Quality Family Planning Services through Integration and Coordination The Kasur Model

April 2014

Tauseef Ahmed PhD

Dr Haris Ahmed, MPH, FRSPH
PAKISTAN OFFICE

CONTRACEPTIVE TRENDS IN PAKISTAN

CPR in Pakistan plateaued during 20012011 18% of married Pakistani womenan estimated 4.6 million (2013)have unmet need for contraception Unintended pregnancy is a major contributor to unsafe abortion In 20122013, approximately onefourth (24%) of all births were unplanned

Contraceptive Trends in Pakistan

(Percentage of currently married women using any method)

2012-2013 Demographic and Health Survey in Pakistan

BACKGROUND

Stagnation in family planning performance over a decade Inadequate coverage, availability and accessibility of FP services Low quality of care, and weak monitoring Minimal support by Health Dept. to own service provision Population welfare and health vertical programmes with weak coordination between stakeholders (serious turf issue)

STUDY DESCRIPTION

Challenges demand solutions: Collaboration and integration of FP services, overall management by District Coordination Team Pathfinders project in Kasur district is designed to: Enhance image and expertise of Family Welfare Centers (FWCs) in counseling and IUD insertion Develop a referral mechanism involving community-based Lady Health Workers (LHWs) esp. IUDs for FWCs (token based) Funded by David and Lucile Packard Foundation

MODEL FOR CHANGE

System Strengthening Innovative FP Counseling Skills Improved Clinical Skills on IUD & Infection Prevention Technical Support & Monitoring

Supportive Supervision

USAID DELIVER
Increase Referrals Supply of Commodities

Client
Monitoring and Real Time Evaluation

OVERVIEW OF INTERVENTION
Social Mobilization and Client Motivation at community level by LHWs (share basic information) 1,350 LHWs cover around 60% of households Functional integration at grassroots improving referrals (services at nominal cost to clients) Women access services on a particular day: Family Health Days at FWCs Focused on newlywed and low-parity couples Preparing FWCs as key facilities to provide long-acting reversible contraception (IUDs) 48 Family Welfare Workers/Centers (whole district) Technical supervision and quality assessment Exit Interviews and Competency Checks (Pathfinder)

PROJECT MANAGEMENT District Technical Committee

Jointly agreed to pilot test the initiative Identified solutions and asked for technical assistance Jointly reviewed monthly performance and addressed Issues
Pathfinder facilitated data gathering and built analytical capacity and provided secretarial support

Assessed overall contraceptive requirements and pursued CWH for timely supplies Regular supervisory visits by Executive District Officer Health and Population Officer

Building Trust Provincial Level

Provincial Secretaries and DGs fully on board Pathfinder built trust between the departments and developed clear operating procedures for coordination

Kasur Model
(April 2013 March 2014)

DEMAND GENERATION

TRAINING MODULES
Innovative counseling tools

IMPROVING SERVICE PROVISION

LHW Program Manager, Punjab, displaying the FP Manual for LHWs

IUD Trainings

Results

Baseline April 2013 Endline Feb. 2014 Catchment Areas of Family Welfare Centers

CONTRACEPTIVE METHOD CURRENTLY USED ALL WOMEN

Condoms and IUCDs have statistically Significant Results

CONTRACEPTIVE MIX AMONG ALL USERS

SOURCE OF OBTAINING CONTRACEPTIVE METHODS

Public sector served
35% women (Baseline Survey) rose to 79% women at Endline
Demand Generation by public sector and working referral system Increased access to public sector

All Main Categories show Statistically Significant Results

EVER AND CURRENT USE OF CONTRACEPTION

Statistically Significant Results

CONTRACEPTIVE USE BY EDUCATION: ENDLINE VS PDHS

PDHS 2012-13 80 70 60 50 40 30 20 10 0 No education Primary Middle 30 48 41 41 61 74

Endline 70 60 44 44

Secondary

Higher

Community-based distribution increases access to FP services for poor and esp. illiterate women

PDHS 2012-13 & Endline 2014

CONCLUSIONS
Community mobilization critical to promote family planning Improved performance as a result of: integration at grassroots and active coordination by DTC Public sector has tremendous capacity to improve performance within existing resources Promotion of IUD requires careful interpersonal communication at community level Pilot model has great potential for sustainability and replication Population Department expressed interest to scale up model in 10 districts)
Minister of Population Welfare, Punjab visit a Family Welfare Center at District Kasur

For more information contact Dr Tauseef Ahmed tahmed@pathfinder.org

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