Improving Contraceptive Access, Use, and Method Mix by Task Sharing Implanon Insertion to Frontline Health Workers: The Experience of the Integrated Family Health Program in Ethiopia

Tefera, Bekele; Lew, Candace; Belayihun, Bekele; Hagos, Kidest Lulu; Asnake, Mengistu

doi:10.9745/ghsp-d-17-00215

Cited by 30 publications

(45 citation statements)

References 6 publications

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“…The intervention was mainly delivered by HEWs who provided FP counselling and aministered MCMs during household visits and at health or outreach posts (in particularly large woredas) [16]. Speci cally, post-partum women were counselled on FP during the 1st, 3rd and 7th day post-natal checks and MCMs were provided alongside the child's '45 day immunisation' or at a later date during a household visit or at health a post or outreach post The 45 day immunisation takes place 6 weeks after birth and encompasses the rst round of immunisations including Penta1 (DTP-HepB1-Hib1,OPV1,PCV1, Rota1) [17].…”

Section: Interventionmentioning

confidence: 99%

“…However, HEWs were not trained in implant removal and this may have adversely affected uptake of implants by women, and self-e cacy of HEWs. National policy in Ethiopia does not task HEWs with implant removal (16). This has resulted in an unmet need of implant removal in the many rural and hard to reach areas (16,40).…”

Section: Perceptions Of Key Actorsmentioning

confidence: 99%

“…National policy in Ethiopia does not task HEWs with implant removal (16). This has resulted in an unmet need of implant removal in the many rural and hard to reach areas (16,40). To address this, the Integrated Family Health Programme (IFHP) has attempted to scale-up the availability of trained health professionals who can provide this service, but the programme has yet to be extensively rolled out.…”

Section: Perceptions Of Key Actorsmentioning

confidence: 99%

See 2 more Smart Citations

What mechanisms drive uptake of family planning when integrated with childhood immunisation in Ethiopia? A realist evaluation

Krishnaratne

Hamon

Hoyt

et al. 2020

Preprint

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Background: Maternal and child health are key priorities among the Sustainable Development Goals , which include a particular focus on reducing morbidity and mortality among women of reproductive age, newborns, and children under the age of five. Two key components of maternal and child health are family planning (FP) and immunisation. Providing these services through an integrated delivery system could increase the uptake of vaccines and modern contraceptive methods (MCMs) particularly during the post-partum period. Methods: A realist evaluation was conducted in two woredas in Ethiopia to determine the key mechanisms and their triggers that drive successful implementation and service uptake of an intervention of integrated delivery of immunisations and FP. This evaluation included the: 1) development of an initial programme theory; 2) review of relevant published theories; 3) analysis of project monitoring data; 4) analysis of qualitative data from 23 semi-structured interviews to determine key mechanisms and drivers; and 5) development of a revised programme theory comprised of context-mechanism-actor-outcome and context-mechanism-intervention-actor-outcome configurations based on empirical findings. Results: The proportion of women who brought their children for immunisation and received MCMs was 63.0% (4,260/6,764) overall [74.3% (2,944/3,961) in Assosa woreda and 46.9% (1,316/2,803) in Bambasi woreda]. Key contextual factors identified were: a strong belief in values among religious leaders and community members that challenged FP; a lack of support for FP from male partners based on religious values; and the use of trained Health Extension Workers (HEWs) to deliver FP services. Within these contexts, intervention components that focused on the alignment of religious texts with FP, the promotion of FP by religious leaders, and the training of HEWs and health care workers on FP counselling and service delivery, influenced the implementation of the intervention and triggered several mechanisms of acceptability, access, and adoption of innovations. Conclusions: Linking context and intervention components to the mechanisms they triggered helped explain the intervention outcomes, and more broadly how and for who the intervention worked. This enabled the development of a programme theory that could be used to inform the integrated delivery of FP services in similar contexts.

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Section: Interventionmentioning

confidence: 99%

Section: Perceptions Of Key Actorsmentioning

confidence: 99%

Section: Perceptions Of Key Actorsmentioning

confidence: 99%

See 1 more Smart Citation

What mechanisms drive uptake of family planning when integrated with childhood immunisation in Ethiopia? A realist evaluation

Krishnaratne

Hamon

Hoyt

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…A few studies examining programmes targeting the components of a CBHS have demonstrated positive outcomes. For example: evidence from a study conducted in Ethiopia among respondents of reproductive age (including adolescents) show that CBHWs can play a significant role in expanding contraceptive use in low-and middleincome countries [20]. Evidence from Ghana suggests that adolescent SRHR activities should also target parents (and community members) as a way of breaking socio-cultural barriers [21].…”

