The document discusses integrating family planning into maternal and child health programs. It provides historical context and examples of how flexible funds have supported family planning integration. Specific strategies discussed include community-based distribution of contraceptives, increasing postpartum family planning access, mobile family planning services, birth spacing messaging, and integrating abortion prevention and post-abortion care.
9. The Flexible Fund Goals and Critical Inputs Critical Inputs Flex Fund will support CA’s to provide Technical Assistance to Fund Recipients: 1) Monitoring and Evaluation 2) Program Strengthening Flex Fund will support centrally funded CAs to promote shared learning among Fund recipients Flex Fund will support PVO Programs through the CSHGP Shared Learning Goal #2 Increase Shared Learning of SOTA on community-based FP/RH approaches Goal #1 Increase access to quality FP/RH services through NGO/PVO Activities. Flex Fund will support PVO Programs through the CSHGP
32. Status of Paramedical Provision of Depo-Provera by CHWs in Africa 2004 TUNISIA MOROCCO SAHARA ALGERIA MAURITANIA MALI NIGER LIBYA CHAD EGYPT SUDAN ETHIOPIA DJIBOUTI ERITREA SOMALIA KENYA TANZANIA DEMOCRATIC CENTRAL RWANDA GABON EQUATORIAL ANGOLA CONGO NIGERIA BENIN DTVOIRE SIERRA SENEGAL GHANA THE GUINEA LIBERIA CAMEROON MALAWI ZAMBIA MOZAMBIQUE MADAGASCAR ZIMBABWE BOTSWANA SWAZILAND LESOTHO NAMIBIA ANGOLA WESTERN UGANDA OF THE CONGO REPUBLIC BURUNDI GUINEA REP. OF TOGO COTE BURKINA FASO GUINEA LEONE GAMBIA BISSAU SOUTH REPUBLIC AFRICAN THE AFRICA Pilot or limited program implementation with MOH approval; national policy restrictions remain in place
33. Countries are pilot testing CHW provision of injectables and instituting policy change National policies now permit scale-up. Scale-up in planning or implementation phase. Countries where pilots are being conducted or will be conducted by 2010 Potential for introduction of a demonstration project and/or policy change TUNISIA MOROCCO SAHARA ALGERIA MAURITANIA MALI NIGER LIBYA CHAD EGYPT SUDAN ETHIOPIA DJIBOUTI ERITREA SOMALIA KENYA TANZANIA DEMOCRATIC CENTRAL RWANDA GABON EQUATORIAL CONGO NIGERIA BENIN SIERRA LEONE SENEGAL GHANA THE GUINEA LIBERIA CAMEROON MALAWI ZAMBIA MOZAMBIQUE MADAGASCAR ZIMBABWE BOTSWANA SWAZILAND LESOTHO NAMIBIA ANGOLA WESTERN UGANDA OF THE CONGO REPUBLIC BURUNDI GUINEA REP. OF TOGO COTE D’VOIRE BURKINA FASO GUINEA GAMBIA BISSAU SOUTH REPUBLIC AFRICAN THE AFRICA
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35. Abortion Prevention and Post Abortion Care An Opportunity for Integration through MCH Programs
43. Youth Programming at the Community Level Addressing Health Care Needs of Youth in MCH Programs
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Notes de l'éditeur
So how many health workers do we need? Looking at the data collection on the workforce needed to meet the MDG goals is a proxy. The number 2.5 is based on studies of immunization coverage and skilled attendants at birth; this is the number of workers needed to achieve 80% coverage. Other more complex interventions may require a higher density. Critical shortage is defined as les than 2.5/1000 and not meeting 80% coverage. Many people are not comfortable with how these numbers were calculated, but they are the best available.
Nearly 100% of women postpartum want to delay or avoid the next pregnancy A 24 months between birth and pregnancy improves health of mother and child. In spite of this 57-60% of births in developing countries occur with birth-to-birth intervals of less than 36 months.
I’d like to take a moment to make a couple clarifications. We use the conventional term CBD for consistency and to embrace activities carried out by community member with limited clinical training. It includes: Paraprofessionals, Health Extension Agents, Nursing assistants, CHW, CRHW, VHT, CHOs, CHWs, When we say injectable contraceptives, we are referring to Depo-Provera (depot medroxyprogestrone acetate) also known as Depo Provera. This is not to rule out the use of Net En, Cyclofem and in the future Depo-Sub Q. We use the shorthand abbreviation of CBD of DMPA. We’re talking about promoting Depo-Provera in the context of a balanced method mix and with the goal of increasing client choice – not promoting it at exclusion of others. Finally, we are talking about adding Depo-Provera to existing CBD programs -- not creating CBD programs. The programs we work with for this innovation are already running, funded, and have met criteria showing they are strong enough to introduce the additional method of Depo-Provera.
The existing literature shows us that: With appropriate training, para-professionals can safely and effectively provide injectable contraception. Clients are equally satisfied with service if not more than their clinic-going counterparts. And finally, an increase in CPR has been shown in areas with CBD of injectable programs and they have been taken to scale in several countries. Despite its strong record of safety and effectiveness, Depo-Provera is still a rare component of CBD programs.
Note that in most countries where the CPR has increased significantly (Ethiopia, Ghana, Malawi, Senegal, Tanzania) it is due exclusively to Depo-Provera use. It is assumed that CPR would NOT have increased to this extent if women did not have access to Depo-Provera. This indicates a trend emerging that the women in many African countries prefer Depo-provera. Why do they like Depo-Provera?
Save Lives
The measurement of worldwide abortion-related mortality and morbidity is difficult. Because of the clandestine nature of a illegal procedures, there are powerful disincentives to reporting. Women don’t report their condition and might not relate it to a complication of an earlier unsafe abortion. Community studies around the world indicate a higher magnitude of unsafe abortion than do health statistics. An estimated 13% maternal deaths worldwide are due to unsafe abortions. 709 deaths per 100,000 unsafe abortions among African women. (100 of times higher than deaths due to safe, legal abortions in developed nations) Abortion Rate and Ratios – number of abortions per every 100 births). Leave 220,000 children to grow up without their mothers Causes loss of productivity, economic burden of public health systems and families Long-term health problems including Infertility Drinking turpentine, bleach or tea made with livestock manure Inserting herbal preparations into the vagina or cervix Placing foreign bodies, such as a stick, coat hanger or chicken bone, into the uterus Jumping from the top of stairs or a roof
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