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Increasing Access to LAFP at the Community Level Pathfinder International Ethiopias Experience

Presented at Throughout the Reproductive Life Course Conference

Washington DC April 02, 2014

Presented by: Co-authors:

Kidest Lulu, MD, MPH Deputy Country Representative, Pathfinder Intl Yewondwossen Tilahun, MD, Obs/Gyn Ketsela Desalegn, MD

Presentation Outline
Background: Ethiopia
Enabling Policy Environment: Family Planning (FP) Ethiopian Government Response Integrated Family Health Programs Response Intervention Methodology Results Lessons Learned

Background: Ethiopia
Total Population - 84 million Annual Population Growth Rate - 2.6% TFR - 4.8 children per woman Maternal Mortality Ratio 676 per 100,000 live births CPR (modern methods) 27.3% Unmet Need for FP 25%

Enabling Policy Environment - FP

National Population, Womens and Health Policies, 1993 -Goal: CPR - 44% and TFR of 4 CPW by 2015 Health Extension Program, 2003 National RH Strategy, 06-15 -Reduce unwanted pregnancies -Enable individuals to achieve their desired family size National AYRH Strategy, 07-15 -No medical reasons for denying any contraceptive method based on young age alone National FP Guidelines, 11

-Access to basic essential health services in under-served communities -FP is one of 16 packages

-Focused on quality of FP services

-Integration of FP with other services -Social mobilization and inter-sectoral collaboration

-Expansion of FP programs
-FP as womens rights issue

40.0% 36.0% 35.0% 30.0% 25.0% 34.0%


20.0% 14.0% 15.0% 10.0% 5.0% 0.1% 0.0% 2000 2005 2011 0.4% 6.0% 3.7%

CPR for modern methods LAFP use Unmet need

CPR, LAFP Use and Unmet-Need for FP, Ethiopia, EDHS 2000 2011

Ethiopian Government Response

The FMOH expanded FP services to the community level through the Health Extension Workers (HEWs) Short acting methods including injectables Implanon scale-up program in 2009

The IUCD scale-up initiative in 2010 Training mid-level health care providers on insertion and removal

Integrated Family Health Programs (IFHP) Response

IFHP: USAID funded program with Pathfinder Intl , JSI, and CORHA (July 2008 Dec. 2014) in Oromia, Amhara, SNNP and Tigray Regions IFHP provided skill-based training for: HEWs on Implanon

Health Center based providers on Implanon, Jadelle, and IUCD insertions removals

IFHPs Response
During the practical trainings thousands of clients were served with methods that could not be provided at the health post (HP) level Indicating Implanon insertion alone at HPs would not address the need for appropriate method choice Implant removal services could not be done by HEWs and need to be addressed at community level

Intervention Methodology
Starting in September 2011, the Back-Up support intervention was progressively instituted by 139 Health Centers The Health Centers needed capacity-building to provide a regular back-up LAFP support to their PHCU health posts
Clinical skills and counseling training,
Post- training equipment, commodity and consumable supplies Regular follow-up

Data was collected from September 2011 to December 2012 from these sites where these Back-Up interventions took place

Client Visits at Health Posts During Back-Up Support by Health Center Staff, Sept. 2011 Dec. 2012
Number FP service visits 41,573 Removal service visits 7,014

Total visits

Total = 48,587
Percent 85.6% 14.4%

FP service visits
Implanon insertions Jadelle insertions IUCD insertions Depo-Provera injections Contraceptive pills Condoms

Total = 41573
Number 7,100 1,004 753 25,231 4,950 2,535 Percent 17.1% 2.4% 1.8% 60.7% 11.9% 6.1% SAM 78.7%

LAFP 21.3%

During 16 months of Back-Up support, there were more than
48,000 visits

More than 14% of the visits were for removal services, mostly for
Implanon removal

21.3% were for LAFP services The Back-Up support also reduced the average time required to
get to the service site from 65 to 47 minutes

Lessons Learned
Capacitating the PHCU health centers enables them to integrate and provide Back-Up services Integrating Back-Up services increases access to and use of LAFP Improves the FP method mix to levels not previously provided at the community/Health Post level Reduces the time and money required to receive the services, potentially increasing clients satisfaction


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