E2A newsletter, September 2014

Community-based family planning in Democratic Republic of the Congo

The under-5 mortality rate in DRC stands at 104 deaths per 1,000 live births.

In Democratic Republic of the Congo (DRC) —where geography, extreme poverty, and the fragility of basic infrastructure drastically limit the reach of healthcare—a strong community-based health workforce is essential to delivering family planning services. Over the next two years, E2A will be working closely with the DRC government and ongoing USAID-funded projects in the country, including the Management Sciences for Health-led PROSANI Project, to create a network of community-based distributors who can deliver quality family planning and maternal, newborn and child health (MNCH) services within an integrated services package.

E2A’s Community-Based Family Planning Program will cover a vast area in three provinces: Katanga, East Kasai, and West Kasai, where, on average, less than 8 percent of reproductive-age women are using a modern contraceptive method.

The program will support health zones within the three provinces and provincial health bureaus to recruit a more robust cadre of community-based distributors, particularly women, and develop the capacity of providers at health posts and health centers to train, support, and supervise them. In addition to family planning, the integrated services package includes components that have proven impact on curbing maternal, infant and child deaths. The package entails:
- Quality community-based family planning services that contain a broad mix of contraceptives including injectables
- Information about and provision of oral rehydration salts and zinc for dehydration
- Information about water purification and the provision of water purifiers
- Provision of maternal and child health services at health posts (which are located closer to rural communities than health centers)

Community-based distributors will specifically receive training on interpersonal communication and counseling on all family planning methods with emphasis on healthy timing and spacing of pregnancy; provision of non-clinical methods, oral rehydration salts, and zinc for management of diarrhea; and use of water purifiers.

Systems strengthening

The program will also build the capacity of health zones and provinces in several areas of health planning and implementation, including commodities logistics systems, training, supervision, data collection tools, and operational and strategic planning. The project relies on facility-based providers, and where necessary, retired and unemployed nurses to provide clinical family planning methods, and to support and supervise community-based distributors on all elements of the integrated services package, while strengthening linkages between community-based distributors, health posts, and health facilities.

Enhancing awareness and demand

Health managers, community- and facility-based providers, and other respected community leaders will be given the skills necessary to conduct effective one-on-one counseling, group sensitization activities, and mass media efforts to promote all elements of the integrated services package. E2A is exploring collaboration with the PROSANI project, C-Change, and other partners to fund local radio programs and use of bulk short message services to disseminate messages widely.

Gender equality and male involvement

Gender-based violence including sexual violence is pervasive in DRC. The program will work closely with the PROSANI project to mitigate gender-based violence and involve men in a way that supports women to make critical decisions about their own health.

E2A is currently recruiting staff for the Community-Based Family Planning Program, and activities are expected to be underway in September-October 2014.

Filling an evidence gap: emergency contraception programs

Although much has been written about emergency contraception and its importance as a contraceptive option for women, much less information has been shown regarding its introduction and scale-up in different country contexts. Countries are therefore left with few resources from which to learn.

To fill this evidence gap, E2A has published a new report —Four Country Case Studies on the Introduction and Scale-up of Emergency Contraception. This report illustrates ways in which governments, nongovernmental organizations, and the private sector have worked together and separately to introduce and scale up emergency contraception within their respective countries. The report includes a literature review which gives a comprehensive background on emergency contraception, and then examines, through information obtained during in-depth interviews with country-based experts, the introduction and scale-up of emergency contraceptive pills in four geographically disparate countries: Mexico, Bangladesh, Kenya, and Senegal. Each country experience is analyzed using two frameworks: the International Consortium for Emergency Contraception’s 9 Steps and the World Health Organization's Building Blocks for Health Systems Strengthening. Following the case studies, a further analysis compares and contrasts the various elements within each effort that led to successful introduction, and later, scale-up, and provides corresponding recommendations based on the analysis.

Hard copies of the report will be available at this year’s “EC Jamboree” hosted by the American Society for Emergency Contraception and the International Consortium on Emergency Contraception, September 25 & 26 in New York City at Baruch College.

Tackling fistula in Ethiopia

Fistula Survivor, Tsehaynesh
Photo by Pathfinder International

The year 2020 represents two ambitious deadlines for Ethiopia: like the 68 other countries that are a part of FP2020, giving many more women and girls access to family planning services and supplies, and uniquely, eliminating obstetric fistula.

While E2A plays a part in both of these country commitments through its support of the Integrated Family Health Program (IFHP), with new funding from USAID Ethiopia, E2A, over the next two years, will dedicate several activities specifically to obstetric fistula elimination. Pathfinder International leads both IFHP and E2A, and will continue to play a primary role in the fistula-elimination work.

National Fistula Elimination Plan

E2A will directly assist with the Government of Ethiopia’s National Fistula Elimination Plan, which seeks to intensify efforts to identify, repair, and rehabilitate women with obstetric fistula across 291 woredas (districts) currently supported by IFHP. The plan includes a phased approach that begins with applying a fistula-eradication strategy in 20 woredas and then replicating that strategy in the other woredas. With technical guidance from E2A’s core partner Management Sciences for Health, E2A will also focus on building the organizational capacity of Hamlin Fistula Ethiopia. Hamlin Fistula Ethiopia runs the Addis Ababa Fistula Hospital, its regional centers, the Hamlin College of Midwives, and the Desta Mender rehabilitation center for fistula patients.

The approach to fistula elimination that will be applied in the 20 woredas is based on the successful approach already applied by Pathfinder International through its leadership of IFHP. A new technical publication—Strengthening the Continuum of Care for Fistula Prevention and Repair in Ethiopia—describes the approach.

Assessment of postabortion care family planning in four West African countries

Despite the promise of high-quality postabortion care , in many settings, family planning is still not included in postabortion care services. And when family planning counseling is provided, contraceptives are not offered simultaneously or at a reasonable cost, limiting women’s access to these methods. Providers still lack training on how to effectively and sensitively counsel postabortion care clients on family planning, and many health facilities are still without the resources necessary to offer high-quality postabortion care family planning services at the point of treatment.

E2A recently published a comprehensive report detailing its assessment of postabortion care programs in Burkina Faso, Guinea, Senegal, and Togo. The assessments, conducted in 2012-2013, examined the implementation of action plans by these four countries for strengthening postabortion family planning services. Findings within the four countries suggest that while some progress has been made implementing postabortion care services within targeted health facilities, much work remains to be done in order to maintain achievements and overcome continuing challenges.

Findings from the report were presented at a regional meeting last October in Saly, Senegal with ministry of health representatives from across Francophone West Africa and Rwanda, as well as staff from multilateral and nongovernmental organizations working in the region to strengthen postabortion care. Based on the findings, countries developed draft roadmaps for strengthening postabortion care, with a focus on the family planning component. Examples of the draft roadmaps are included in the meeting report.

In Burkina Faso and Togo, E2A is now working on elements of the two country roadmaps—by assisting with the development of a national postabortion care strategy in Burkina Faso and strengthening provider capacity to deliver quality postabortion care services in Togo.

E2A will present findings from the postabortion care assessment at the Third Global Symposium on Health Systems Research in Cape Town, South Africa, on October 3.

Download the full assessment report and four corresponding policy briefs in English or French.