Cfphs presentation for evalation comments from o f and j
- 1. Community Based Family Planning and HIV/ AIDS Services Project Project Team: Mexon Nyirongo – COP; Njuru Nganga – DCOP; Joyce Wachepa – FP Advisor; Flora Khomani – HIV/AIDS Advisor; Chimwemwe Msukwa – M&E Advisor; Olive Mtema – Policy Specialist; Carol Bakasa – Gender/Communication; Ricky Nyaleye – Gender/Communication
- 2. RATIONALE • FP is the key to improvement of socio-economic wellbeing of people in developing countries. • Access to FP services in rural areas is limited. • Modern FP method can help avert unwanted pregnancies thereby reducing MMR and IMR in Malawi . • The project works through a network of CBDAs and HSAs to provide FP and HIV & AIDS services in the hard to reach underserved areas.
- 3. Project Geographic Scope Karonga (11): CFPHS = Project Head Office Kasungu (3): BASICS & CFPHS Nkhotakota (6): CFPHS Mangochi (21): BASICS, CFPHS, & TBCAP Salima (9): BASICS & CFPHS Balaka (16): BASICS & CFPHS Phalombe (26): BASICS & CFPHS Chikwawa (18): BASICS & CFPHS
- 4. CFPHS Approaches • Define and develop the supply and capacity of service providers at district, health center and community levels • Create demand for FP and HIV & AIDS services through BCC, community networks and outreach • Review current policies and advocate for supportive policies
- 5. FFSDP MODEL DELIVERY OF QUALITY, INTEGRATED SERVICES for FP and Prevention & Treatment of HIV/AIDS/STIs FULLY COMMUNITY MANAGEMENT& SUPPORT SYSTEMS LEADERSHIP SUPPORT FUNCTIONAL DISTRICTS Engaged traditional & at Zonal & National Levels elected leaders Technical & Operational Support FULLY Social marketing & Clear policies & guidelines BCC activities SUPPORTIVE Adequate norms & protocols Community Trained & motivated COMMUNITIES Effective strategies & involvement approaches for different staff Sufficient equipment, PROVIDERS Positive social groups RH/FP (incl. CBDAs Local FBOs/NGOs Planning & mgt tools drugs, & supplies CLIENTS atmosphere (stigma Adequate /HSAs) motivated and engaged Human resource mgt reduction, reduction infrastructure Community structures Financial mgt systems & tools •Proven FP capacity with •Well informed of GBV) involved: women’s & Supply mgt system Functional referral Attention to performance improvement •Aware of FP benefits men’s groups, youth Mgt information system system opportunities •Able to freely chose underserved & high- associations Quality assurance system Functional MIS •Regular formative preferred FP method risk groups Local governments supervision •Understand their rights Affordable services involved in all activities •Adapted info. system •Continue use of chosen Informed choice •Incentives method and adhere to •Respect for clients’ indications for use Political rights Support, •Understanding of Social needs of both genders Dialogue, & Support & Advocacy Sustainable use of quality, integrated Local FP/RH services Ownership Enabling policy and social environment 5
- 7. FP service Accomplishments • 1003 CBDAs trained • 293 Supervisors trained; • 361 HSAs trained in DMPA • 96 Nurses and Clinical officers trained in LTPM • 15 TOTs and 205 providers trained in Standard Days Method. • SDM provision started January 2010 7
- 8. FP Service Provision CFPHS Trained Provider inserting Jadelle DMPA Practicum 8
- 9. FP Results • About 90,046 DMPA doses given by HSAs Jan-Dec 09 • 271,799 people counseled on FP and HIV messages 9
- 10. Results: New and Old Clients By HSAs and CBDAs Yr 09 CBDAs made 3,007 referrals for other FP methods. Thus likely drop in new users
- 12. 12
- 13. FP service delivery Challenges • Retention of CBDAs vs incentives • Reporting • Proper disposal of hazardous waste • Drop out of service providers. 13
- 14. HIV TESTING AND COUNSELING SERVICES 14
- 15. Accomplishments • 76 CBDAs trained in Door to Door provision of HTC. • 15 HSAs trained in HTC • 13 HSAs trained in HTC Supervision 15
- 16. HTC SERVICE RESULTS • 83, 220 people learned their HIV status between Sept 08 and Dec 09 through door to door integrated HTC and FP services by the 76 trained CBDAs 16
- 17. People Counseled & Tested for HIV – by Quarter Dec 08
- 18. HTC Service Delivery Challenges • Proper disposal of hazardous waste • Availability of Test Kits 18
- 19. DEMAND CREATION 19
- 20. Activities: Increase demand for contraceptives and HIV testing • Message design workshop conducted • Communication strategy document developed • Branded BCC campaign launched page 20
