents.

Conduct educational and communication campaigns before the mobile unit

goes through an area

Social marketing agents will announce and promote the deployment of the mobile unit

shortly before it goes through an area to create demand and inform people about the

services that will be provided.

Conduct mobile unit deployments

Mobile units will make regular tours to offer women a full range of contraceptives when

fixed health facilities sites cannot do so.

Monitor and evaluate the activities of mobile units

Units will be regularly supervised and audited to ensure the quality of services provided.

Implement advanced strategies

The staff at health facilities with good levels of personnel and equipment will go to

facilities that are not as well-equipped on a fixed date (e.g., the 17th of every month) to

offer a full range of contraceptives. Health facilities that receive such visits will be

responsible for publicizing the visits and providing temporary solutions until they take

place.

Figure 13. Implementation schedule – Improve coverage of suburban and rural populations

through mobile units and advanced strategies

2013 2014 2015

Conduct educational and communication

campaigns before the mobile unit goesthrough an area


Monitoring

meeting

Monitoring

meeting

Monitoring

meeting

Monitoring

meeting

Monitoring

meeting

Monitor and evaluate the activities of

mobile units

MappingImplement advanced strategies

Activity


Training Training TrainingTrain service providers for mobile units

RenewalRenewalAcquisition

Acquire new infrastructure and

equipment for mobile units Acquisition

Identify additional needs in

terms of mobile units Mapping

Activities



A.2.1

A.2.2

A.2.3

A.2.4

A.2.5

A.2.6

A.2Improve coverage of suburban and rural populations throughMobile Units and advanced strategies

A.2.7

A.2.8


22

3.3 Improve coverage of rural populations by strengthening community-based services

Community-based services make it possible to reach populations that are not near health

facilities:

Strengthen FP's position in Community-Based Services

Communicate the value of CBD for FP to health care professionals, who will

communicate this message to the public. Also, strengthen the interaction between health

care professionals and CBD agents.

Strengthen the partnership between public bodies and Community-Based Services.

Integrate the activities of agent management structures into the action plans of the health

districts and support national and local consultation frameworks for dialogue between

NGOs, agent management structures and health departments.

Identify and meet additional needs for Community-Based Services

Additional agents will be recruited in areas requiring urgent reinforcement. They will

receive training and a marketing kit as well as an initial supply of contraceptives.

Enhance the quality of services provided by community agents

Agents will distribute condoms and pills and provide advice on all contraceptive

methods. Agents will refer women to Health Facilities based on what methods they are

not able to provide themselves or for an initial prescription.

Conduct supervision to improve and increase the services provided by agents

Supervision and evaluation visits will be conducted to ensure the effectiveness of the

service.


23

Figure 14. Implementation Schedule – Improve coverage of rural populations by

strengthening Community-Based Services


4.1 Monitor and evaluate plan implementation

Support staff in charge of monitoring and evaluation

Implementation and monitoring structures will be strengthened, in particular through the

recruitment of staff placed at the DSME.

Define key monitoring indicators, calculation methods, periodicity and clarify

collection responsibilities

A consensus will be reached regarding what indicators to monitor as well as what

calculation methods and collection frequency to use.

Train qualified staff to record and consolidate data

Staff qualified to consolidate data at the regional and health district levels as well as

those qualified to record health data in health facilities will be trained.

Provide tools for data collection and monitoring of patients in health facilities

Data collection registries and consultation forms needed to monitor patients will be

made available to health facilities.

Monitor and coordinate the implementation of the plan at the central, regional

and health district levels

Regions and health districts will monitor completion of activities and attainment of

objectives by holding regular meeting.

2013 2014 2015

Identify and meet additionalneeds for Community-Based

Services

Training Training Training Training Training

Conduct supervision to improve and increase

the services provided by agents

Activity

Consultation

meeting

Consultation

meeting

Consultation

meeting

Strengthen FP's position in

Community-Based Services Diagnosis

and planning

Strengthen the partnershipbetween

public bodies and

Community-Based Services

Mapping

Enhance the quality of service

provided by community agents

Activities



A.3.1

A.3.2

A.3.3

A.3.4

A.3.5

A.3Schedule - Improve coverage of rural populations by strengtheningCommunity-Based Services


24

Control the quality of data collected and its consolidation

A national survey conducted on a sampling basis will ensure the quality of data.

