Systems approach to monitoring and evaluation guides scale up of the Standard Days Method of family planning in Rwanda

Igras, Susan; Sinaï, Irit; Mukabatsinda, Marie; Ngabo, Fidèle; Jennings, Victoria; Lundgren, Rebecka

doi:10.9745/ghsp-d-13-00165

Cited by 14 publications

(14 citation statements)

References 8 publications

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“…Additional data sources, such as a repeat of this evaluation, may be needed in a few years to assess improvements in monitoring systems and other gaps in programming. [11] Furthermore, there is a need for disaggregated data on implant insertions and removals, such as by age and whether women are new contraceptive users or method switchers. DHIS data are sourced from the PHC Tick Register, which as a monitoring tool is constrained by the limited data it gathers, which does not include age, for example.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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“…In India, SDM was included in the Jharkhand state registry and procurement systems, but because it was not incorporated in the national procurement and health management information systems (HMIS), CycleBeads ® had to be produced by a local organization, to bypass national procurement processes (IRH 2013c). Procurement of essential supplies, such as IEC materials and CycleBeads ® , should be integrated into the existing supply chain to ensure aligned procurement models (Igras et al 2014).…”

Section: Procurement and Stock Outsmentioning

confidence: 99%

Standard Days Method of contraception: Evidence on use, implementation, and scale up

Wright¹,

Iqteit²,

Hardee³

2015

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Since the early 2000s, the Standard Days Method (SDM) of family planning has been tested, introduced, and scaled up in countries around the world. SDM is a fertility awareness-based method for avoiding unprotected intercourse during the fertile period, days eight through 19 of a woman's menstrual cycle (for women whose cycles range from 26 to 32 days). Most SDM users utilize a visual aid-CycleBeads ®-to assist their correct use of SDM. In a 2002 trial, the method's first year failure rate (5 per 100 woman years with correct use and 12 per 100 woman years for typical use) was established, commensurate with certain other modern methods of contraception; since then, SDM has been introduced as well as studied in a variety of low and middle income countries (LMIC), and has been scaled up in some. This working paper summarizes the results of a structured review on SDM by the Evidence Project in 2014. This review utilized standardized search strings and systematic screening and abstracting criteria for reviewing available peer-reviewed and grey literature reports on SDM outcomes. Fifty-two reports and peer-reviewed articles were included and abstracted for data and information on client outcomes, provider outcomes, SDM service delivery characteristics, cost effectiveness, and implementation and scale up documentation. The included literature covered SDM implementation, scale up, social marketing, provider training, costing, and studies of most significant change in 23 countries from 1999 to 2014. This review of evidence on SDM tells us that the method appeals to a specific tranche of womenthose with unmet need, who desire to use non-hormonal contraception, and who are new to the use of effective modern FP methods. SDM as a method has correct and typical failure rates on par with some other modern methods of contraception (diaphragms, female condoms, and male condoms) and its prevalence is similar to some other modern methods that have been around for longer periods of time (female condoms, implants, IUDs, and male sterilization). SDM is easy to use and satisfying to users, it increases knowledge about the fertile period among both women and men, and it promotes male engagement in FP. It can be offered by a range of public and private providers throughout the health system. Scale up of SDM use requires stakeholder buy in and participation, early introduction of SDM into policies, guidelines, norms and curricula, inclusion of SDM into HMIS, procurement, and training systems, supportive supervision and refresher training, and publicprivate partnerships. In order to facilitate sustainable and systematic scale-up, particular attention needs to be to the procurement and availability of CycleBeads ® , agreement within the international community that SDM is a modern method, inclusion of SDM in national surveys, and the expansion of cadres providing SDM. IRH SDM Implementation and Scale up Studies Special studies undertaken within IRH Implementation and Scale up Studies 2 Other 3 Efficacy Trial Method Working Paper ▪ 45

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“…[1][2][3][4] However, making this transition is not easy. It requires creating ownership in the institutions that are expected to implement successful interventions on a large scale and working within existing system constraints or finding ways in which constraints can be alleviated.…”

Section: Introductionmentioning

confidence: 99%

From Project to Program: Tupange’s Experience with Scaling Up Family Planning Interventions in Urban Kenya

Keyonzo¹,

Nyachae²,

Kagwe³

et al. 2015

Reproductive Health Matters

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This paper describes how the Urban Reproductive Health Initiative in Kenya, the Tupange Project (2010-2015), successfully applied the ExpandNet approach to sustainably scale up family planning interventions, first in Machakos and Kakamega, and subsequently also in its three core cities, Nairobi, Kisumu and Mombasa. This new focus meant shifting from a "project" to a "program" approach, which required paying attention to government leadership and ownership, limiting external inputs, institutionalizing interventions in existing structures and emphasizing sustainability. The paper also highlights the project's efforts to prepare for the future scale up of Tupange's interventions in other counties to support continuing and improved access to family planning services in the new context of devolution (decentralization) in Kenya.

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Systems approach to monitoring and evaluation guides scale up of the Standard Days Method of family planning in Rwanda

Cited by 14 publications

References 8 publications

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

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

Standard Days Method of contraception: Evidence on use, implementation, and scale up

From Project to Program: Tupange’s Experience with Scaling Up Family Planning Interventions in Urban Kenya

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