- 21. Listening Club activities • 25 FP Listerners clubs (already existing) per district were trained. • Trained 2 members from each club to lead the listening activity. • Listerners clubs meeting conducted every Wednesday • Discussion guides developed to assist during listening activity. page 21
- 22. Community drama performances • A script based on the radio drama series was developed for community drama performances • Three community drama troupes per district identified and trained. • Troupes asked to perform regularly in their communities. page 22
- 23. Community Sensitization/ Open days • CBDAs, HAS and HTC Counselors showcase the services they provide. • As of December 2009, 13 open days were held throughout the project districts. page 23
- 24. Integration of Gender Based Violence into all activities • Developed GBV modules with the help of a GBV consultant. • Ensured that GBV was incorporated in the training of CBDAs and private sector providers • Ensured that all materials developed for the BCC campaign were gender sensitive page 24
- 25. Increased accessibility to oral and injectable contraceptives • Initiated family planning provision through private clinics, pharmacies and drug stores • Trained 292 private sector providers in FP service provision • Distributed 12 813 cycles of oral contraceptives and 99 285 vials of injectable contraceptives. page 25
- 26. Results: • 32 525 people reached through community drama • 56 034 people (26 676 male and 29 358 female) reached with family planning and HIV and AIDS services through open days. 26
- 27. Demand creation and increasing access: Open Day 27
- 28. POLICY AND ADVOCACY 28
- 29. Policy Landscape analysis Activities • Consultative meetings • Document review • Disseminated findings at FP sub committee 29
- 30. Results • 9 policy areas identified • Policy on CBD of DMPA included in SRHR policy • Oral pills de regulated • Policy language on social marketing included in SRHR policy 30
- 31. CBD of DMPA Activities Results • Several debates • MoH decision on HSAs March • HPI feasibility Study 2007 2008 • Operational barriers study • Consensus to pilot HSA.. • DMPA initiative Madagascar study tour in June 2008 • Policy statement on CBD of • DMPA Stakeholder’s dissemination meeting July 2008 • guidelines and training • materials developed and SRHR policy review approved Oct. 2008 • Guidelines development • Guidelines disseminated June Workshop 2009 31
- 32. Integration of FP and HIV/AIDS Survey • Objectives: meaning, purpose, challenges, lessons • Data collected in Sept. 2009 • Report submitted to MSH home office • Dissemination and consensus building workshop in May 2010. • Results expected to guide policy and guidelines development 32
- 33. Social Marketing Guidelines • Literature review • Consultations • Interviewed CBDAs in two districts • Lessons learnt from other countries presented to RHU and options for Malawi discussed • RHU prefers to pilot in urban or semi urban using a private sector organisation • Government’s policy of free health services • Working with PSI to pilot 33
- 34. Advocacy with Faith Based Organizations • Consultative meetings with Muslim clerics on FP and HIV/AIDS services and Islam • Conducted high level advocacy conference in August 2009 • Resolutions a guide to Muslims on FP and HIV/AIDS issues; and future programmes • FP and HIV/AIDS presentations at women’s gatherings 34
- 35. Advocacy with regulatory bodies • Pharmacy, Medicines and Poisons Board of Malawi • Medical Council of Malawi • Nurses and Midwives Council of Malawi 35
- 36. Policy Challenges • Conflict between policy, practice and regulation. • Policy on free health service affecting community based social marketing efforts and private sector involvement. • HSA provision of other contraceptive methods. • Ministry’s view regarding CBDA administration/provision of DMPA at the community level • Sustainability and scale-up of CBD program • Integration of FP and HIV/AIDS services 36
- 37. MONITORING AND EVALUATION 37
- 38. Monitoring and Evaluation • CFPHS Project falls under USAID SO 8 • SO 8 has 4 Intermediate results as follows: o Increased use of improved health behaviours and services o Improvement of quality services o Increased access to services o Strengthening health sector capacity.
