Scale-up of Integrated Family Planning and Emergency Obstetric and Neonatal Care in Uganda, Salwa...

8/12/2019 Scale-up of Integrated Family Planning and Emergency Obstetric and Neonatal Care in Uganda, Salwa Bitar - FP Integration with Health Services Panel 2

1/17

Integrated Family Planning and Emergency Obstetric andNeonatal Care in Uganda

Dr. Salwa Bitar, E2A, STRIDES (MSH) and ASSIST (URC)

Global Technical Meeting Throughout the Reproductive Health Course, April 2-3, Washington, DC


2/17

E2A-STRIDES-ASSIST Partnership

- STRIDES: led by Management Sciences for Health (MSH) in Ugandato build capacity in MCH, FP-RH, nutrition, and malaria interventions in

15 districts.

- Evidence to Action (E2A): USAIDs global flagship for strengthening

FP and RH service delivery and scaling up best practices.- E2A-STRIDES partnership is based on applying global approaches

within a local context. E2A offers short-term TA to support STRIDES to

introduce, implement, synthesize, and document Improvement

Collaborative results.

- ASSISTis URCs quality improvement (QI) project, which collaborates

with STRIDES in two saving mothers giving life districts.


3/17

Objectives of Presentation

Emphasize the importance of using the Improvement Collaborative(IC), a systematic approach for scaling up a FP/maternal and

newborn health (MNH) package.

Share field experience and process of integrating FP services into

Essential Obstetric and Neonatal Health (EONH) services.

Share QI changes, results, challenges and lessons learned from

using the IC to integrate FP in immediate postpartum MNH services

in Uganda.


4/17

Significance/Background for Intervention in

Uganda

Maternal mortality: 438/100,000

Neonatal mortality: 27/1000

Contraceptive use: 30%

High unmet need for FP: 34%

Missed opportunity to offer PPFP: 57% of deliveries are facility based

(UDHS 2011)

DHS data from 27 countries: 65% of women 012 months postpartum have

an unmet need for FP.


5/17

Essential features

Improvement objectives

Organizational structure

Initial implementation package

Spread strategy

QI teams

Monitoring system

Coaching system

Shared learning

Tested implementation

package

ImprovementCollaborative (IC):

An organized network of a

large number of sites that

work together for a

specified period of time to

achieve significant

improvements in a

focused topic through

shared learning andintentional spread

methods.

The Improvement Collaborative


6/17

Process: Introducing the IC to Integrate FP in

Immediate Postpartum Care

In March 2012, QI teams from 10 facilities in two districts developed a QI

workplan using the IC methodology.

In June 2012, the process was expanded to an additional 36 facilities in 8

new districts.

QI teams agreed on the improvement objectives, the implementationpackage and data collection (baseline and monthly progress data).

Existing standards, job aids, checklists, clinical tools, and indicators utilized

to build capacity in clinical aspects.

Coaches trained in facilitative supervision, tools, indicators, data.


7/17

Uganda QI Teams Develop Action Plans (March 2012)


8/17

Patient Flow and Infrastructure


9/17

Package of Best Practices Introduced through the

IC

Essential Obstetric Care:

measured through Partograph use and active

management of third stage of labor (AMSTL)

Essential Newborn Care (ENC):measured through 7 ENC elements (immediate

breastfeeding, keeping baby warm, cord care, etc.)

Immediate Postpartum FP Counseling and Services


10/17

Illustrative QI Changes by QI teams

Implementation and adherence to MCH evidence-based standards

Improved registers and data collection

Internal reallocations of drugs to address stock outs

QI teams made photocopies of Partograph tool to address shortage.

Skilled providers offered on-the-job training on long-term FP methods to

their peers in other sites.

Documentation journals and flow charts used to measure changes and

improvements .

Experience sharing between QI teams on quarterly basis, acceleratedproblem-solving


11/17

Partograph Use

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

2 months prior to implementation 6 months after implementation 12 months after implementation

PARTOGRAPH USE

PHASE I AND PHASE II Facilities

Phase I Facilities (9)

Phase II Facilities (35)


12/17

Essential Newborn Care

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%


APPLICATION OF ENC

PHASE I AND PHASE II FACILITIES




13/17

Immediate Postpartum FP Counseling

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%


PPFP COUNSELING

PHASE I AND PHASE II Facilities




14/17

Immediate Postpartum FP Uptake

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%




PPFP UPTAKE

PHASE I AND PHASE II FACILITIES


15/17

Provider bias and low competency in PPIUD

Womens lack of awareness about immediate PPFP

Solutions:

On-the-job training to providers

QI teams encouraged to link with community and

ANC

STRIDES has introduced PPIUD insertions and

emphasized documenting LAM acceptance and referral

to outpatient services

Challenges/Solutions: FP counseling & uptake


16/17

The IC empowers teams to explore simple and locally generated

solutions rather than relying on the central level.

Systematic approaches for scaling up best practices accelerate the

scale-up of high-quality services.

The IC can be introduced at any time during program implementation.

Programs can use the IC to accelerate local capacity building,

empowerment, and institutionalization.

Lessons Learned


17/17

For copies of this presentation or for additionalinformation, please contact:Salwa Bitar

[email protected]

1201 Connecticut Avenue NW, Suite 700Washington, DC 20036, USA

WWW.E2APROJECT.ORG

Thank you!
mailto:[email protected]:[email protected]

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