Since 1993, AVSC has been working with three university hospitals in Egypt to pilot-test a service model designed to increase contraceptive access and options for Egyptian women.

The model, called the Safe Reproductive Health Program, consists of systematically screening, referring, and counseling women at high risk of poor obstetrical outcome (mortality and morbidity of the mother and the infant) and offering them an expanded range of contraceptive options at more service points.

The program strengthens links among prenatal, postpartum, and family planning services and increases the involvement and cooperation of staff from different service departments.

Counseling and client information systems are key elements of the program, which emphasizes meeting the particular needs of high-risk women. The program is part of a strategy to expand the method mix offered in the national family planning program and to increase the availability and use of postpartum contraception throughout Egypt.

Orientations for Hospital Staff

AVSC staff and consultants have provided technical assistance and training to help establish the Safe Reproductive Health Program at Ain Shams University in Cairo, Shatby Maternity Hospital at Alexandria University, and Mansoura University.

One of the most important activities of the program has been a series of orientation workshops for hospital staff that bring together a mix of doctors, nurses, social workers, and administrators from the departments of obstetrics and gynecology, pediatrics, and internal medicine.

These on-site orientations, conducted by AVSC, inform staff about the nature and magnitude of maternity risk in Egypt, introduce them to the Safe Reproductive Health Program, and engage their active involvement in screening, referring, and serving high-risk women. Following a viewing of the film Why Did Mrs. X Die?, participants are oriented to a service model designed to prevent morbidity and deaths among high-risk women and their infants. An update on contraceptive technology, an overview on client communications and counseling, and an introduction of a new client-screening tool are included.

These interdepartmental orientations use interactive training methods to encourage active participation and include exercises that foster greater client awareness and a client-oriented service approach. The orientations have proved very effective in generating a "team approach" to services and engendering staff support and enthusiasm for the program. Participants say they find the sessions to be innovative and appreciate them for their content and design.

Breaking Down Barriers

During the one-day workshops that have been conducted at the three sites, the training has effectively broken down the traditional barriers among levels of staff to enable spirited exchanges and sharing of ideas.

At each hospital, staff who have contact with clients at different points in different departments are now part of a larger team that is better able to identify, inform, refer, and serve women in need of reproductive health information and services.

After one year of project activity at the three hospitals, significant progress has already been documented. More clients now receive services at the sites. Standards of practice for postpartum IUD (PPIUD) insertion and medically indicated tubal ligation have been developed.

New PPIUD services have been initiated, and there are increased awareness and support for tubal ligation services for high-risk women. Client counseling has been introduced and enthusiastically received, and infection prevention practices have been assessed and strengthened at each site. A client information system has also been designed and is being introduced to strengthen and monitor referral links.

The government of Egypt has asked for AVSC assistance in expanding the Safe Reproductive Health Program to other university hospitals and to the national public-sector program over the next two years.

AVSC's work in Egypt is made possible through funding from the U.S. Agency for International Development.

Georgeanne Neamatalla is the area director for AVSC International's programs in Egypt, India, and Turkey. Dr. Maaly Guimei is AVSC's regional program and quality coordinator for Egypt.