Upload
paley
View
45
Download
0
Embed Size (px)
DESCRIPTION
Integrating Family Planning Services into EPI: the Polomolok Experience in the Philippines. Strengthening Governance for Health Project (HealthGov) June 2011. Facilitating factors. Multiple contacts with mothers at service delivery point: 4-5 visits over newborn’s first 11 months - PowerPoint PPT Presentation
Citation preview
Integrating Family Planning Services into EPI: the
Polomolok Experience in the Philippines
Strengthening Governance for Health Project (HealthGov)
June 2011
1
Facilitating factors
• Multiple contacts with mothers at service delivery point: 4-5 visits over newborn’s first 11 months
• 90% of women within first year after delivery want to space or limit pregnancy, high unmet need for FP
• High access and awareness of EPI services - at least 85% fully immunized child (FIC) coverage present at service delivery point
• Immunizations and FP provided by same (trained) midwives, on different days and times (referrals made)
2
Polomolok Municipality, Province of South Cotabato (Mindanao)
3
Lake Sebu
SOUTH COTABATO
Tiboli
Surralah
TupiBanga
Sto. NinoKoronadal
TantanganNoralla
Tampakan
To Isulan
To Tacurong
To GeneralSantos City
Philippines Map
Implementation• 10 month pilot test in one local government unit (LGU): Polomolok
Municipality• 1 Rural Health Unit (RHU -- municipal health center) & 28 Barangay Health
Stations (BHS) involved• Began study with 1-day orientation of all medical personnel – explained
purpose, approach & key messages• Developed map of facilities and FP and MCH service providers• Pre-tested 3 verbal messages (translated in local dialect) in two locales
4
• Messages:– “Your child is young & you should be concerned about having
another pregnancy”– “Your health facility provides FP services that can help you”– “You should visit our FP services after your immunization today for
more information”
• Trained 25 rural health midwives (RHWs-based in BHS), 56 barangay health workers (BHWs), 2 RHU nurses and 1 doctor in FP messages
• Study did not collect special immunization data but data available from routine reporting to government FHSIS
5
• Baseline & end-line survey questionnaire developed to measure client changes in knowledge, attitudes & practices (KAP)
• Data collected on new FP acceptors, method mix & CPR (from same monthly period during 2008 and 2009)
• KAP survey administered in 28 BHS – randomly selected mothers of reproductive age (MRA) bringing children in for immunizations were surveyed (baseline: n=269; end-line: n=183)
6
• BHW—administered survey, registered child for immunization & delivered messages
• RHM – administered immunization & delivered same messages
• 2 “Innovations” in Poblacion-4 BHS – Distributed 3 FP messages in written format (found
mothers to be distracted during verbal delivery) & posted messages in entry way
7
8
Key Findings
38% increase in New FP acceptors after 10 months, Polomolok Municipality
YEAR
MAR APR MA
Y JUN JUL AUG SEP OCT NO
VDEC
TO-TAL
2008 151 136 164 149 123 113 151 136 164 149 1,405
2009 176 205 235 178 191 164 176 205 235 178 1,943
%increas
e
16.6 50.7 43.3
19.5 55.3 45.1
16.6 50.7 43.3 19.5
38.3
(March-December, 2008 vs 2009)
9
CPR Increased by 6 percentage points
46%49%
55%
40%
45%
50%
55%
Percent
2007 2008 2009
CPR by Year
Contraceptive Prevalence Rate, Municipality of Polomolok, South Cotabato
CPR
Source: FHSIS
10
Shift in Method PreferenceHigher preference for modern methods, lower preference for
traditional methods after six months (June 2009 vs Dec. 2009, Polomolok)
0
5
10
15
20
25
30
Perc
ent
FP Methods
Jun-09
Dec-09
11
Health centers as primary source of FP information increased from 47% to 87%
(among FP users)
47
1912 10
87
4 5
0102030405060708090
100
Health Center Family / Relative Friend / neighbor None
Source of Information
Perc
ent Jun-09
Dec-09
(June 2009 vs December 2009, Polomolok)
12
126% increase in new FP acceptors over 3 months in Poblacion-4 BHS
(written FP messages & posters in addition to oral messages)
YEAR MAR APR MAY JUN TOTAL2008 8 7 12 16 432009 40 20 14 23 97
% 400.0 185.7 16.7 43.7 125.6
(March-June, 2008 vs 2009)
Immunization DataPolomolok Municipality—source: FHSIS)
• Does not appear to be negative
• Fully Immunized Child (FIC) coverage rates – 2008: 96%– 2009: 99%
13
Potential Best Practices & Processes Needed for Effective Integration
• Local ownership and support (from local government and health officials)
• Posted and take-home written messages --written FP messages stapled to immunization records to prevent loss -- along with verbal messages
• Client follow-up to prevent FP drop outs• Assuring the availability of FP commodities to meet increased
demand• Ongoing performance monitoring (at facility & LGU levels) –
nurse monitors FP referral message delivery; local Department of Health reps monitor LGU
14
Potential Barriers to Integration
• Lack of local political (elected) & technical (health officials) support
• Lack of contraceptive and immunization supplies
• Lack of trained providers (in both services)
• Overcoming social norms that pose barriers in some communities to accessing services (e.g. Muslim and indigenous populations)
15
Current Gaps and Priority Next Steps
• Study limitations:– Results from only 1 municipality – do not yet know if these can
be replicated elsewhere– This study included monitoring component, but program impact
was not measured (no control group)– Caution about data quality – data cleaning going on now, may
change CPR, # of FP acceptors
• Steps to Strengthen study: – Examining FP data in comparable municipalities in province,
with no FP-EPI integration over same period
16
Priority Next Steps• Implementing quasi-experimental program impact study in 2
provinces (with intervention & control groups)• Besides FP-EPI, measuring impact of FP integration with
other MNCHN services: postpartum care, vit A supplem.• Immunization data (FIC) being collected in addition to FP
data • Tracking availability of FP commodities and services (since
creating demand)• Implementing Data Quality Control (DQC) trainings for
midwives, nurses, project staff to assure reliability• Study outcomes will determine methodologies to scale up
integration interventions
17