Introducing Norplant at the Periphery Aguima Tankoano, MD, MPH, Chief of Party
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Transcript of Introducing Norplant at the Periphery Aguima Tankoano, MD, MPH, Chief of Party
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Resource Mobilization and Partnership to
Increase FP Coverage Through
Access to Quality Services Introducing Norplant at the Periphery
Aguima Tankoano, MD, MPH, Chief of Party Marcel Sagbohan, MD, MSC, Deputy Chief of Party
Susan B. Aradeon, Ph.D., BCC Advisor PROSAF Transition Phase/Benin
Conference on Repositioning Family Planning in West Africa organized by Advance Africa in Accra, Ghana
February 15-18, 2005
Source: PROSAF phase transitoire/presented by Susan ARADEON # 1
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Collaborators Introduce Norplant at the Periphery in Benin
• PROSAF and USAID – the major Benin family health project
• ABPF and IPPF – the Benin family planning association
• MSP: the Ministry of Public Health,– The Family Health Directorate and UNFPA
• Department of Health of Borgou/Alibori in northern Benin (DDSP)
Source: PROSAF phase transitoire/presented by Susan ARADEON # 2
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Three Objectives for the Introduction of Norplant Services
• increase availability of FP services in BA by broadening the range of contraceptives
• increase the potential of the health system in BA to protect more couples each year from too closely spaced and unwanted pregnancies
• reinforce collaboration between the principal actors in the health sector
Source: PROSAF phase transitoire/presented by Susan ARADEON # 3
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The Norplant Case Demonstrates the Power of Synergy
• synergy to reinforce the capacity of the health services and providers
to organize and offer family planning services
• synergy to secure and finance contraceptive products
Source: PROSAF phase transitoire/presented by Susan ARADEON # 4
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Synergistic Collaboration in Stages
1. Preliminary discussions on necessity and feasibility of offering Norplant in BA.
2. Negotiations with the MSP Directorate of Family Health
3. Memorandum of Understanding between PROSAF and ABPF
Source: PROSAF phase transitoire/presened by Susan ARADEON # 5
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Synergistic Collaboration in Stages(continued)
4. Mobilization of resources and Norplant supplies
5. Training and supervision of 20 Norplant providers
6. Annual monitoring of Norplant use
Source: PROSAF phase transitoire/presented by Susan ARADEON # 6
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Preliminary Discussions Reached a Consensus
• approach to follow
• roles and responsibilities of each party
• sites that would house the Norplant services
• number of providers to train
Source: PROSAF phase transitoire/presented by Susan ARADEON # 7
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Negotiations with the MSP Family Health Directorate
• MSP approval to introduce Norplant at the peripheral level
• Norplant kits supplied by UNFPA
Source: PROSAF phase transitoire/presentrd by Susan ARADEON # 8
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Memorandum of Understanding between PROSAF and ABPF
Assured close and effective collaboration
ABPF: transfer skills using their staff expertise and training materials
+ provide back-up Norplant and materials through its own channel
PROSAF: finance the training + supply each trainee with the essential 21 item Norplant insertion/removal kit
Source: PROSAF phase transitoire/presented by Susan ARADEON # 9
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Mobilizing Government Support
PROSAF relied on a variety of approaches• letters • preliminary meetings• follow-up meetings with key personnel at
the DSF • informal meetings with other influentials
in order to exert effective pressure
Source: PROSAF phase transitoire/presented by Susan ARADEON # 10
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Agreement on Training Site
• Strong pressure to send trainees to an existing site in Cotonou
• Dept of Health Director and PROSAF insisted that Norplant introduction be fully decentralized and sustainable at the department level.
• PROSAF financed transformation of ABPF clinic into a Norplant training center
• URC financed cost of bringing Cotonou trainers for the training and post-training supervision.
Source: PROSAF phase transitoire/presented by Susan ARADEON # 11
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Pro-Active Service Providers
• Service providers in Alibori advocated with their zonal health management teams (ZHMT) for inclusion of Norplant training in the PBA (German) Project activities
• PBA funded training for 7 service providers
Source: PROSAF phase transitoire/presented by Susan ARADEON # 12
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Maintaining Momentum While Resolving Supply Problems
• ABPF did supplement the MSP start up supplies
• Service Providers purchased their initial service delivery supplies (5 implants) their health center’s community fund.
• PROSAF provided kits to 4 district-level health centers where the midwives had been trained with PBA funds.