Section: Introductionmentioning

confidence: 99%

Can sexual health interventions make community-based health systems more responsive to adolescents? A realist informed study in rural Zambia

Mulubwa¹,

Hurtig²,

Zulu³

et al. 2020

Reprod Health

111

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Introduction: Community-based sexual reproductive interventions are key in attaining universal health coverage for all by 2030, yet adolescents in many countries still lack health services that are responsive to their sexual reproductive health and rights' needs. As the first step of realist evaluation, this study provides a programme theory that explains how, why and under what circumstances community-based sexual reproductive health interventions can transform (or not) 'ordinary' community-based health systems (CBHSs) into systems that are responsive to the sexual reproductive health of adolescents.Methods: This realist approach adopted a case study design. We nested the study in the full intervention arm of the Research Initiative to Support the Empowerment of Girls trial in Zambia. Sixteen in-depth interviews were conducted with stakeholders involved in the development and/or implementation of the trial. All the interviews were recorded and analysed using NVIVO version 12.0. Thematic analysis was used guided by realist evaluation concepts. The findings were later synthesized using the Intervention−Context−Actors−Mechanism−Outcomes conceptualization tool. Using the retroduction approach, we summarized the findings into two programme theories. Results: We identified two initial testable programme theories. The first theory presumes that adolescent sexual reproductive health and rights (SRHR) interventions that are supported by contextual factors, such as existing policies and guidelines related to SRHR, socio-cultural norms and CBHS structures are more likely to trigger mechanisms among the different actors that can encourage uptake of the interventions, and thus contribute to making the CBHS responsive to the SRHR needs of adolescents. The second and alternative theory suggests that SRHR interventions, if not supported by contextual factors, are less likely to transform the CBHSs in which they are implemented. At individual level the mechanisms, awareness and knowledge were expected to lead to value clarification', which was also expected would lead to individuals developing a 'supportive attitude towards adolescent SRHR. It was anticipated that these individual mechanisms would in turn trigger the collective mechanisms, communication, cohesion, social connection and linkages.

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“…That is, injectable contraception clients, in particular, are pleased with the provision of this method through CHWs, who in turn have been shown to be capable of and amenable to providing this service. With regard to LARCs, and implants in particular, CHWs and nurses trained to provide this method demonstrated the feasibility and safety 5 and increased access to contraceptive methods 18 .…”

Section: Discussion and Recommendationsmentioning

confidence: 99%

Evaluation of a pilot program for task sharing short and long-acting contraceptive methods in Burkina Faso

et al. 2019

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Background: The Family Health Directorate of the Ministry of Health (MoH/FHD) and Marie Stopes Burkina Faso (MS BF), with implementing partners, Association Burkinabé pour le Bien-être Familial (ABBEF) and Equilibres & Populations (Equipop) collaborated to conduct a pilot project in Burkina Faso focused on “increasing access to family planning (FP) services through task-sharing short- and long-acting family planning methods to primary care cadres.” Four cadres of providers were trained to provide intrauterine devices (IUDs) and implants, while community health workers (CHWs) were trained to provide pills and subcutaneous injectables. FHI 360 and the Institut Supérieur des Sciences de la Population (ISSP) evaluated the project’s impact on method uptake, client satisfaction, safety, acceptability and the feasibility of task sharing. Methods: The evaluation employed service statistics, client exit interviews (quantitative) and in-depth interviews (qualitative). New FP clients, community representatives, MoH officials, and pilot project-trained FP providers from Dandé and Tougan districts participated in these interviews. Results: Providers, community representatives and government officials all spoke favorably of the pilot project and considered it a boon to women and the communities in which they lived. FP clients were satisfied with their methods and the services they received from their respective providers, and they reported no safety concerns. However, service statistics did not show a clear and steady increase in method uptake for the four methods beyond spikes coinciding with pre-existing free contraceptive weeks. Conclusions: Results of the evaluation were largely positive. These evaluation findings are being used to guide decisions about scale-up.

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Improving Contraceptive Access, Use, and Method Mix by Task Sharing Implanon Insertion to Frontline Health Workers: The Experience of the Integrated Family Health Program in Ethiopia

Abstract: Between 2009 and 2015, 1.2 million women received Implanon implants from trained Health Extension Workers. Of the approximately 7,000 implant service visits made during the first 6 months, 25% were among women who had never used contraception before.

Cited by 30 publications

References 6 publications

What mechanisms drive uptake of family planning when integrated with childhood immunisation in Ethiopia? A realist evaluation

What mechanisms drive uptake of family planning when integrated with childhood immunisation in Ethiopia? A realist evaluation

Can sexual health interventions make community-based health systems more responsive to adolescents? A realist informed study in rural Zambia

Evaluation of a pilot program for task sharing short and long-acting contraceptive methods in Burkina Faso

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