E2A Newsletter, February 2015

Official launch of community-based family planning program in DRC

E2A relies on strong partnerships with governments in the countries in which we work to improve the delivery of health services so that they will be sustained long beyond the life of our project—and the Democratic Republic of the Congo (DRC) is no exception.

On February 6, with the Ministry of Health, the National Reproductive Health Program, USAID representatives, and other relevant USAID-funded projects working in the country, E2A officially launched its comprehensive community-based family planning program in the DRC, which will operate in select zones of three particularly underserved provinces: West Kasai, East Kasai, and Katanga.

With the support of USAID DRC, E2A aims to raise awareness about family planning in the three provinces, generating demand for quality services, while simultaneously ensuring the delivery of high-quality family planning and maternal, newborn, and child health services at the community level.

At the launch in Kinshasa, government officials endorsed the program for its alignment with DRC’s national strategic plan for repositioning family planning, established last year. A dramatization also took place, in which a typical situation in the DRC was acted out: a woman who had had seven children was pregnant again. Her youngest child was just 15 months old. An elder counseled the woman and her husband on family planning.

The dramatization demonstrates what E2A’s program attempts to do: root the delivery of integrated, high-quality family planning services at the community level by involving respected community members. The program intends to ensure that community-based systems are directly supported by highly skilled practitioners from health facilities, which in turn, are supervised and supported by a strong public health system.

The two days prior to the launch were spent holding a workshop with the aforementioned stakeholder groups to discuss imminent issues and plans, such as how to align the work of community-based distributors with national policies and norms, integrate gender throughout the project, avoid the stock-out of essential commodities, and incorporate the project work plan into zonal and provincial health plans.

The program is currently in the midst of: recruiting a robust cadre of community-based distributors in the three provinces by working with community leaders and health zone officials, with a focus on recruitment of women; staffing provincial project offices with project officers who will oversee facility-and community-based activities; and orienting other key program staff.

Read more about E2A’s program in the DRC.

Improving the quality of postabortion care in Togo

Like others in West Africa, Togo’s public health system has been working hard to guarantee that postabortion care services are delivered in a safe, effective, and accessible way, which includes the assurance that family planning counseling and a range of contraceptive methods are offered at the same time and location as  treatment for incomplete abortion.

Postabortion care, of course, comes on a long list of priorities that Togo must undertake to improve the health of its population. E2A, along with several other partners in Togo focusing on postabortion care, has therefore worked alongside the country’s Division of Family Health to keep postabortion care services in the spotlight and ensure all women seeking postabortion care have access to quality postabortion-family planning services. As a high-impact practice recognized by USAID, postabortion care is meant to inherently include family planning counseling and provision of methods, although many countries, including Togo, have struggled to fully incorporate high-quality family planning services.

Evidence for change

E2A first conducted an assessment in Togo in 2012 (alongside assessments of postabortion care services in Burkina Faso, Guinea, and Senegal) to identify areas where postabortion care services could be improved and is currently working to improve the quality of postabortion care services at six health facilities. Among its findings, E2A found that postabortion care services in Togo were challenged by:

  • The inability to offer postabortion care services in a separate space from the maternity delivery room.
  • Limited capacity among providers to offer counseling and a full range of contraceptive methods at point of treatment.
  • The cost charged to postabortion care clients for purchase of contraceptive methods.
  • The lack of a national standardized postabortion care register.
  • Limited capacity for monitoring and evaluation of postabortion care services.

E2A disseminated findings from its assessment to the Division of Family Health and staff from district health offices and health facilities, including those that took part in the assessment.

To rectify the aforementioned challenges, a country team from Togo developed a roadmap for improving postabortion care services at a regional workshop co-hosted by E2A in October 2013.

Taking evidence to action

E2A is now assisting Togo with activating that roadmap by increasing access to postabortion care-family planning services, expanding the method mix offered during postabortion care to include long-acting reversible contraceptives, and generally improving quality, with a focus on youth-friendly postabortion care services.

E2A is working with six health facilities to improve the quality of postabortion care services, and has appointed a three-person quality-improvement team at each of the facilities: one who is in charge of family planning at the facility, the other who oversees the maternity ward, and the district supervisor for family planning and reproductive health.  E2A has also appointed a quality-improvement team at the Division of Family Health that is responsible for monitoring at each facility.

E2A supported a four-day training with representatives at the Division of Family Health and target facilities on quality improvement, where they identified specific performance gaps at their facilities and objectives for improvement.  Twenty-three national and district supervisors, which included the representatives from the Division of Family Health, were also trained on facilitation skills and use of IntraHealth International’s Optimizing Performance and Quality tools to strengthen postabortion care service delivery.  After the training, quality-improvement processes were initiated at each facility, including a presentation of objectives for improvement to facility managers and colleagues.

During that visit, E2A shared key messages with service providers on: the need for family planning (regardless of whether the abortion was provoked induced or spontaneous);  return to fertility after abortion; and the importance of pregnancy spacing and method eligibility criteria for postabortion care. Additionally, all target facilities now report using standardized postabortion care registers, after E2A had adapted and translated the postabortion register from the PAC Global Resource Center for use in Togo.

Stembile Mugore, E2A’s Senior Advisor for Clinic Performance Improvement, is now in Togo conducting postabortion care and contraceptive technology updates for the quality-improvement teams with emphasis on long-acting methods.

Engaging faith-based groups at ACHAP biennial meeting in Kenya

According to the World Health Organization, faith-based communities provide an estimated 40 percent of health care in many African countries.   As a project with significant presence in Africa and a commitment to improving family planning and reproductive health service delivery, E2A has naturally chosen to work with religious leaders and faith-based groups. E2A has provided grants to Christian groups in Ethiopia, Kenya, and Uganda, and just last week, co-led a session at the African Christian Health Association Platform’s (ACHAP) biennial meeting on how faith-based leadership in Africa is an integral part of improving family planning and reproductive health.

At the session on February 23, also hosted by Christian Connections for International Health, and Georgetown’s Institute for Reproductive Health, representatives from the three groups that have received grants from E2A—the Uganda Protestant Medical Bureau (UPMB), the Ethiopian Evangelical Church Mekane Yesus (EECMY), and the Christian Health Association of Kenya (CHAK)—shared successes related to improvements that have been made to family planning services they are delivering.

Calls for action for religious leaders related to family planning and sexual and reproductive health were also shared, and the role of religious leaders in tackling challenges related to the demand for family planning discussed.  Religious leaders, who are respected both spiritually and for the leadership roles they play in their societies, can be influential in their communities and among government officials charged with developing health policies. They have the unique ability debunk religious and social misconceptions related to family planning that continue to impede the uptake of family planning services across Africa.

During roundtable discussions, participants gained hands-on knowledge of tools, guidelines, and standards that can be applied to improve family planning services, and heard about experiences with involving religious leaders, men, and youth in family planning.

At the end of the session, participants affirmed the commitment of their respective organizations to family planning and discussed plans for realizing those commitments.