Institutionalizing postpartum family planning and postpartum intrauterine device services in Nepal: Role of training and mentorship

Thapa, Kusum; Dhital, Rolina; Karki, Yagya B.; Rajbhandari, Sameena; Amatya, Sapana; Pande, Saroja; Tunnacliffe, Emily-Anne

doi:10.1002/ijgo.12604

Cited by 20 publications

(28 citation statements)

References 15 publications

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“…This points to a major deficit in the training of health professionals on-the-job in order to make them system-ready for delivering services to the community members. This finding comes at the backdrop of previous studies which have established the important role of on-the-job training [25,26].…”

Section: Discussionmentioning

confidence: 63%

Community-Based Health Planning and Services Plus programme in Ghana: A qualitative study with stakeholders in two Systems Learning Districts on improving the implementation of primary health care

et al. 2020

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BackgroundIn 1999, Ghana introduced the Community-Based Health Planning and Services (CHPS) as the key primary health care strategy. In this study, we explored the challenges, capacity development priorities, and stakeholder perspectives on improving the CHPS concept as it has been fraught with a myriad of challenges since its inception. Our study is the outcome of the national programme for strengthening the implementation of CHPS Initiative in Ghana (CHPS+) introduced in 2017. MethodsThis exploratory research was a qualitative study conducted in two Systems Learning Districts (SLDs) of CHPS+ in the Volta Region of Ghana from March to May, 2018. Four focus group discussions and two general discussions were conducted among 60 CHPS+ stakeholders made up of health workers and community members. Data analyses were conducted using conceptual content analysis. Statements of the participants were presented as quotes to substantiate the views expressed. ResultsNegative attitude, high attrition, inadequacy and unavailability of health professionals at post when needed were challenges associated with the health professionals. Late referrals, PLOS ONE | https://doi.lack of proper community entry and engagement, non-availability of essential logistics, distance of CHPS compounds from communities, and inadequate funding were challenges associated with the health system. Lack of community ownership of the CHPS programme, lack of security at CHPS compounds, and late reporting of cases by the community members were also realised as challenges emanating from the community members. Priority areas for capacity development of health workers identified included logistics management, community entry and engagement, emergency delivery, managing referrals at the CHPS level, and resuscitation of newborns. ConclusionHealth-worker, community, and health systems-based challenges inhibit the implementation of CHPS in Ghana. Capacity development of health professionals and continuous community engagement are avenues that can improve implementation of the programme.Community-Based Health Planning and Services Plus programme in Ghana: A qualitative study with stakeholders PLOS ONE | https://doi.

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Section: Discussionmentioning

confidence: 63%

Community-Based Health Planning and Services Plus programme in Ghana: A qualitative study with stakeholders in two Systems Learning Districts on improving the implementation of primary health care

et al. 2020

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“…Before service introduction, all obstetric doctors and a cohort of labor ward midwives were trained in vaginal PPIUC insertion using 33‐cm Kelly forceps (Roberts Surgical Healthcare Ltd). This technique has been widely described in the literature and is advocated by the Royal College of Obstetricians and Gynaecologists (RCOG) . After delivery of the baby and placenta, ring forceps are applied to the anterior cervix to straighten the utero‐cervical canal.…”

Section: Methodsmentioning

confidence: 99%

Provision of immediate postpartum intrauterine contraception after vaginal birth within a public maternity setting: Health services research evaluation

Cooper

McGeechan

Glasier

et al. 2019

Acta Obstet Gynecol Scand

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This is an open access article under the terms of the Creat ive Commo ns Attri bution-NonCo mmerc ial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. Abstract Introduction: Expanding access to postpartum intrauterine contraception (PPIUC) can reduce unintended pregnancies and short inter-pregnancy intervals; however, provision across Europe is limited. Our aim was to determine the feasibility, clinical outcomes and patient satisfaction of providing immediate PPIUC after vaginal birth using a health services research model. Material and methods: Phased introduction of PPIUC across two Lothian maternity hospitals; all women intending vaginal birth during the study period without a contraindication to use of the method were eligible to receive PPIUC. Midwives and obstetric doctors were trained in vaginal PPIUC insertion using Kelly forceps. Women received information antenatally and had PPIUC insertion of either a levonorgestrel intrauterine system or a copper intrauterine device within 48 hours of vaginal birth.Follow-up was conducted in-person at 6 weeks postpartum and by telephone at 3, 6 and 12 months. Primary outcomes were: uptake, complications (infection, uterine perforation), expulsion and patient satisfaction at 6 weeks; and method of continuation up to 12 months. Secondary outcomes included hazard ratio for expulsion adjusted for demographic and insertion-related variables.Results: Uptake of PPIUC was 4.6% of all vaginal births; 465/447 (96.1%) of those requesting PPIUC successfully received it and most chose a levonorgestrel intrauterine system (73%). At 6 weeks postpartum, the infection rate was 0.8%, there were no perforations and 98.3% of women said they would recommend the service. The complete expulsion rate was 29.8% (n = 113) and most had symptoms (n = 79). Of the additional 121 devices removed, 118 were because of partial expulsion. The rate of complete/partial expulsion was higher for insertions by midwives compared with those by doctors. The re-insertion rate after expulsion/removal was 87.6% and method continuation at 12 months was 79.6%. | 599COOPER Et al.

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“…La metodología enseñada y utilizada fue la inserción alta en el fondo uterino con ayuda de unas pinzas Kelly. En Nepal la formación se hacía en la propia consulta y tuvo un gran éxito, con la ventaja de que el personal no tenía que salir del lugar de trabajo para recibir un curso de formación organizado 11 . La distribución de tareas entre matronas y enfermeras para la inserción del DIU resultó muy eficaz en la India 12 , Nepal 10 , Kenia 10 y Tanzania 13 , con un aumento de las tasas de aceptación y muy poca variación en las tasas de complicaciones.…”

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Institucionalización de los dispositivos intrauterinos posparto

2019

Intl J Gynecology & Obste

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Institutionalizing postpartum family planning and postpartum intrauterine device services in Nepal: Role of training and mentorship

Cited by 20 publications

References 15 publications

Community-Based Health Planning and Services Plus programme in Ghana: A qualitative study with stakeholders in two Systems Learning Districts on improving the implementation of primary health care

Community-Based Health Planning and Services Plus programme in Ghana: A qualitative study with stakeholders in two Systems Learning Districts on improving the implementation of primary health care

Provision of immediate postpartum intrauterine contraception after vaginal birth within a public maternity setting: Health services research evaluation

Institucionalización de los dispositivos intrauterinos posparto

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