Abstract
ObjectiveEvaluate implementation of misoprostol for postabortion care (MPAC) in two African countries.DesignQualitative, program evaluation.SettingTwenty-five public and private health facilities in Rift Valley Province, Kenya, and Kampala Province, Uganda.SampleForty-five MPAC providers, health facility managers, Ministry of Health officials, and non-governmental (NGO) staff involved in program implementation.Methods and main outcome measuresIn both countries, the Ministry of Health, local health centers and hospitals, and NGO staff developed evidence-based service delivery protocols to introduce MPAC in selected facilities; implementation extended from January 2009 to October 2010. Semi-structured, in-depth interviews evaluated the implementation process, identified supportive and inhibitive policies for implementation, elicited lessons learned during the process, and assessed provider satisfaction and providers’ impressions of client satisfaction with MPAC. Project reports were also reviewed.ResultsIn both countries, MPAC was easy to use, and freed up provider time and health facility resources traditionally necessary for provision of PAC with uterine aspiration. On-going support of providers following training ensured high quality of care. Providers perceived that many women preferred MPAC, as they avoided instrumentation of the uterus, hospital admission, cost, and stigma associated with abortion. Appropriate registration of misoprostol for use in the pilot, and maintaining supplies of misoprostol, were significant challenges to service provision. Support from the Ministry of Health was necessary for successful implementation; lack of country-based standards and guidelines for MPAC created challenges.ConclusionsMPAC is simple, cost-effective and can be readily implemented in settings with high rates of abortion-related mortality.
Highlights
The vast majority (87%, n04,758) of women served in public facilities received misoprostol for postabortion care (MPAC), compared with only 39% (n 0373) of women seen by private midwives
Health center administrators and policy makers were very satisfied with the MPAC program, and perceived that women receiving MPAC services were satisfied as well
MPAC is a simple, cost-effective and scientifically proven intervention, services are not available where needed*as is the case in many parts of Africa
Summary
Study overview In both countries, a baseline assessment of health facilities participating in the project was conducted prior to the implementation of MPAC services. Trained health care workers provided MPAC for 13Á25 months, at which time this qualitative evaluation of the program, utilizing in-depth interviews with program participants, was completed. This project was designed and implemented by Ipas, an international non-governmental organization (NGO) dedicated to ending preventable deaths and disabilities from unsafe abortion, in partnership with local Ministries of Health. Health facilities within these provinces were purposively selected to participate based on demand for PAC, willingness of providers and administrators to support implementation of the pilot program, and availability of necessary infrastructure for service provision. In Kenya, five public hospitals were included; in Uganda, two public hospitals and 18 clinics belonging to private midwives were included
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