Figure 15. Implementation schedule – Monitor and evaluate the implementation of the plan

Stimulus Plan Budget

1. Summary of Costs

For the 2013-2105 period, the cost of the plan is 14.7 billion CFA francs (27.5 million

US dollars19)

Demand: 3.5 billion CFA francs/6.6 million US dollars

Supply (product availability): 0.7 billion CFA francs/1.3 million US dollars

Access: 4.4 billion CFA francs/8.2 million US dollars

Monitoring and evaluation: 0.8 billion CFA francs/1.5 million US dollars

Contraceptive purchasing: 5.3 billion CFA francs/9.9 million US dollars

19 Exchange rate of CFA francs/$ is 0.00187995 (rate on 09/03/2012)

2013 2014 2015

Define key monitoring indicators,

calculationmethods, periodicityand clarify collectionresponsibilities

Definition of

indicators

Baseline

indicator

survey

Support staff in charge of monitoring and

evaluation Implementation

of the framework

Activity

Control the quality of data collected

and its consolidation Data

quality survey

Data

quality survey

Data

quality survey

Monitor and coordinate the implementation

of the plan at the central, regionaland health district levels

Provide registries for data collectionProvision

of registries

Provision

of registries

Provision

of registries

Train qualified individuals to record

and consolidate data

Activities



Schedule - Monitor and evaluate the implementation of the planS.1

S.1.1

S.1.2

S.1.3

S.1.4

S.1.5

S.1.6


25

Figure 16. Budget breakdown by priority action (CFA francs)

Figure 17. Budget breakdown by priority action (US dollars)

The FP stimulus budget is 9.4 billion CFA francs excluding contraceptives

(14.7 billion CFAF including contraceptives)

811

811

669

700

Urban populations (mass media campaigns) 1,195

Total Monitoring & Evaluation

1,638

Total 14,651

Purchase of contraceptives3 5,274

Rural populations (outreach)

Total excluding contraceptives 9,377

Monitoring and evaluation of plan implementation

Total Access 4,365

Community-based services 1,366

Mobile units and advanced strategies 1,335

Primary health facility service quality

669

1,665

Total Supply

Reduce supply shortages through information

management2’

Total Demand 3,533

Youth and adolescents


Creating

demand

Monitoring

and evaluation

Supply

(productavailability)

Access

Products

D.1

D.2

D.3

A.1

A.2

A.3

S.1

O.1

Budget1 million CFA francs, 2013-2015

24%

5%

30%

6%

36%

100%

1 The costs do not include the involvement of the public health system (e.g., public of f icials' time)’ ’

2 Excluding the cost of contraceptives

3 Estimate based on Reality Check (USAID tool)

The FP stimulus budget is 17.6 million US dollars excluding

contraceptives (27.5 million US dollars including contraceptives)

Total Demand 6,641

Youth and adolescents 1,315

Total Monitoring & Evaluation

2,246

Rural populations (outreach)

Total 27,544

Purchase of contraceptives3

Urban populations (mass media campaigns)

9,915

Total excluding contraceptives 17,629

1,524

Monitoring and evaluation of plan implementation 1,524

Total Access 8,206

Community-based services 2,567

Mobile units and advanced strategies 2,509

Reduce supply shortages through information

management2’

Primary health facility service quality 3,130

Total Supply 1,257

1,257

3,080


Creating

demand

Monitoringand evaluation

Supply

(productavailability)

Access

Products

D.1

D.2

D.3

A.1

A.2

A.3

S.1

O.1

Budget1 thousand USD, 2013-2015

24%

5%

30%

6%

36%

100%

1 The costs do not include the involvement of the public health system (e.g., public of f icials' time)’ ’

2 Excluding the cost of contraceptives

3 Estimate based on Reality Check (USAID tool) )


26

2. Budget Breakdown by Year

Figure 18. Budget breakdown by year

The budget for carrying out activities is larger for the first year than subsequent years

due to launch costs.

3. Breakdown of Budgets

Figure 19. Allocated budget – Increase demand among rural populations through outreach

Budget1, Billion CFA francs, 2013-2015

SOURCE: 2010 (Preliminary) DHS; Statistical Yearbook of Health, DGISS, 2011 (preliminary version); MSI; ABBEF; interviews,

1 The costs do not include the involvement of the public health system (e.g., public of f icials' time);

the cost of contraceptives is based on a Reality Check (USAID tool) estimate

1.8 2.0

5.3

1.5

Cost of activities

Total

Cost of contraceptives

14.7

9.4

2015

4.6

2.6

2014

4.4

2.6

2013

5.7

4.2

Increase demand among rural populations through outreachD.1

510

696

261

1,638Total

Train facilitators of women's homes on

community-based services

Integrate FP activities in Community

Development Plans

27

2

Conduct educational outreach with the support

of local leaders

Train local leaders 125

Monitor and coordinate outreach activities

Educate national leaders about

outreach activities17D.1.1


1 The costs do not include the involvement of the public health system (e.g., public of f icials' time)

D.1.2

D.1.3

D.1.4

D.1.5

D.1.6

D.1.7

D.1


More than 48,000 outreach

activities conducted by morethan 370 facilitators



27

Figure 20. Allocated budget – Increase demand among urban populations through mass

media campaigns

Figure 21. Allocated budget – Educate adolescents and young people about FP

Increase demand among urban populations through mass

media campaignsD.2

146

813

1,195

126

Total

Support the implementation and

monitoring framework59

Conduct an Internet campaign

(particularly on social networks)

30

8

Broadcast the mass media campaign

(television, radio and billboards)


