Abstract
In 2009, the Ethiopian Federal Ministry of Health launched an Implanon scale-up program with the goal of improving the availability of long-acting reversible contraceptive (LARC) methods at the community level. The Integrated Family Health Program (IFHP) supported the ministry to train Health Extension Workers (HEWs), a cadre of frontline health workers, on Implanon insertion. Prior to this task-sharing initiative, HEWs were only permitted to provide short-acting contraceptive methods; Implanon insertion services were only available at higher-level health facilities, such as health centers and above. To train HEWs on Implanon insertion, IFHP followed a phase-based approach, which consisted of a learning phase (July to September 2009) that transitioned into a scale-up phase (December 2009 to December 2015). Training began with a series of service delivery-based training of trainers (TOT) sessions for clinical care providers selected from health centers followed by rollout trainings on Implanon insertion for HEWs selected from health posts. Immediately after the Implanon rollout trainings, each trained HEW was provided with consumables and Implanon implants to enable them to initiate the Implanon services at their respective health post. To reinforce knowledge and skills, we conducted mentoring visits and performance review meetings. From July 2009 to September 2015, 98 TOT sessions trained 2,328 clinicians and 320 rollout trainings reached 8,436 HEWs. A total of 1,382,318 women received contraceptive services through any IFHP-supported service delivery point, 1,273,990 of whom received an Implanon implant. The IFHP approach proved to be a successful model for increasing access to contraceptive methods in the community, and the program supported the integration of Implanon services into the existing public health service delivery system.
Highlights
Global Health: Science and Practice 2017 | Volume 5 | Number 4 intrauterine devices (IUDs) accounting for just 9.9% of total modern contraceptive use among all women in 2016 (7.9% and 2.0%, respectively).2long-acting reversible contraceptive (LARC) offer highly effective protection from unintended pregnancy and contribute significantly to reducing unmet need for family planning.5 long-acting reversible contraceptives (LARCs) prevent maternal and neonatal deaths by allowing women to delay childbearing, space births, avoid unintended pregnancy and abortion, and stop childbearing when they have reached their desired family size.6 LARCs are characterized by their effectiveness, length of efficacy, reversibility, and rapid and predictable return of fertility after discontinuation of the method
All clients contacted by Integrated Family Health Program (IFHP) who sought an implant during the training of trainers (TOT) sessions, rollout trainings, and clinical practicum period (N=7,254) agreed to participate in the assessment. (In our experience, we have found that clients in the IFHP catchment area are usually willing to provide information if they know that the assessment is to be used for program improvement)
From July 2009 to December 2015, IFHP facilitated 98 TOT sessions with 2,328 clinical health care providers stationed at the health-center level
Summary
Global Health: Science and Practice 2017 | Volume 5 | Number 4 intrauterine devices (IUDs) accounting for just 9.9% of total modern contraceptive use among all women in 2016 (7.9% and 2.0%, respectively).2LARCs offer highly effective protection from unintended pregnancy and contribute significantly to reducing unmet need for family planning. LARCs prevent maternal and neonatal deaths by allowing women to delay childbearing, space births, avoid unintended pregnancy and abortion, and stop childbearing when they have reached their desired family size. LARCs are characterized by their effectiveness, length of efficacy, reversibility, and rapid and predictable return of fertility after discontinuation of the method. Global Health: Science and Practice 2017 | Volume 5 | Number 4 intrauterine devices (IUDs) accounting for just 9.9% of total modern contraceptive use among all women in 2016 (7.9% and 2.0%, respectively).. LARCs offer highly effective protection from unintended pregnancy and contribute significantly to reducing unmet need for family planning.. LARCs prevent maternal and neonatal deaths by allowing women to delay childbearing, space births, avoid unintended pregnancy and abortion, and stop childbearing when they have reached their desired family size.. LARCs are characterized by their effectiveness, length of efficacy, reversibility, and rapid and predictable return of fertility after discontinuation of the method. A single rod subdermal implant that is inserted under the skin of the upper arm, prevents unintended pregnancy for at least 3 years.
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