With the single-visit approach for cervical cancer prevention, women with positive “visual inspection of the cervix with acetic acid wash” (VIA) test results receive immediate treatment of the precancerous lesion with cryotherapy. The approach worked successfully for women with HIV in Ethiopia in secondary and tertiary health facilities, with high screening and cryotherapy treatment rates. Sustainability and appropriate scale-up of such programs must address wider health system challenges including human resource constraints and shortage of essential supplies.

Following the introduction of IUDs into the Ethiopian public health sector, use of the method increased from <1% in 2011 to 6% in 2014 in a sample of 40 health facilities. This shift occurred in the context of wide method choice, following provider training, provision of post-training supplies, and community-based awareness creation. The IUD was acceptable to a diverse range of clients, including new contraceptive users, those with little to no education, those from rural areas, and younger women, thus suggesting a strong latent demand for IUDs in Ethiopia.

Background: Donor funded projects are small scale and time limited, with gains that soon dissipate when donor funds end. This paper presents findings that sought to understand successes, challenges and barriers that influence the scaling up and sustainability of a tested, strengthened youth-friendly service (YFS) delivery model providing an expanded contraceptive method choice in one location – the YFS unit – with additional units in Amhara and Tigray, Ethiopia. Methods: This retrospective mixed methods study included interviews with key informants (KIs) (qualitative arm) and analysis of family planning (FP) uptake statistics extracted from the sampled health facilities (quantitative arm). A multistage convenience purposive sampling technique was adopted to randomly select 8 health facilities aligned with respective woredas, zones and regional health bureaus (RHBs). A semi-structured interview guide soliciting information on 6 scaling-up elements (stakeholder engagement, roles and responsibility, policy environment, financial resources, quality of voluntary FP services and data availability and use) guided the interviews. Fifty-six KI interviews were conducted with policy-makers, program managers, and clinic staff. Recurring themes were triangulated across administrative levels and implementing partners. Relevant FP data (acceptor status, age and method uptake) were extracted from the 8 sampled health facilities for a thirteen-month period. Qualitative findings triangulated with FP service statistics assessed the influence of the 6 scaling-up elements with trends in long-acting reversible contraceptive (LARC) uptake before and after training. Results: Our findings depict that respondents were knowledgeable and supportive of an expanded method mix. Statistically significant increases in long-acting contraceptive uptake were noted at 2 of the 8 health centers. Fidelity to the tested model was operationally constrained; respondents frequently mentioned trained staff absences and turnover as obstacles in offering quality FP services. Conclusion: Despite conducive policy environment, supportive stakeholders, favorable environment, and financial support for trainings, statistically significant increases in LARC uptake occurred at only 2 of the 8 health centers; indicating the influence of weak health systems, poor quality of voluntary FP services and a ceiling effect. Scale-up processes must consider potential bottlenecks of weak health systems and availability of financial resources by addressing these as crucial elements in any systematic scale-up framework.

Background: Maternity waiting home (MWH) within primary health care facilities is an ideal platform to reach women with family planning education and counseling. MWH users interact with health care providers on a regular basis throughout their waiting period and can prepare to initiate family planning method of their choice immediately after childbirth. However, to date, there has been no clear evidence about the use of MWHs to increase uptakes of immediate postpartum family planning (IPPFP). Therefore, the aim of this study is to assess the contribution of MWHs to increase IPPFP uptake among women who deliver in health facilities in Ethiopia.Methods: A comparative cross-sectional study design was conducted to collect quantitative data from women who gave birth in the past 12 months. Multi-stage random sampling procedures were employed to select 884 women. Descriptive summary and logistic regression with 95% confidence intervals were conducted in Stata 14 to analyze the data.Result: The prevalence of IPPFP use among women who used MWHs was 44% and 36% among those who did not use MWHs. The use of MWHs significantly contributed to increase immediate postpartum family planning uptake (OR = 1.48, 95% CI = 1.08- 2.04, p=.016).Conclusions: This study showed that, MWHs significantly contributed for improving IPPFP uptake by an average of 8%-point difference for beneficiaries within 48 hours after delivery. Developing a comprehensive package of service for maternal care has the potential to improve family planning uptake of postpartum women. Women’s who have used maternity waiting home more likely utilized postpartum family planning than women who have not used maternity waiting home. Providing a comprehensive package of services, including family planning information and counseling, in maternity waiting homes can have a positive impact on improving postpartum family planning use.

Background: Lack of timely household (HH) level data to inform evidence-based decision-making for improved, timely and targeted health interventions is challenging. Integrated Family Health Program (IFHP) developed and implemented a system for collecting data on an on-going basis at household levels.Objective: To discuss the implementation of the continuous household surveys of the IFHP.Methods: Continuous surveys were used for generating timely data for monitoring outcome indicators. Integrated Family Health Program conducted continuous cross-sectional household surveys in its four major target regions over the past 6 years. This approach facilitated the aggregation of data annually, thus enabling progress to be tracked over time and timely decision-making. A total of 2560 households were interviewed each year and trend report synthesised for use.Result: Key performance indicators in the areas of family planning, and maternal and child health were considered for the study. Time series analysis data revealed overall progress in each outcome indicator. The report was shared among key programme staff to provide data for informed programmatic decision-making.Conclusion: The surveys as part of other programme activities proved to be a feasible and efficient way to generate timely data for programme outcome monitoring. Documenting the design and implementing data collection and feedback mechanism for prospective description and outcome monitoring potentially represents a new paradigm for course correction.Recommendation: Programme implementers should plan integrated continuous programme outcome monitoring mechanism as part of programme design rather than waiting for mid-term or end-term project evaluation.