Define the messages and channels that

correspond to each profile12

Identify barriers to the use of FP and define

target profilesD.2.1


D.2.2

D.2.3

D.2.4

D.2.5

D.2.6

D.2.7

D.2

TV and radio campaigns

Billboard campaigns in major cities




Educate adolescents and young people about FPD.3

265

178

195

700

Train school nurses 45

Revitalize education about population in the

formal and informal systems



Define the messages and channels that are

appropriate for young people and teenagers

Identify barriers to the use of FP among young

people and adolescents0

Total

Participate in building Listening Centers for

young people’

D.3.1


D.3.2

D.3.3

D.3.4

D.3.5

D.3.6

D.3.7

D.3

Campaigns specifically targeting young

people (TV and radio spots, TV show)

Billboard and flyer campaigns in places

frequented by young people

Budget1, million CFA francs, 2013-2015



28

Figure 22. Allocated budget – Reduce supply shortages in primary health facilities by

improving information collection and management

Figure 23. Allocated budget – Improve service quality in Basic Health Facilities

O.1

120

109

162

247

669Total


Strengthen agents' skills for data

consolidation/collection and supervision

Complete staff training on the use of

information systems30

Strengthen coordination within the health

district for supplying contraceptives again1

Hold national and regional workshops about

the contraceptive acquisition tables (TAC)

Inventory the availability of contraceptivesO.1.1


O.1.2

O.1.3

O.1.4

O.1.5

O.1.6

O.1

Reduce supply shortages in primary health facilities by improving informationcollection and management

Training of 50 agents per year

on using information systems

78 regional workshops about

the contraceptive acquisitiontables per year



A.1

573

833

Total 1,665

86

Monitor and evaluate improvements

in service quality123

Finish equipping Health Facilities

Improve training of service providers

Reward the best Health Facilities

and health districts

50

A.1.1


A.1.2

A.1.3

A.1.4

A.1.5

Improve service quality in Basic Health Facilities

1,624 service providers

trained in clinical FP

3,789 service providers

trained in counseling

1,082 days of facilitative

supervision per year

Upgrading the equipment in

822 health facilities

Budget 1million CFA francs, 2013-2015


A.1

Test Uniject injectables in pilot areas


29

Figure 24. Allocated budget – Improve coverage of suburban and rural populations through

mobile units and advanced strategies

Figure 25. Allocated budget – Improve coverage of rural populations by strengthening


A.2

239

94

508

192

269

2

Total 1,335

Implement advanced strategies

Monitor and evaluate the activities of mobile units


Conduct educational and communication campaigns

before the mobile unit goes through an area

Train service providers for mobile units 5


Acquire infrastructure and equipment for

mobile units25

Identify additional needs in terms of

mobile unitsA.2.1



2 including one newly added unit

A.2.2

A.2.3

A.2.4

A.2.6

A.2.7

A.2

Improve coverage of suburban and rural populations through

mobile units and advanced strategies

5 mobile units2

each reaching an average of 4,430 new users of long-term methods per year

5,900 days of advanced

strategy per year

Budget1million CFA francs, 2013-2015

A.2.5

A.2.8

A.3

363

296

695

Total 1,366

Conduct supervision to improve and

increase the services provided by agents

Enhance the quality of services provided

by community agents

Identify and meet additional needs for


Strengthen the partnership between public

bodies and Community-Based Services 9

Strengthen FP's position in

Community-Based Services2A.3.1


A.3.2

A.3.3

A.3.4

A.3.5

A.3

Improve coverage of rural populations by strengthening


2,700 additional agents (in addition to

the current 4,500) trained and equipped

Regular refresher courses

7,200 days of agent supervision

per year




30

Figure 26. Allocated budget – Monitor and evaluate the implementation of the plan

4. Presentation of the Costing Tool

The costing tool allows for dynamic change of variables:

Type of activities (frequency, schedule and intensity)

Unit costs associated with each sub-activity

Regional distribution of activities

A total of more than 1,500 lines makes it possible to determine the costs of activities

and sub-activities.

Figure 27. Overview of the costing tool

Monitor and evaluate the implementation of the planS.1

212

202

113

66

811

194

Total

Control the quality of data collected

and its consolidation

Monitor and coordinate the implementation

of the plan at the central, regional and health district levels

Provide registries for data collection

Train qualified individuals to record

and consolidate data

Define key monitoring indicators,

calculation methods, periodicity and clarify collection responsibilities

22

Support staff in charge of monitoring

and evaluationS.1.1


S.1.2

S.1.3

S.1.4

S.1.5

S.1.6

S.1

Training of over 3,000 service

providers in recording health data

Provision of more than 3,000

data collection registries




31

Organization of Implementation and Monitoring

1. Principles

The National Family Planning Stimulus Plan will be implemented by the DSME. Two

guiding principles have been defined:

Implementation and evaluation of the plan require a strong commitment from

the government, partners and civil society representatives

DRSs are accountable for implementing the plan and monitoring indicators in

their region, including results dependent on non-public structures

2. Strengthening the DSME's Teams

To ensure the activities are carried out and the plan's results are monitored, the DSME's

staff will be strengthened. Three profiles will be recruited:

Physician specializing in reproductive health

- Monitor the completion of activities at the national level

- Prepare and facilitate meetings of steering and technical committees for FP

subjects

- Conduct a performance dialogue with DRSs, monitor their results and propose

corrective actions if necessary

Health associate specializing in reproductive health

- Support the physician specializing in reproductive health

- Ensure governance logistics (e.g., ensuring meetings are conducted properly,

agendas are followed, documents are prepared)

Health associate for monitoring and evaluation

- Facilitate information feedback in collaboration with the DGISS

- Create a national monitoring trend chart

- Support the regions in creating regional monitoring trend charts

This enhancement of the DSME will also benefit other reproductive health-related

activities.

