FP/HIV Programming in Ethiopia

Endale Workalemahu (M.D., MPH) PSI/ETHIOPIASeptember 18, 2015

Only 46% of sexually active young women in Ethiopia age 15-24 report ever having used a modern FP method

FSWs face numerous barriers to consistent modern FP use such as lack of access, stigma and providers attitudes

Key Takeaway: HIV prevention interventions designed to reach FSWs are currently well positioned to reach these young women but often do not offer comprehensive FP services due to fragmented programming approaches.

Problem

M

M

Peer Education Components:•HIV prevention & treatment•STI prevention & treatment•FP methods & informed choice•Life planning and vision•Negotiation & relationships•Savings and business skills

Integrated Clinical Services:• HIV counseling & testing• STI screening & treatment• FP counseling & referrals• GBV screening & referrals• TB screening & referrals• Condom demonstration

Facility-level interventions

Community-level interventions

Peer educators refer FSWs either to network clinics or to tents during clinical outreach events.

As necessary, outreach clinical workers refer FSWs to network

clinics.

Modern FP Service Delivery:• Pills• Injectables• Condoms

• Implants• Emergency

Contraception

Modern FP services added to integrated clinical service package during clinical outreach events.

Solution: Integrated Clinical Services

How? FSW Population Density Map, Metema, Amhara

After 18 months of implementation 5,150 FSWs accessed voluntary FP services integrated with comprehensive HIV services.

20% of all FP clients were non-users prior to the visit.

The total incremental cost of adding FP services to the existing clinical package was approximately $0.92  per FP client served.

Results

Female sex workers (80%)

Young 19-24 (43%)

Single (71%)

Background Characteristics of Beneficiaries

20.0%

80.0%

Non-UsersCurrent FP Users

Reaching FP Non-Users

94.4%

5.6%

Acceptors Non-acceptors

Non-users

All Beneficiaries

Contraceptive Method Type Among Current Users and Non-Users

Injectable Pills Implant Others0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

63.2

28.7

6.0

2.1

47.1

26.123.1

3.5

Current users Non users

Per

cen

tag

e

1. Comprehensive approach by existing HIV project simplified FP integration

2. Layering FP services on top of an existing project and collaboration with stakeholders reduced costs

3. Mapping data was key for reaching underserved key populations

Lessons

Adding modern FP services to existing HIV combination prevention  programs that reach key underserved populations, can be an appropriate and cost-effective means to increasing FP access  

How do we sustain the services and such integration under MULU?– Extend the reach through such low cost FP services– Community trust, leverage existing peer support structure– Continue the outreach and add FP services at the Drop in Centers

(DICs)

Conclusion

PSI/USAID supports 54 Drop in Centers which have agreements/license from MOH to Provide Integrated clinical services

Equipment and commodities including FP supplies can be leveraged from existing mechanism

Trained providers

Looking to the Future

Thank you!