Source: PROSAF phase transitoire/presented by Susan ARADEON # 13
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20 Norplant Providers Trained by ABPF Staff
• three 10-day sessions during the second half of 2002
• limited to seven participants, given the supervision and coaching requirements during the practice sessions
• reinforced by one supervision visit by the training team
Source: PROSAF phase transitoire/presented by Susan ARADEON # 14
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Trainer’s Kit and Learner’s Kit with 15 Training Modules
1. Recap of Other Contraceptive Methods and Preliminary Questionnaires
2. Norplant
3. Norplant Counseling
4. Clients’ Rights
5. Client Assessment
6. Norplant Service Organization and Management
7. Infection Prevention
8. Norplant Insertion and Removal Techniques
9. Managing Norplant Side Effects
10. Insertion/Removal with Clients (Clinical Practicum)
11. Completing Forms
12. Norplant Stock Management
13. Mid-term Questionnaire
14. Participants’ Action Plan
15. Participants’ Course Evaluation
Source: PROSAF phase transitoire/presented by Susan ARADEON # 15
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Distribution of the Trained Norplant Service Providers
Trained by Facility Type
Training Session
DateDepartmental
Hospital Zonal
Hospital Maternity
Center
1 3rd Quarter 2002 1 3 3
2 4th Quarter 2002 1 0 5
3 4th Quarter 2002 0 3 4
Total
Service Providers 2 6 12
Source: PROSAF phase transitoire/presented by Susan ARADEON # 16
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Annual Monitoring of Norplant Use
• Couple Years of Protection (CYP) calculations: factor of 3.5 = 1 insertion
• Integrated into the Dept. of Health National Routine Health Information System (SNIGS)
Source: PROSAF phase transitoire/presented by Susan ARADEON # 17
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Results of the Synergy Among the Collaborators
• A significant 53% increase in the CYP between 2002 in 2003
• Rapid appropriation by the Health Zone Management Teams (HZMT)– budgeted the re-supply of the entrants
for the continuation and the sustainability of Norplant.
Source: PROSAF phase transitoire/presented by Susan ARADEON # 18
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Graph 1: CYP evolution and comparison between CYP pre and post introduction of Norplant
2001-2004 in Borgou and Alibori
7875
7122
51465439
YEAR 2001 YEAR 2002 YEAR 2003 YEAR 2004
CYP Pre Norplant CYP Post Norplant
Source: PROSAF phase transitoire/presented by Susan ARADEON # 19
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Graph 2 : Comparison between the CYP provided by Norplant and the total CYP:
2003 and 2004 in Borgou and Alibori
2247 2111
7875
7122
YEAR 2003 YEAR 2004
Norplant CYP Total CYP
Source: PROSAF phase transitoire/presented by Susan ARADEON # 20
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Norplant Impact on CYP in 2003 and 2004
• Without Norplant, the CYP would have stagnated near the 2002 level.
• 29% of the CYP in 2003 and 30% in 2004. • Even though purchases doubled for short-
term methods (oral contraceptives and Noristerat injectables),
• Norplant’s greater conversion factor resulted in a greater CYP for Norplant than the combined CYP for both these methods.
Source: PROSAF phase transitoire/presented by Susan ARADEON # 21
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In 2002, Benin already had
• local and international partners commited to enhancing health systems and FP
• expertise to introduce Norplant services
• financial resources for Norplant introduction
Source: PROSAF phase transitoire/presented by Susan ARADEON # 22
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However, Without Leadership from
PROSAF and ABPF Norplant services would still be minimal• Constant networking and feedback was essential to generating and maintaining
the synergy among the partners that kept the program on track.• Partner commitment had to be mobilized Partner commitment had to be mobilized
and remobilizedand remobilized to face each hurdle along the road to provision of Norplant in the farthest corners of the nation.
Source: PROSAF phase transitoire/presented by Susan ARADEON # 23
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Source: PROSAF phase transitoire/presented by Susan ARADEON # 24
Synergy generated through leadership that sustained partner commitment
NORPLANTP
E
R
MSP/UNFPA
COMMUNITY
ABPF
SERVICE PROVIDERS
PBA
DDSP
HZMTPROSAF
PARTNERS
EXPERTISE
RESOURCES
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Lessons Learned
1. the existence of a latent demand for Norplant (acceptance of side effects)
2. the capacity of Norplant to
rapidly and durably increase
couple protection
3. the power of leadership to generate synergistic collaboration among agencies to mobilize and share resources for significantly greater FP coverage.
Source: PROSAF phase transitoire/presented by Susan ARADEON # 25
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What’s Next
• Resolve stock-out problems
• Carry out cost analysis
• Increase promotion of Norplant
Source: PROSAF phase transitoire/presented by Susan ARADEON # 26