3. Support for Governance of Implementation and Monitoring

The implementation of the FP stimulus plan will be based on existing coordination and

monitoring structures.


32

Figure 28. Governance for plan implementation

Central level

- Steering Committee: biannual steering of the main performance indicators and

implementation of strategic decisions

- Technical Committee: quarterly monitoring of process and performance

indicators and adjustment of the action plan if necessary

- DRS perspectives and assessment meeting: biannual review of results and

sharing of experiences among regional leaders

- National TAC: biannual estimate of future contraceptive needs and volumes to

acquire

Regional level

- Management Board: quarterly monitoring of indicators and decision-making

on the implementation of activities in the region

- Regional TAC: biannual estimate of future contraceptive needs for each region

Health District level

- PKI/district health team (ECD) meeting: quarterly monitoring of

performance indicators and decision-making on the implementation of activities

in the health district

- PKI/ECD/management committees (COGES) meeting: quarterly monitoring

of performance indicators and decision-making on the implementation of activities

with the involvement of communities and COGES

- District Health Council: biannual monitoring of performance indicators

(consultation framework expanded to include civil society)

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Every 6 months (add a point about the subject)

Activity

PKI/ECD meetings

(incorporation of health facilities

into the health district)

Frequency / sequencing

Health district

Quarterly (date varies depending on the

health district)

District health board

Regional

Biannually

1 month before the national TAC

Regional TAC

DRS assessment and

prospects meeting

National TAC

Biannually

Biannually

Quarterly

Biannually

Boards of directors

(incorporation of health districts

into the DRSs)

QuarterlyTechnical committee

Central

Steering Committee



33

4. Monitoring Indicators

4.1 Performance indicators

Performance indicators will be monitored at the national level by the DSME, the steering

committee and the technical committee, and at the regional and district levels. These

indicators will measure progress but only the contraceptive prevalence indicator, using

a population study, will be used to evaluate the success of the national contraceptive

stimulus plan.

Six performance indicators will be monitored on a quarterly basis:

Protection/year combination

New users of contraceptives

Number of women using contraceptives

Rate of abandonment

Number of health facilities/DRD that did not experience a supply shortage

during the period.

The bottlenecks will be identified by comparing regional data.

On the supply side, the annual survey on the availability of contraceptives will also

produce a more accurate annual picture.

4.2 Process indicators

Process indicators will be monitored at the national level by the DSME and the technical

committee as well as by the regions and health districts. The process indicators defined

will assess the achievement rate of the eight priority actions.

Figure 29. Model of process indicators

Quarter 1 of 2014

Demand

Supply (product availability)

Access

Monitoring and

evaluation

ILLUSTRATIVE

40 30 75% Staff trained

13 13 100% Supervision visits

76 75 99% Monitoring meetings Monitor and evaluate the implementation of the plan

2,700 2,700 100% Agent recruitments

200 145 73% Agents trained Improve coverage of rural populations by strengthening community-based services

5 5 100% Mobile units operational Improve coverage of suburban and rural populations through mobile units and advanced strategies

85 60 71% Supervisions

125 125 100% Health facilities equipped

540 540 100% Service providers trained Improve the service quality of primary health facilities

40 40 100% Staff trained Reduce supply shortages in primary health facilities by improving information collection and management

20 20 100% CEJ staff trained

3 2 67% Operational CEJs equipped

120 120 100% Planned TV and radio spots broadcast

Educate adolescents and young people about FP

540 540 100% TV and radio spots broadcast Increase demand among urban populations through mass media campaigns

400 400 100% Local leaders trained 4,000 3,500 88% Outreach activities Increase demand among rural populations

through outreach

Scheduled activities Completed

activities Rate of

completion

Scheduled/completed process indicators Priority actions

Q1 2014


34

APPENDICES

Status and Challenges

1. Creating demand

The total demand for spacing out or limiting births (whether met or not) among women

of childbearing age was 40% 20 in 2010: This is the first barrier to the use of Family

Planning.

