it’s got promise! recent advances in family planning and immunization integration, chelsea cooper...
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It’s Got Promise! Recent Advances in Family Planning and Immunization Integration
Throughout the Reproductive Life Course: Opportunities and Challenges for Empowering Girls and WomenApril 2014
Chelsea Cooper, Social & Behavior Change Communication Advisor, MCHIP Trinity Zan, Senior Technical Officer, FHI 360
Overview
• Rationale for integration• Recent and emerging evidence• “Promising” High Impact Practice
– Programmatic recommendations
Why Integrate?
FP & Immunization Integration
High Unmet Need in PP
Period
Importance of Healthy Timing & Spacing for MCH
Low Use of Postpartum
Services; High Use of Immunization
Up to 5 contacts with Mothers in
First Year
Women & Providers
Supportive
• Cluster randomized, two-group, separate sample, pre/post-test designs
• Intervention in both studies: Job aid for individual risk/need assessment based on LAM criteria for use at each immunization contact; Same-day FP services at same location
• Intervention in Rwanda: Group talks, brochure, supportive supervision
FHI 360 Studies in Ghana/Zambia and Rwanda
Results: Use of Any Family Planning Method—Ghana & Zambia
Results: Use of Any Family Planning Method—Rwanda
Control Intervention0
20
40
60
80
100
5851 49
57
Baseline Follow-up
%
*statistically significant at p=0.1Model accounts for clustering by facility and facility*time, age, parity, education, religion and partner approval of FP
+ 8%
+8 % Intervention- (7)% Control15% point difference *
- 7 %
N=403 N=403N=422 N=426
Results from Rwanda continued: Immunization Rates Not Affected by Intervention
Jul-10 Sep-10 Nov-10 Jan-11 Mar-11 May-11 Jul-11 Sep-1160
70
80
90
100
Average number of Measles immunizations, by month
Intervention Control
Month - Year
# Im
mun
izati
ons
All dates are post-intervention
Challenges to Integration: Lessons from FHI 360 Assessment in Jharkhand, India—2010-2011
Health system:• Inadequate
infrastructure • Supply-chain
problems for family planning
• Weak record keeping and reporting for both services
Human resources:• No specific policy• Insufficient training
on integration • Provider myths &
misperceptions • Gaps in staffing• Insufficient
management of frontline staff
• Lack of IEC materials
Community-level:• Misperceptions
among women, husbands, & mothers-in-law
• Inadequate mechanisms to involve husbands
• Limited knowledge on community resources
• Descriptive assessment in Lohardaga District included interviews with mothers, providers and managers
Development of Standard Operating Procedures and IEC/IPC Materials for Providers
The Integrated Service Delivery Model in Liberia
Collaboration between MoHSW + MCHIP
Combined Service Provision Model: Use of routine immunization contacts at fixed facilities where vaccinators provided one-on-one immunization and FP messages and referrals for same-day FP services
Piloted at 10 health facilities in Bong and Lofa counties from March-Nov 2012
Designed as a pilot program using a scalable model per MOHSW guidance10
The Approach
11
ALL women who bring infants for vaccination receive messages and referrals for FP
Job aid to guide vaccinator communication
Key messages designed strategically to address barriers and enablers identified through formative assessment Stigma and sensitivity regarding
contraceptive use by mothers of babies who are not yet walking
Clients offered a leaflet to take home which describes benefits of FP
Source: MCHIP
Participating Facilities New Contraceptive Users
March-Nov 2011 v. 2012
LOFA BONG
12
90% increas
e
73% increas
e
New Contraceptive users during March-Nov 2011 and 2012 in Participating
Facilities
13
0
500
1000
1500
2000
2500
Bong Lofa
2012 NEW FP USERS REFERRED FROM EPI2012 NEW FP USERS NOT REFERRED FROM EPI ON SAME DAY2011 NEW FP USERS
44%
66%56%
34%
Source: MOHSW/CHT/MCHIP Supervision Data
BONG LOFA
1182
2039
517
983
Immunization Findings: March-Nov 2011 vs. March-Nov 2012
14
Pilot facilities All other facilities0%
2%
4%
6%
8%
10%
12%
9%10%
5%
11%
Bong : Percentage Change in Penta 1, 3 doses admin-istered
Pilot facilities All other facilities
-20%
-10%
0%
10%
20%
30%
40% 35%
-11%
21%
-6%
Lofa : Percentage Change in Penta 1, 3 doses administered
Penta 1Penta 3
“Crowd sourced” interactive map on HIP implementation on K4Health website
High Impact Practices (HIP): FP & Immunization Integration in “Promising” Category
HIP brief endorsed by over 20 organizations
Interagency Working Group: What Have We Learned?
Lessons: FP & Immunization
Integration
Integrate During
Routine Immunization Services
Collect Data on Impact of Integration
on Immunization Services
Political & Community Support are
Critical
Health System
Issues Must be Addressed
More Evidence Needed…
• Communication• Integration
models• Cost-
effectiveness• Scaling up…Etc.
The FP & Immunization Integration
Toolkit houses relevant
resources developed to-
date!
FHI 360 & MCHIP Teams Lisa DulliGwyneth VanceKate Rademacher Mackenzie GreenMarga EichleaySteve SortijasThéophile NsengiyumvaShrabanti SenDeepika YadavJennifer WessonBill FingerJohn StanbackFidèle Ngabo
Nyapu TaylorRebecca FieldsAnne PfitzerElizabeth SasserElaine CharuratRobert SteinglassMarion Subah
THANK YOU! PROGRESS PPFP portfolio:
http://fhi360.org/projects/progress-technical-area-postpartum-family-planning
MCHIP: http://www.mchip.net/ppfp HIP Map:
http://www.k4health.org/topics/high-impact-practices-family-planning
FP/Immunization Integration Toolkit: http://www.k4health.org/toolkits/family-planning-immunization-integration
Working Group: [email protected] or [email protected]