implant programming - advancing partners

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Implant Programming

Marie Stopes International Ghana

George Akanlu, Director Regional Operations Marie Stopes International Marie Stopes International

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Ghana Context Limited access to a full range of voluntary family planning services FP choice is limited in rural communities Limited skilled personnel to provide long acting reversible contraception and permanent methods Gaps in availability of commodities at facility level Costs and access barriers

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Contraceptive use

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Implants 18% IUD

2% Female S

2% Male S

0% Condom 11%

Injectables 36%

LAM 0%

Pill 16%

Other 15%

Contraceptive Method Mix

27 31

28 32

29 26

30

11

23 25

0

5

10

15

20

25

30

35

CPR by Region

CPR use

• Similar proportion of contraceptive use in urban and rural areas but variations between regions

• Volta has the highest CPR at 32% and Northern the lowest at 11%

Key takeaway: • Implants more preferred LARCs. • Jadelle most preferred implants

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130 BlueStar Social Franchises BlueStar is MSI’s network of trained and quality-assured private clinical providers. 52 MS Ladies

MS Ladies are midwives, nurses or community health workers who work as self-employed providers in their own communities.

8 Mobile Clinical Outreach/Inreach Teams & 2 Public Sector Strengthening Teams We run mobile clinics on a rotation basis, taking services to locations with limited infrastructure, such as remote rural locations urban slums, and public sector facilities.

MSIG Service Delivery Models

9 Centres of excellence Static centres provide all services in urban and peri-urban settings

Call Center: Marie Call A dedicated call centre to provide information and referrals to services


Clinical Quality


• Recruitment, training & competency assessment to ensure competent service providers

• Dissemination of clinical guidelines

• Quarterly comprehensive supportive supervisory visit

• Annual internal and external quality assurance audits

• Annual refreshers for providers (counseling is key)

• Ensuring infection prevention measures are in place

• Improved/encouraged incident reporting and management


Implant Provision in MSIG’s Service

Delivery Channels



Estimated proportion of Voluntary FP nationally provided by MSI

2014 2015 2016

Total Voluntary FP

11.4 11.6 17.3

LAPM 31.6 38.5 45

Source: MSI Impact 2 Estimater

Jadelle and implanon NXT are the two products in Ghana Jadelle is more preferred Until 2015, implant services were provided by mid-wives. Trained and certified Community Health Nurses (CHNs) can now provide implants. MSIG trains all providers in our service delivery channels (includes franchised private and PSS facilities)


Spotlight: Reaching Clients at MSIG Static Centres and Social Franchisees


• FP awareness raising activities (satisfied client videos, community durbars, market storms etc)

• Community mobilization for BCC and referrals for voluntary FP through community level workers, Gov’t and other orgs

• Group education sessions, individual counseling and voluntary FP services offered

• Back-up and referral systems (cross referrals)

• Quality assurance monitoring and supervision to maintain high service quality

• Call center offers an anonymous platform for client engagement & referrals

• Branding


Providing free voluntary FP services to the doorsteps of clients (in reach for Kayayes and outreach to other under served communities) Awareness raising activities (satisfied client videos, community durbars) Community mobilization for BCC and referrals for FP through public sector health promoters. Targeted mass media campaigns Quality assurance monitoring and supervision to maintain high service quality

Spotlight: Reaching the Underserved through Mobile Clinical Outreach Teams and MS Ladies


MSIG Voluntary FP Method Mix – All Channels

34,073

45,716 53,490

36,624

80,009

93,832

53,795

34,176

45,288

61,601 65,156

68,162

34,476

14,182

2,418 2,543 6,438

31,674

7,803 8,743 7,824

14,433

23,017

54,534 54,613 55,537

73,131

52,401

830 1,730 1,578 1,913 1,455 1,376 898 5 20 39 40 49 61 33

2011 2012 2013 2014 2015 2016 2017*

Injectables Pills & EC IUDs Implants Tls Vas


16%

5%

1%

0% 0%

13%

4%

1%

4%

0%

12%

9%

1%

6%

7%

9%

6%

2%

6%

11%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

Removal in Centers Removal in BS Removal inOutreach

Removal in PSS Removal in MSLadies

Proportion of Implants Removals Per Channel

2014 2015 2016 2017

Major Reasons:

Changes in menstrual cycle (majority) Request by husbands/relatives Ready to have a child

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Client •Implant insertion less invasive •Less/no pain during insertion •Jadelle is preferred to Implanon – longer years of protection. •Free implant services accessible from mobile teams.

Provider •Implanon easy to insert because of its single rod •Providers more proficient in implant insertion compared to IUD •More providers trained in implant insertion (Nurse Aids etc)

Client/provider insight


Specific Programmatic Challenges • Generally low uptake of LARCs in Ghana due mostly to

misconceptions (e.g. implants cause infertility, fibroid etc)

• Voluntary FP services not included in NHIS benefits package, thus cost is still a barrier.

• High rate of removal of implants, especially in centers.

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Thank you

implant programming - advancing partners

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