Figure 30. Barrier to better contraceptive prevalence

Challenge No. 1: rural demand21:

- 1.5 million women do not want to space out or limit births


understanding of it


Challenge No. 2: urban demand22:

- 280,000 women do not want to space out or limit births


understanding of it


20 2010 DHS (preliminary)

21 2010 DHS (preliminary); Technical Committee; 2012 population projection

22 2010 DHS (preliminary); Technical Committee; 2012 population projection

2011, thousands, married women aged 15-49

SOURCE: 2010 (preliminary) DHS; 2003 DHS; 2007 to 2020 population projections by region and province, 2009, INSD

-27%-34%-16%

-60%

Women using FP

(contraceptive

prevalence)4

490

Women wishing

to use FP3

670

Women aware

of FP2

1,020

Women wishing

to space out or

limit births1

1,220

Total number

of women

3,030

100 % 40 % 34 % 22 % 16 %

Opposition to

spacing out or

limiting births

Ignorance

about FP

Opposition to

using FP

Supply shortages Problems with

access to services

1 2010 DHS2 The proportion of married women who know about FP and want to limit births but do not use FP was estimated as similar to the proportion of married

women who do not use and do not intend to use contraception in the future but who know about FP (2003 DHS data)’3 The proportion of married women who want to use FP but cannot was estimated as similar to the proportion of married women whodo not use and do

not intend to use contraception in the future, and cannot (2003 DHS data)

4 Modern and traditional contraceptive methods (2010 DHS data)

Proportion of the

population, %

Barriers

#


35

Figure 31. Distribution of women without access to FP

Outreach campaigns (e.g., involvement of local leaders, community agents) are

preferable for rural populations because of their limited access to media. On the other

hand, mass media campaigns are preferred for reaching urban populations, which have

greater access.

Figure 32. Exposure to FP messages and total FP demand according to place of residence

Challenge No. 3: demand among youth and adolescents:

- 2.2 million23 girls and adolescents under 15 in 2010 will be of childbearing age

by 2020.

23 Demographic projections from 2007 to 2020 by region and province from 2007 to 2020 by region and province, 2009, INSD

2011, thousands, married women aged 15-49

280

1,530

40

160

70

280

Opposition to

using FP

Women who do not

want to space out or

limit births1

Women who want to

space out or limit births

but know little or

nothing about FP2

Women who want to

space out or limit births

and know about FP but

do not want to use it3

Obstacles Positive perception

of high fertility

Information on the

existence of FP

and the methods

available

Information on the

benefits of using FP

Information on

the benefits of

limiting/spacing

out birthsMessages

Total

390

1,970

SOURCE: 2010 (preliminary) DHS; 2003 DHS; 2007 to 2020 population projections by region and province from 2007 to 2020 by region and province, 2009, INSD

1 2010 DHS

2 The proportion of married women who know about FP and want to limit births but do not use FP was estimated as similar to th e proportion of married women to do not use and do not

intend to use contraception in the future but who know about FP (2003 DHS data)

3 The proportion of married women who want to use FP but cannot was estimated as similar to the proportion of married women who do not use and do not intend to use contraception

in the future and cannot (2003 DHS data)

Ignorance about FP

Total 1,810 200 350

Urban

population

Rural

population

SOURCE: 2003 DHS, 2010 DHS; Demographic projections f rom 2007 to 2020 by region

and province 2009, INSD

2010, %, women aged 15-49

36

56

Rural environmentUrban environment

820 2,210

Married women, thousands,

aged 15-49, 2011x

Total FP demand, married women,%

Exposure to at least one message

on FP through mass media


36

Figure 33. Burkina Faso population age pyramid

Therefore, to increase the level of total demand, young people must be educated since they

will, in the future, form the majority of the population of women of reproductive age.


Challenge No. 4: small-scale supply shortages in primary health facilities

persist despite improvements observed since the second half of 2011

After significant supply shortages in 2011, stakeholders' actions have reduced shortages

at primary health facilities for the most popular products24 to less than 6% in 2012. Thus,

several recent initiatives greatly reduced national supply shortages that occurred in the

past (e.g., implants in 2011), in particular with:

- Implementing Contraceptive Acquisition Tables (TAC)

- Launching weekly monitoring of the supplies of Health Facilities and District

Distribution Depots

24 Pills, injectables and implants

SOURCE: Demographic projections f rom 2007 to 2020 by region and province f rom 2007 to 2020 by region and province, 2009, INSD

5-9 1,215

10-14 1,021

15-19 834

20-24 746

25-29 609

30-34 514

35-39 386

40-44 335

45-49 259

2010-2020, thousands, aged 5 to 49

1,282

1,034

809

615

472

410

324

276

219

2,200

Total

3,000

5-9 1,608

10-14 1,405

15-19 1,197

20-24 1,001

25-29 815

30-34 729

35-39 592

40-44 494

45-49 367

1,686

1,488

1,252

948

689

514

405

360

285

2010 2020

AgeMen WomenAge Men Women


37

Figure 34. Inventory of the availability of contraceptives

However, interviews with those involved in the supply of contraceptives (at the central,

regional and health facility levels) emphasized weaknesses in the system for collecting

and managing information about supplies:

