Gaps in monitoring systems for Implanon NXT services in South Africa: An assessment of 12 facilities in two districts

Abstract

Background. Implanon NXT, a long-acting subdermal contraceptive implant, was introduced in South Africa (SA) in early 2014 as part of an expanded contraceptive method mix. After initial high levels of uptake, reports emerged of frequent early removals and declines in use. Monitoring of progress and challenges in implant service delivery could identify aspects of the programme that require strengthening. Objectives. To assess data management and record keeping within implant services at primary care facilities. Methods. We developed a checklist to assess the tools used for monitoring implant services and data reporting to district offices. The checklist was piloted in seven facilities. An additional six high-volume and six low-volume implant insertion clinics in the City of Johannesburg (CoJ), Gauteng Province, and the Dr Kenneth Kaunda District, North West Province, were selected for assessment. Results. All 12 facilities completed a Daily Head Count Register, which tallied the number of clients attending the clinic, but not information about implant use. A more detailed Tick Register recorded services that clinic attendees received, with nine documenting number of implant insertions and six implant removals. A more specific tool, an Insertion Checklist, collected data on insertion procedures and client characteristics, but was only used in CoJ (five of six facilities). Other registers, which were developed de novo by staff at individual facilities, captured more detailed information about insertions and removals, including reasons. Five of six low-volume insertion facilities used these registers, but only three of six high-volume facilities. No facilities used the form specifically developed by the National Department of Health for implant pharmacovigilance. Nine of 12 clinics reported data on numbers of insertions to the district office, six reported removals and none provided data on reasons for removals. Conclusion. For data to inform effective decision-making and quality improvement in implant services in SA, standardised reporting guidelines and data collection tools are needed, reinforced by staff training and quality assessment of data collection. Staff often took the initiative to fill gaps in reporting systems. Current systems are unable to accurately monitor uptake or discontinuation, or identify aspects of services requiring strengthening. Lack of pharmacovigilance data is especially concerning. Deficiencies noted in these monitoring systems may be common to family planning services more broadly, which warrants investigation.

User perspectives on Implanon NXT in South Africa: A survey of 12 public-sector facilities

“…The methods used to select the facilities and the results of other components of the evaluation have been detailed elsewhere. [9,10] We extracted contact details of women aged >18 years who had had an implant inserted since 2014 (n=751). In total, 262 of these women agreed to be interviewed, with the remainder either not contactable (telephone number not recorded or invalid), or not willing to participate.…”

Strengthening implant provision and acceptance in South Africa with the ‘Any woman, any place, any time’ approach: An essential step towards reducing unintended pregnancies

“…[46] Calls, lasting 4 minutes on average, might be feasible in SA, given that women's contact details are routinely collected at each clinic visit, although these details are often incomplete and subject to frequent changes. [47] Other studies examining active follow up had less promising findings, even though these were mostly in high-income countries and had weaker study designs. [48][49][50] Intervene as soon as possible when bleed ing is presented as a problem.…”

Factors influencing post-partum women’s choice of an implantable contraceptive device in a rural district hospital in South Africa

“…11,15 At present there is a need in South Africa to better understand the extent and reasons for a decline in use of the implantable device. 16 The aim of this study was to explore the factors that influence women's choice of Impla-nonNXT® in the South African context.…”