PROGRESS Newsletter #2

Malawi Evaluation Finds Community-Based Distribution of Injectable Contraception Works Well

FHI recently completed an evaluation in Malawi of the provision of the injectable contraceptive depot-medroxyprogesterone acetate (DMPA) at the community level by health surveillance assistants (HSAs). "The study results demonstrate that HSAs can safely provide injectable contraceptives," said Dr. Chisale Mhango, director of the Malawi Ministry of Health, Reproductive Health Unit. The U.S. Agency for International Development (USAID) supported the study, done in collaboration with the MOH.

Community health workers in Malawi, Uganda (photo above), and other countries now provide DMPA.

HSAs are the lowest-level cadre of paid workers in the Malawi public health system. FHI is now working with the MOH to design a follow-on study to examine whether volunteer workers known as community-based distribution agents (CBDAs) can also provide DMPA. Currently, CBDAs in Malawi already provide pills and condoms.

The findings reinforce the global evidence base on safety and effectiveness while highlighting the need to review programmatic issues relevant to country-specific situations, such as training, workload, supply chains, follow-up of women, and the relationships between volunteer and paid community workers.

New Report on Follow-Up Actions from 2009 International
Family Planning Conference

In June, the Implementing Best Practices (IBP) Initiative released a report calling for five actions for change based on the 2009 International Family Planning Conference held in Uganda. FHI/PROGRESS was the lead author of the report, working with the IBP Secretariat at the World Health Organization (WHO). The report, available here (PDF, 1.7 MB), summarizes how discussions about family planning and development joined at the conference to create a powerful flow of ideas and information. It calls on the 31 IBP member agencies to use evidence-based practices in family planning (FP) in visionary ways to:

• Promote FP in policies/plans
• Increase FP access and options
• Improve FP supply systems and financing options
• Integrate FP with health/non-health services
• Include men and underserved youth

Integrating Family Planning and Immunization Services
Holds Promise

FHI/PROGRESS, working in collaboration with the Maternal and Child Health Integrated Program (MCHIP), has produced a valuable new resource, "Integration of Family Planning with Immunization Services." This technical brief, available here (PDF, 515 KB), outlines what may be an effective way to reach postpartum women who want to avoid another pregnancy in the short term but are not using a modern family planning method. The recommended vaccination schedule for children allows for multiple health care contacts with infants and their mothers during the first year of life, and a majority of women seek immunization services for their children (80 percent in Africa and 84 percent in Southeast Asia). At the same time, there is a high unmet need for family planning for postpartum women. By integrating these immunization visits with family planning counseling and services, more postpartum women will have improved access to family planning information and linkages to services. PROGRESS is also supporting research on this type of integrated service to see what types of job aids and interventions might be most effective.

 Number 2 • August 2010

FHI India Helps Government Expand Methods in National Program

In an operations research project in six India sites, some public sector service providers and community health facilitators are reporting client interest in the intrauterine device (IUD) called the "Multiload 375" — a copper IUD that protects women for up to five years. The study, led by PROGRESS, has a pre-post qualitative design that has included training among 127 providers and 427 community health facilitators, resulting in 540 insertions of the Multiload 375 since the introduction began in mid-June. The project is designed to help the Government of India assess the feasibility of introducing the Multiload 375 under its National Family Planning Program. The final research results will help the Government identify issues related to introducing this method, including facility- and community-level barriers and operational needs within the existing public health care system.

International Organizations Endorse Technical Consultation Conclusions

In 2010, leading international medical associations and family planning donors and service provision organizations endorsed the findings reached by technical and program experts convened last year by the World Health Organization, in collaboration with USAID and FHI. The experts found in the 2009 consultation that community-based provision of progestin-only injectable contraceptives by appropriately trained community health workers is safe, effective, and acceptable. The new endorsements come from the International Confederation of Midwives, International Council of Nurses, International Federation of Gynecology and Obstetrics (FIGO), International Planned Parenthood Federation, Marie Stopes International, United Nations Population Fund (UNFPA), and the World Bank.

Study Tour in Uganda Helps Gather Support for Community-Based Family Planning

In July 2010, a delegation from the Uganda Ministry of Health (MOH), including Acting Director General of Health Services Dr. Nathan Kenya Mugisha, visited Nakasongola district to see how village health teams (VHTs) are providing the injectable contraceptive DMPA. FHI Uganda and Save the Children coordinated the trip, working with the Advance Family Planning Project and Partners in Population and Development, which are funded by the Gates and Packard Foundations. The tour was designed to help MOH officials gain a comprehensive, first-hand understanding and appreciation of how VHTs provide DMPA and the implications and benefits for expanding this practice in other parts of Uganda. After the tour, Dr. Mugisha called upon FHI and implementing partners to scale up the practice within currently implementing districts and help it expand to other districts. The end goal is for Uganda to amend national guidelines and service standards to allow VHTs to provide injectables throughout the country.

PROGRESS (Program Research for Strengthening Services) is a five-year project awarded to FHI 360 by the U.S. Agency for International Development (USAID) in June 2008. The project seeks to improve access to family planning among underserved populations by providing global technical leadership and working in selected countries. PROGRESS currently works in eight countries in sub-Saharan Africa and in India.