- In health facilities, supply managers are poorly trained and educated about the

importance of feedback

- Health districts do not always transmit the number of shortage days recorded at

health facilities and the method of taking shortages into account when

determining future needs is not consistent

- At the central level, the needs generated by future activities (e.g., activities to

create demand) are not taken into account when determining future needs


Challenge No. 5: quality of service and equipment at health facilities:

- 400,000 married women do not have access to FP because of the health

facilities' poor quality of service and equipment25

Challenge No. 6: access for people living in suburban areas:

- 50,000 married women living in suburban Ouagadougou and Bobo-Dioulasso

have unmet FP needs partly due to inadequate access to health facilities26

Challenge No. 7: rural access

- 710,000 married women live more than 10 km from a health facility27

25 Estimated using data from the RESPOND project; team analysis; 2012 population projection

26 Unmet needs for contraception in formal and informal neighborhoods of Ouagadougou, Institut National d’Etude

Démographique, Paris, ISSP, Université de Ouagadougou, 2011; Technical Committee; 2012 population projection

27Statistical Yearbook of Health, DGISS, 2011

SOURCE: Interviews; Survey on the availability of modern contraceptives and maternal health products at the points of service delivery in BurkinaFaso, Ministry of Health, UNFPA, 2011 DHS 2010 (preliminary), on-site visit to the Kombissiri Health District(July 18, 2012)

Primary health facilities out of supplies (UNFPA survey)%, 2011

5

4

26

Not measured3

Health facilities out of

supplies at month end%, 2012, average from January

to June, Kombissiri Health District1

6

2

4

7

Not distributed

Use of various

contraceptive methods2

Thousands of married women

aged 15-49, 2011

9

97

48

103

188

Condoms

Pills

Injectables

Implants

IUD

1 Contraceptives usually distributed by health facilities: male condoms, pills (Microgynon), injectables (Depo-Provera), implants (Jadelle) and IUD2 Data on contraceptive use (DHS, 2010); data on the number of married women aged 15 to 49 (INSD)3 The UNFPA survey shows that implants are not available in 47% of health facilities and IUDs are unavailable in 80% of health facilities; however these figures

are largely due to health facilities' inability to administer these methods (e.g., lack of qualified or trained staff, lack of equipment)

Not measured3


38

Long-term contraceptive methods and injectables are mainly used in countries that have

achieved high contraceptive prevalence. Access to these contraceptive methods remain

limited in Burkina Faso.

Figure 35. Rate of use of the various contraceptive methods


Challenge No. 8: The quality and completeness of available data can be

improved

Figure 36. Availability and measurement frequency of key indicators

Contraceptive prevalence reported by married women (modern methods)

%, 15-49 years old

SOURCE: Demographic and Health and Multiple Indicator Cluster Survey (DHSBF-MICS I, II, III and IV), Measure DHS and ICF Macro

1993, 1999, 2003 and 2010 (preliminary)

4.3 4.8

6,2

3.02.9

2.5

1.00.40.1

2010

15.0

3.90.2

2003

8.6

1.70.1

1999

4.8

1.10.4

1993

4.1

0.1 4.9

10.2

20.8

25.8

26.3

Rwanda

45,2

7.6

1.1

Malawi

4,8

11.3

0.2

Ethiopia

27.3

0.5

6.0

Short-term (excluding injectables)

Injectables

Long-term

Other

Burkina Faso

1993 to 2010

Other countries

2010

Data collection

Distribution

Availability

Communication

Volume distributed

by health facilities (by type of contraceptive

and health facility)

Areas

Coverage

Key indicator

SOURCE: Statistical Yearbook of Health, DGISS, 2011; interviews

Quarterly (DGISS)

2 times a year (TAC)

Number of days of

supply shortage (by type of contraceptive and

health facility)

Number of persons

qualified to dispense contraceptives (by type of

contraceptive and district)

2 times a year (DGISS)

Quarterly (DGISS)

Annually (Survey

on the availability of modern contraceptives)

Number of communication

activities (by type of activity and district)

Quarterly (for outreach

activities – DGISS)

Structures

currently affected

Public

Private for-profit

Public

Private for-profit

Public (excluding

community workers)

Public

Private for-profit

Contracted NGOs

(low quality of data collected)

Data consolidation

and transmission

2 times a year

(DGISS)

The DGISS does

not consolidate this data

Annually (Survey

on the availability of modern

contraceptives)

Quarterly

(for outreach activities – DGISS)

Annually (DGISS)

2 times a year (TAC)


39

Breakdown of Regional Objectives by Distribution Route

Figure 37. Actions and objectives – Central region

Figure 38. Actions and objectives – Boucle du Mouhoun region

Proposed actions

94

9

32

6

47

138 service providers trained in clinical FP1

322 service providers trained in counseling1

92 days of facilitative supervision per year

Upgrading equipment in 46 health facilities as

of 2013

Public health

facilities

Goal sheet: Central regionCurrent

coverage,

2012, thousands

Improved coverage by the current 3 mobile

units to reach an average of 4,430 new users

of long-term methods per year per unit.

