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Scaling Up Access to and Use of Quality Implant Services

EngenderHealth’s Implant Program

Scaling Up Access to and Use of Quality Implant Services, a grant awarded by the Bill & Melinda Gates Foundation, focuses on increasing access to quality contraceptive implant services in a context of informed choice and volunteerism in three countries of Sub-Saharan Africa having great need: the Democratic Republic of the Congo, Tanzania, and Uganda. EngenderHealth is working with collaborating partners Jhpiego, John Snow Inc. (JSI) and the Clinton Health Access Initiative (CHAI) to increase knowledge, acceptability, and use of hormonal implants.

EngenderHealth’s hormonal implant initiative is being implemented as part of a larger effort to increase access to and use of voluntary family planning (FP) services, information, and supplies for an additional 120 million women and girls in the world’s poorest countries by 2020. Our work supports the partnership between the donor community and pharmaceutical companies developed as part of a global commitment reached during the London Summit on Family Planning (FP2020), as well as the overall Millennium Development Goals for each country.

Within this project, EngenderHealth will:

  • Create, expand, and support FP service delivery by increasing the number of trained implant providers, FP counselors, supervisors, managers, and support personnel
  • Integrate quality assurance and quality improvement supervision and training into all activities
  • Create an environment that supports wide access to implants by offering a range of contraceptive methods and information and prioritizing client rights and choice, medical follow-up care, and access to removal services on demand.

The Country Programs

Democratic Republic of the Congo (DRC)
The unmet need for FP in the DRC is at 24% among married women. By 2015, there will be 3.2 million more women of reproductive age than in 2007 (using EngenderHealth’s Reality Check tool for projections). The total fertility rate is high (6.3 lifetime births per woman), and access to health care is poor, leading to poor health outcomes. Modern contraceptive uptake remains low (6.7% of women of reproductive age).-Given the long history of conflict in the DRC, FP programs have only begun to gain funding and momentum, and there is great need for increased access to contraception, including long-acting reversible methods such as the implants and the intrauterine device (IUD). With this project, EngenderHealth expands its portfolio of work in the DRC beyond fistula care, to support the Ministry of Health and other local organizations in upgrading their FP quality and reach.

Tanzania
EngenderHealth, in partnership with the Ministry of Health and Social Welfare (MOHSW), currently works in Tanzania nationwide on FP, gender issues, FP-HIV integration, and other health initiatives. The use of implants in Tanzania has increased steadily since 2004, with the most significant increases resulting from the introduction of Implanon®. The expansion of EngenderHealth’s FP program to all 26 regions of the country has also contributed to an increase in uptake of this long-acting reversible method. The increase demonstrates the positive effect of the RESPOND Tanzania Project’s (RTP’s) expansion of services to lower level facilities and task shifting to nurse practitioners. Given this strong recent growth in implant use in Tanzania, it is clear that implants will play an important role in addressing high unmet need for FP (22% among women of reproductive age).

The new project will augment what is currently happening within the national FP program by training providers who would not have been trained with existing resources in undersupported districts. EngenderHealth and the MOHSW will work in conjunction with the pharmaceutical companies to increase access to and use of FP at the facility level, as well as using Special FP Days and mobile outreach services to access hard-to-reach communities.

Uganda
Uganda faces high unmet need and low contraceptive use. As of 2011, all modern contraceptive methods were being used by only 21% of women of reproductive age, and the implant by only 2%. Unmet need, in contrast, is at 34%. Currently, more than half of all modern contraceptive use in Uganda consists of the injectable (11%). Offering a broader method mix, with a focus on long-acting methods, is one important step toward decreasing unmet need and increasing couples’ ability to plan their families.

The hormonal implant initiative will upgrade the skills of service providers who have not been trained in long-acting reversible methods. Most importantly, the project will continue mentoring trained staff in clinical and counseling fields. Potential clients will be notified of mobile outreach services and facility-based Special FP Days, and the project will support capacity building among both Ministry of Health staff and supervisors. The goal is to increase access to and use of all FP methods, including hormonal implants.

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