Through the Expand Family Planning (ExpandFP) Project, EngenderHealth seeks to increase access to and use of family planning, with a focus on hormonal implants and in a context of voluntarism and informed choice. Funded by The Bill & Melinda Gates Foundation, the project is under way in three countries with great need for FP in Sub-Saharan Africa: the Democratic Republic of the Congo (DRC), Tanzania, and Uganda.
In collaboration with local governments, ExpandFP focuses on building the capacity of public-sector health facilities to offer high-quality family planning services for women and girls. We are actively scaling up family planning services by improving service delivery at health clinics and employing mobile outreach approaches to reach the most remote, vulnerable populations. We seek to ensure that a range of contraceptive methods and information are available; client rights and choices are assured; medical follow-up care is offered; and access to implant and intrauterine device (IUD) removal services is in place. Quality assurance and quality improvement initiatives are part and parcel of all project activities.
EngenderHealth’s work supports the partnership between the donor community and pharmaceutical companies developed as part of FP2020, a global commitment to providing FP information and contraception for an additional 120 million women and girls in the world’s poorest countries by 2020. EngenderHealth works with collaborating partners of The Gates Foundation’s Implants Access Program (IAP), Jhpiego, John Snow Inc. (JSI), and the Clinton Health Access Initiative (CHAI).
Through this project, EngenderHealth is working to:
- Create, expand, and support family planning service delivery by increasing the number of trained providers—especially for implants and IUDs—as well as family planning counselors, supervisors, managers, and support personnel;
- Integrate quality assurance and quality improvement supervision and training into all activities;
- Ensure accurate reporting and use of data for decision-making, especially for contraceptive security;
- Build an enabling environment that supports wide access to family planning by offering a full method mix of short-acting, long-acting reversible, and permanent contraceptive methods, while prioritizing client rights and choice, medical follow-up care, and access to removal services on demand;
- Create demand for and awareness of family planning services through information and communication materials, client mobilization using community health workers, and engagement of key community members.
The Country Programs
By 2015, the DRC will be home to 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 limited, leading to poor health outcomes. Given the long history of conflict in the DRC, family planning programs have only begun to gain funding and momentum, and there is great need for increased access to contraception, including long-acting reversible contraceptive (LARC) methods such as implants and IUDs. In Kinshasa alone, 30.4% of married women of reproductive age have an unmet need for family planning. To address this gap and expand access to contraception, EngenderHealth is implementing ExpandFP in Kinshasa, a city of more than 10 million people.
Through ExpandFP, EngenderHealth supports the Ministry of Health to build capacity at provincial health facilities by training providers to administer LARC methods, including implants. The project supports nine clinics in the greater Kinshasa area to offer family planning services daily and to host special family planning events where services are available free of charge. These events include free services once a month at the nine facilities and mobile outreach services, which often serve more than 1,000 clients per week.
In the first year of the project, more than 11,600 clients received family planning services in Kinshasa, of which approximately 74% voluntarily adopted implants. Anecdotal evidence points to several reasons for this large uptake of implants, including: large latent demand for this highly effective method; the fact that it is a new option for women; and recent training and quality improvement activities by multiple donors. In 2015, ExpandFP will conduct a client study in the DRC, Uganda, and Tanzania to better understand women’s perceptions of quality and method choice.
In partnership with the Ministry of Health and Social Welfare (MOHSW), EngenderHealth works in Tanzania nationwide on family planning, 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 family planning program to all 26 regions of the country has also contributed to increased uptake of this long-acting reversible method. The increase demonstrates the effectiveness of the RESPOND Tanzania Project (RTP) in expanding services to lower-level facilities and task-shifting to nurse practitioners. Given this strong growth in implant use in Tanzania, it is clear that implants will play an important role in addressing high unmet need for FP, which was 22% among women of reproductive age as of 2010.
ExpandFP complements the national family planning program by training providers at 21 facilities who would not otherwise have been trained in undersupported districts near Arusha and Iringa. EngenderHealth and the MOHSW work to increase access to and use of FP at the facility level and conduct special family planning days and mobile outreach services to access hard-to-reach communities.
During the first year of the project, more than 44,689 clients received family planning services across Arusha and Iringa, of which approximately 35% voluntarily adopted implants.
Ugandan women have a high unmet need for family planning and low contraceptive use. As of 2011, only 21% of women of reproductive age were using modern contraceptive methods, and only 2% were using implants. By contrast, unmet need among Ugandan women 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 an important step toward decreasing unmet need and increasing couples’ ability to plan their families.
ExpandFP supports six health facilities in two districts of Uganda (three in Hoima and three in Masaka) by building the capacity of service providers who have not been trained in long-acting reversible methods. The project also supports special family planning days at the clinics and mobile outreach services for rural areas in their larger catchment area. The project works with Village Health Teams, which inform the community about the special event days, in addition to providing information on family planning methods overall. Now in its second year, the project is working with youth groups, peer educators, and health care providers trained in youth-friendly services to ensure greater access to family planning services for youth. During the first year of the project, more than 8,432 clients received family planning services across the two districts, of which approximately 27% voluntarily adopted implants.
ExpandFP is supported by generous contributions from The Bill & Melinda Gates Foundation.