- 39. Monitoring and Evaluation • 3 Indicators chosen to monitor SO8 as follows: o Percentage of under-five children sleeping under insecticide-treated bed nets o Contraceptive prevalence rate o Use of condoms during risky sex • Only last two relate to the CFPHS Project
- 40. Monitoring and Evaluation • Contribute to Goal Level indicators • Total fertility rate • Prevalence of HIV among 15 to 49 year olds 40
- 41. Critical Assumptions • Facilities are adequately staffed. • Political and professional support is available for CBDAs to deliver FP and HIV/AIDS services. • Policies have been approved by MOH enabling CBDAs to provide injectable contraceptives. • Contraceptives, STI medicines, and HIV test kits are available.
- 42. Monitoring and Evaluation: Main Outputs for Project Monitoring – Program Inception • Detailed Implementation Plan (DIP) • Performance Management and Evaluation Plan (PMEP) Indicator definitions Work plan Data Quality Assessment checklist • Baseline Survey » Conducted April 2008 » Report released January 2009
- 43. Life of Project Outputs • Monthly reports • Quarterly Reports • Bi-annual Reports • Annual Reports
- 44. Challenges • Staff turnover high • Data collection difficult by design (work in hard to reach areas) • Data management
- 45. Looking forward • Improve data management • Use of modern communication systems for data reporting – Associated challenges of expenses involved • Staff and Volunteer (CBDA) motivation
- 46. OVERALL LESSONS LEARNT 46
- 47. Major Lessons Learned • Well trained non-medical workers can effectively provide selected FP methods. • Community based services reduces workload at health facilities. • SDM has created a lot of interest among the catholic community in FP; • Increased training of LTPM providers has increased demand for Jadelle;
- 48. Major Lessons learned cont… • Demand Creation activities improves service uptake • Integrated community based FP and HTC services reduce stigma • High level advocacy improves political will. 48
- 49. Capacity gaps in FP and HIV&AIDS issues A sustainable advocacy strategy is exist among the Muslim community important 49
- 50. Conclusion • Scaling up integrated CFPHS can accelerate meeting the FP and HIV & AIDS demands of the underserved rural communities. 50
Editor's Notes
- #2: Center for Health Services (formerly known as Center for Health Programs—created from the merger of Center for Country Programs and Center for Health Outcomes with the Field Office Support Unit last July)
- #3: Here it is expected that the project provides an elevator speech about the project. Please remember to mentioned the partners working on the project, and scope of the project, and overall summary
- #21: Clinic talks- 245 Community dramas – 32 525 Open days – 22 431
- #28: CBDA presenting his posters during an open day
- #30: Policy areas: CBD of DMPA policy, integration, social marketing, regulation of hsas, community administration of DMPA, public private partnerships policy, role of TBAs, CB of HTC. Challenges: Most stakeholders, especially health workers, took a long time to accept the policy change on CBD of DMPA and HTC by non professionals; some are not yet convinced
- #32: Challenge: the existing contradiction between Policy and regulation to do with HSAs
- #33: Objectives: definition, purpose, challenges, lessons from CFPHS for policy change and recommendations to RH anHIV units
- #34: Contradiction of free services, Policy on “Free health service” influencing RHU’s decisions on social marketing Lack of evidence on “willingness to pay” for health services challenges:
- #36: Field visit with MCM in february 2010, WHO brief shared, awaiting feedback. We will have a similar trip with the two other regulatory bodies.
- #39: SO 8 = Increased Use of Improved Health Behaviours and Services