Date/Time: Thursday, November 14, 2013 Session:

Author(s):

2.2.11 Family Planning and Quality of Care

Dinesh Singh, Jhpiego/MCHIP Ravi Anand, Jhpiego Renu Pandey, Jhpiego Somesh Kumar, Jhpiego Rashmi Asif, Jhpiego Vikas Yadav, Jhpiego Naresh Chandra Joshi, Jhpiego Bulbul Sood, Jhpiego

Title of Abstract: Improving postpartum family planning services through supportive supervision and on-site orientation in Uttar Pradesh, India Abstract Type: Topic: Program/Best Practices Abstract Effective family planning programs

Government of India supported by USAID and MCHIP initiated a Postpartum IUCD (PPIUCD) program in December 2009 to improve maternal and newborn heath in Uttar Pradesh, one of the largest and most populous states of India. The strategy included training the providers in PPFP/PPIUCD services at designated training locations and providing onsite supportive supervision for the trained providers. Four training sites and 15 service delivery sites (including training sites) were strengthened by building the capacity of 105 doctors for PPIUCD service delivery through competency based training. Each training site was provided with 2 Zoe pelvic models, long PPIUCD insertion forceps to ensure fundal placement of the IUCD, facility based IEC material and posters for the client information and job aids for the providers. The service delivery sites received all the materials and instruments except the Zoe pelvic models. It was expected that the trained providers will initiate the postpartum family planning services including postpartum IUCD at their sites post training. Supportive supervision visits were conducted by the MCHIP team to coach and assist the newly trained service providers to deliver high quality PP family planning services.

Significance/background

Program intervention/activity tested

The uptake of PPIUCD services at the project sites was slow and happened only on the days the trained providers were present. There were no services provided during shifts when the trained providers were not available. Hence, from September 2012, during supportive supervision visits, the MCHIP program staff initiated whole-site orientation of facility staff. This approach was to reach all key stakeholders of service delivery and help create and sustain an enabling environment. Through

this paper, the effect of supportive supervision and onsite orientations of all staff on program performance is shared.

Methodology
MCHIP staff conducted monthly post-training supportive supervision at the training and service delivery sites with trained providers to ensure quality of PPFP/PPIUCD services, identify gaps or barriers for service delivery and provide handholding and problem solving. Limited number of trained providers for PPFP/PPIUCD at the site and inadequate counseling for family planning were identified as major reasons for low acceptance of postpartum family planning including PPIUCD. Hence, one day on-site orientation of all the relevant staff coming in contact with the clients was conducted during these supportive supervision visits by MCHIP team to emphasize the importance of healthy timing and spacing of pregnancy, including PPIUCD as a safe and effective method in the basket of options, counseling, infection prevention practices and provision of PPFP/PPIUCD services on each day of the week. This strategy was carried out in 15 facilities in Uttar Pradesh between October 2012 and March 2013. A total of 450 facility staff (120 doctors, 28 residents and 140 staff nurses, 12 counselors, 75 ward boys and 75 ward ayas, approximately 30 persons each site) were oriented. 6 months data from observations made by the program staff during supportive supervision visits and from PPIUCD insertion and follow-up registers in the facilities from April 2012-September 2012 (no on-site orientation) were compared with 6 months data from October 2012-March 2013 (on-site orientation).

Results/key findings
On-site orientation of doctors, staff nurses, ANMs and family welfare counselors was conducted and 450 staff oriented to benefits of healthy timing and spacing of pregnancy, postpartum family planning counseling including counseling for PPIUCD.The increase in service providers resulted in women being counseled during antenatal, early labor and postpartum periods and provision of PPIUCD services 24X7. Proportion of women who delivered at the facilities accepting PPIUCD increased from 3% during the no on-site orientation phase to 5% during the on-site orientation phase. Total acceptors of family planning during no on-site orientation phase were 11096 and during the on-site orientation period were 15441 i.e. 39% increase of acceptors.Comparing the facility records for the family planning methods during these two periods, the number of acceptors of family planning methods increased 184% for OCPs, 82% for female sterilization, 52% for male sterilization, 15% for condoms and 87% for PPIUCD during the latter 6 months. Number of acceptors of interval IUCD decreased 17% during this period.

Program implications/lessons
Supportive Supervision and on-site orientation of all staff proved to be an important strategy to make PPFP/PPIUCD services available 24X7 by trained staff with improved counseling and service delivery as indicated by increase in proportion of clients accepting family planning methods.