Post on 04-Jan-2017
Scaling up PPIUD services across India while ensuring quality of services Bulbul Sood, Jhpiego/India
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Huge unmet need (73% in first 3
months)
Birth-to-birth interval (57.6 % of
births had birth interval of less than
36 months) Source: SRS 2011
High vulnerability to unintended
pregnancy (Due to low awareness)
JSY was bringing women to
facilities - are more receptive to
accept FP methods
Why Postpartum Family Planning is Crucial for Family Planning?
JSY Beneficiaries: 2005 to 2014
Source: HMIS, MOHFW, GoI
~ 450,000 PPIUCDs inserted
States >20
Training Sites 75
Service Providers
Doctors 3121
Nurses 6161
Service Delivery Sites
Medical Colleges 44
District Hospitals 300
Sub District Facilities 673
LAD
LAD
* till March-2015
Rapid Expansion of PPFP/PPIUCD Services: Impact at Scale
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Phased Expansion of PPFP/PPIUCD Services
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PPIUCD Experience in India
146568
99389
68974
35672 31135
25252 21205
14863 12929 9318 9017
3806 2633 2091 1405 1104 870 825 717
0
20000
40000
60000
80000
100000
120000
140000
160000
Total Reported PPIUCD Insertions Feb-10 to Apr-15
N = 487,773
Data as on 01/06/2015 Data as on 01/06/2015
Data as on 01/06/2015 Source: PPIUCD Monthly reports
Post- placental (within 10 min)
57%
Post-partum (within 48 hrs)
22%
Intra- cesarean
21%
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Trend of Number of Facilities Reporting PPIUCD Insertion Services: Impact at Scale
21 75
200
395
717 728
0
50,000
100,000
150,000
200,000
250,000
0
100
200
300
400
500
600
700
800
2010 2011 2012 2013 2014 2015*Year
Nu
mb
er
of
PP
IUC
D In
sert
ion
s
Nu
mb
er
of
Faci
litie
s
*April - 2015
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Proportion of PPIUCD Acceptors Among Institutional Deliveries (Jan-11 to Apr-15)
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
Jan Mar May Jul Sep Nov Jan Mar May Jul Sep Nov Jan Mar May Jul Sep Nov Jan Mar May Jul Sep Nov Jan Mar
2011 2012 2013 2014 2015
PP
IUC
D A
cce
pto
rs
Month
Total deliverie
s: 51,52,47
9
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0%
5%
10%
15%
20%
25%
30%
35%
40%
Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15
% P
PIU
CD
acc
ep
tors
Month
Bihar Chhattisgarh Jharkhand Madhya Pradesh Rajasthan UP
Data as on 01/06/2015 Total deliveries=10,08,689
Trend of PPIUCD Acceptors among Institutional Deliveries 6-HFS (Nov 14 to Apr 15)
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3.1%
2.1%
5.8%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
8.0%
9.0%
10.0%
Expulsion Infection Removal
Data as on 01/06/2015 Data as on 01/06/2015
Data as on 01/06/2015
Follow-up Findings (Based on Jan 11 – Apr 15 Data)
N=262,866
Data as on 01/06/2015 Data as on 01/06/2015
Data as on 01/06/2015 Source: PPIUCD Monthly reports
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Strategies for Successful Scale-up
System Based
Approach
Implementation through the
system
Using NRHM Funds
Policy shifts
FP as MNCH intervention
Focus on spacing
Contextualization of program strategies
Task shifting
Insertion: Drs to SNs
Dedicated counsellors
Standardization of processes
(SOPs) for each program
component
Decentralizing institutional
training capacity
Aggressive, continued and
inclusive advocacy
Government led initiative
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Investing in Quality during Scale-up
Focus on PPFP
Competency based training
Use of customized clinical standards
Emphasis on counselling - hiring of dedicated counsellors
Strong follow-up systems, including robust data collection systems
Generation of local evidence through studies
Structured supportive supervision visits
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Annual Explosion Rates
4.41%
2.22% 1.99%
3.35% 3.23% 3.32%
2010(n=521)
2011(n=10,056)
2012(n=25,564)
2013(n=46,184)
2014(n=1,28,916)
2015(n=52,146)
* Till Apr-15
Expulsion rates have remained at acceptable level even after rapid scale-up and withdrawal of external TA from all but 6 states of India
-
5
10
15
20
25
10-11 ($3,370,360) 11-12 ($4,428,112) 12-13 ($8,134,230) 13-14 ($11,711,962) 14-15 ($19,326, 771)
Mill
ion
s $
USAID BMGF Norway Packard Foundation Govt of India BMGF TSU LAD
**GOI funding converted from INR to US $ as per current exchange rate i:e INR 61.43 per US $.
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“Buy-in” of All Stakeholders for Successful Scale-up and Sustainability (PPFP)
THANK YOU