Mobile units also cover the Plateau-Central

and South Central regions

331 days of advanced strategies per year

Mobile

units and

advanced

strategies

760 additional agents (added to the current 433)

trained and equipped with a complete

demonstration kit

Establish regular ref resher courses and

replenish kits

1,193 days of agent supervision per year

CBD

Private health

facilities

Additional

women expected

2013-2015, thousands

SOURCE: DHS 2010 (Preliminary), General Census of Population and Housing (GCPH) 2006 in Burkina Faso, Technical Committee,

ABBEF data, MSI Data, Interviews

39

86

134

5

5

Demand creation will also be ensured by:

– 6,000 outreach activities

– Mass media activities (shared with other regions). (e.g., 2 spots

per day on Burkina National Television (TNB), 9 months per year)

Establish methods to ensure regional monitoring

1 additional woman per

week per provider trained

in counseling

The units cover 4,430

additional women per year

2 additional women per day

of advanced strategy

Increase coverage of existing

agents to 12 women

Comments

1 Number of service providers trained over 3 years

Goal sheet: Boucle du Mouhoun region



Proposed actions

46

4

4

1

37





of 2013

Public health

facilities

Current

coverage,

2012, thousands

No mobile unit provided


Mobile

units and

advanced

strategies



demonstration kit


replenish kits

386 days of agent supervision per year

CBD

Private health

facilities

34

7

26

0

0

Comments

Additional

women expected


Less than one additional

woman every other week

per service provider trained

in counseling



– Mass media activities (shared with other regions).

(e.g., 2 spots per day on TNB, 9 months per year)






agents to 12 women


40

Figure 38. Actions and objectives – Hauts-Bassins region

Figure 39. Actions and objectives – West Central region

Goal sheet: Hauts-Bassins region



Proposed actions

56

2

17

5

32





of 2013

Public health

facilities

Current

coverage,

2012, thousands

Introduction of one mobile unit


Mobile

units and

advanced

strategies



demonstration kit


replenish kits


CBD

Private health

facilities 24

81

0

108

2

The unit covers 4,430 additional

women per year

’



Comments

Additional

women expected











in counseling


agents to 12 women

Goal sheet: West Central region



Proposed actions

49

5

17

1

26





of 2013

Public health

facilities

Current

coverage,

2012, thousands

Improved coverage of the current mobile unit to

reach an average of 4,430 new users of

long-term methods per year per unit.


Mobile

units and

advanced

strategies



demonstration kit


replenish kits


CBD

Private health

facilities

22

7

13

2

1

The current unit covers 4,430

additional women per year

’



Comments

Additional

women expected


One additional woman every

3 weeks per service provider









agents to 12 women


41

Figure 40. Actions and objectives – East Central region

Figure 41. Actions and objectives – East region

Goal sheet: East Central region



Proposed actions

25

3

4

11

7





of 2013

Public health

facilities

Current

coverage,2012, thousands

Mobile

units and

advanced

strategies

No additional agent provided

(currently 700)

Establish regular ref resher courses

for current agents


CBD

Private health

facilities

25

6

19

0

1

Comments

Additional

women expected





in counseling









2 additional women per

day of advanced strategy

Increase coverage of

existing agents to 12 women

Goal sheet: East region



Proposed actions

25

10

3

1

11





of 2013

Public health

facilities

Current

coverage,

2012, thousands

Mobile

units and

advanced

strategies



demonstration kit


replenish kits


CBD

Private health

facilities

34

26

7

0

0

Comments

Additional

women expected













in counseling



Increase coverage of

existing agents to 12 women


42

Figure 42. Actions and objectives – North region

Figure 43. Actions and objectives – North Central region

Goal sheet: North region



Proposed actions

23

9

4

1

9

Current

coverage,

2012, thousands

28

6

21

0

1

Comments

Additional

women expected









woman every 4 weeks per

service provider trained

in counseling




agents to 12 women





of 2013

Public health

facilities

Mobile

units and

advanced

strategies


trained and equipped with a complete demonstration kit

Establish regular ref resher courses

and replenish kits


CBD

Private health

facilities



Goal sheet: North Central region



Proposed actions

25

3

1

11

10

Current

coverage,

2012, thousands

26

20

6

0

0

Comments

Additional

women expected














agents to 12 women





of 2013

Public health

facilities

Mobile

units and

advanced

strategies


(currently 882)


replenish kits


CBD

Private health

facilities




43

Figure A.16 Actions and objectives – Sahel region

Figure 44. Actions and objectives – South Central region

Goal sheet: Sahel region



’

Proposed actions

9

4

2

1

3





of 2013

Public health

facilities

Current

coverage,

2012, thousands

Mobile

units and

advanced

strategies


(currently 342)


replenish kits


CBD

Private health

facilities

16

4

12

0

0

Comments

Additional

women expected













1 additional woman per day



agents to 12 women

Goal sheet: South Central region

Proposed actions

10

2

4

1

3

Current

coverage,

2012, thousands

27

2

21

4

0

Comments

Additional

women expected
















agents to 12 women





of 2013

Public health

facilities

Mobile

units and

advanced

strategies

No additional agents (added to the

current 176)


replenish kits


CBD

Private health

facilities

One mobile unit f rom the Central region also

covers the South Central region



44

Figure 45. Actions and objectives – Plateau-Central region

Figure 46. Actions and objectives – Cascades region

Goal sheet: Plateau-Central region



’

Proposed actions

18

7

8

1

2





of 2013

Public health

facilities

Current

coverage,

2012, thousands

Mobile

units and

advanced

strategies



demonstration kit


replenish kits


Private health

facilities

18

5

9

1

3

Comments

Additional

women expected








One mobile unit f rom the Central region also

covers the Plateau-Central region


One additional woman

every 5 weeks per service

provider trained in counseling




agents to 12 womenCBD

Goal sheet: Cascades region



Proposed actions

7

3

1

0

3





of 2013

Public health

facilities

Current

coverage,

2012, thousands

Mobile

units and

advanced

strategies



demonstration kit


replenish kits


CBD

Private health

facilities

24

5

0

0

18

Comments

Additional

women expected











4 weeks per service

provider trained in counseling




agents to 12 women


45

Figure 47. Actions and objectives – Southwest region

Breakdown of Activities and Sub-Activities

Priority actions were broken down into activities and sub-activities:

Goal sheet: Southwest region



Proposed actions

4

2

1

0

1





of 2013

Public health

facilities

Current

coverage,

2012, thousands

Mobile

units and

advanced

strategies



demonstration kit


replenish kits


CBD

Private health

facilities

14

3

11

0

0

Comments

Additional

women expected



woman every 7 weeks per

service provider trained

in counseling












agents to 12 women

D.1 Increase demand among rural populations through outreach D.1.1 Educate national leaders about outreach activities D.1.2 Monitor and coordinate outreach activities D.1.3 Train local leaders D.1.4 Conduct educational outreach with the support of local leaders D.1.5 Integrate FP activities in Community Development Plans D.1.6 Train facilitators of women's homes on community-based services D.1.7 Organize FP week in each district

D.2 Increase demand among urban populations through mass media campaigns D.2.1 Identify barriers to the use of FP and define target profiles D.2.2 Define messages and channels corresponding to each profile D.2.3 Design and test the mass media campaign D.2.4 Broadcast the mass media campaign (television, radio and billboards) D.2.5 Conduct an Internet campaign (particularly on social networks) D.2.6 Conduct outreach at major national events D.2.7 Support the implementation framework and monitor results D.3 Educate adolescents and young people about FP D.3.1 Identify barriers to the use of FP among young people and adolescents D.3.2 Define the messages and channels that are appropriate for young people and adolescents D.3.3 Design the communication campaign D.3.4 Broadcast the communication campaign D.3.5 Revitalize education about population in the formal and informal systems D.3.6 Train school nurses D.3.7 Participate in building Listening Centers for young people


46

A.1 Improve service quality in Basic Health Facilities A.1.1 Improve training of service providers A.1.2 Finish equipping Health Facilities A.1.3 Monitor and evaluate improvements in service quality A.1.4 Reward the best Health Facilities and health districts A.1.5 Test Uniject injectables in pilot areas A.2 Improve coverage of suburban and rural populations through mobile units and advanced strategies A.2.1 Identify additional needs in terms of mobile units A.2.2 Acquire infrastructure and equipment for mobile units A.2.3 Acquire supplies for mobile units A.2.4 Train service providers for mobile units A.2.5 Conduct educational and communication campaigns before the mobile unit goes through an area A.2.6 Conduct deployments with mobile units A.2.7 Monitor and evaluate the activities of mobile units A.2.8 Implement advanced strategies A.3 Improve coverage of rural populations by strengthening community-based services A.3.1 Strengthen the FP's position in Community-Based Services A.3.2 Strengthen the partnership between public bodies and Community-Based Services A.3.3 Identify and respond to additional needs for Community-Based Services A.3.4 Enhance the quality of services provided by community agents A.3.5 Conduct supervision to improve and increase the services provided by agents O.1 Reduce supply shortages in primary health facilities by improving information collection and management O.1.1 Inventory the availability of contraceptives O.1.2 Hold national and regional workshops about the contraceptive acquisition tables (TAC) O.1.3 Strengthen coordination within the health district for supplying contraceptives O.1.4 Complete staff training on the use of information systems O.1.5 Strengthen agents' skills in data consolidation/collection and supervision O.1.6 Supervise managers of health facility supplies S.1 Monitor and evaluate the implementation of the plan S.1.1 Support staff in charge of monitoring and evaluation S.1.2 Define key monitoring indicators, calculation methods, periodicity and clarify collection responsibilities S.1.3 Train qualified individuals to record and consolidate data S.1.4 Provide tools for data collection and monitoring of patients in health facilities S.1.5 Monitor and coordinate the implementation of the plan at the central, regional and DS levels S.1.6 Control the quality of data collected and its consolidation

national family planning stimulus plan 2013...

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