Resource Mobilization and Partnership to Increase FP Coverage Through Access to Quality Services Introducing Norplant at the Periphery Aguima Tankoano, MD, MPH, Chief of Party Marcel Sagbohan, MD, MSC, Deputy Chief of Party Susan B. Aradeon, Ph.D., BCC Advisor PROSAF Transition Phase/Benin Conference on Repositioning Family Planning in West Africa organized by Advance Africa in Accra, Ghana February 15-18, 2005 Source: PROSAF phase transitoire/presented by Susan ARADEON # 1

Collaborators Introduce Norplant at the Periphery in Benin PROSAF and USAID –the major Benin family health project ABPF and IPPF –the Benin family planning association MSP: the Ministry of Public Health, –The Family Health Directorate and UNFPA Department of Health of Borgou/Alibori in northern Benin (DDSP) Source: PROSAF phase transitoire/presented by Susan ARADEON # 2

Three Objectives for the Introduction of Norplant Services increase availability of FP services in BA by broadening the range of contraceptives increase the potential of the health system in BA to protect more couples each year from too closely spaced and unwanted pregnancies reinforce collaboration between the principal actors in the health sector Source: PROSAF phase transitoire/presented by Susan ARADEON # 3

The Norplant Case Demonstrates the Power of Synergy synergy to reinforce the capacity of the health services and providers to organize and offer family planning services synergy to secure and finance contraceptive products Source: PROSAF phase transitoire/presented by Susan ARADEON # 4

Synergistic Collaboration in Stages 1.Preliminary discussions on necessity and feasibility of offering Norplant in BA. 2.Negotiations with the MSP Directorate of Family Health 3.Memorandum of Understanding between PROSAF and ABPF Source: PROSAF phase transitoire/presened by Susan ARADEON # 5

Synergistic Collaboration in Stages (continued) 4.Mobilization of resources and Norplant supplies 5.Training and supervision of 20 Norplant providers 6.Annual monitoring of Norplant use Source: PROSAF phase transitoire/presented by Susan ARADEON # 6

Preliminary Discussions Reached a Consensus approach to follow roles and responsibilities of each party sites that would house the Norplant services number of providers to train Source: PROSAF phase transitoire/presented by Susan ARADEON # 7

Negotiations with the MSP Family Health Directorate MSP approval to introduce Norplant at the peripheral level Norplant kits supplied by UNFPA Source: PROSAF phase transitoire/presentrd by Susan ARADEON # 8

Memorandum of Understanding between PROSAF and ABPF Assured close and effective collaboration ABPF: transfer skills using their staff expertise and training materials + provide back-up Norplant and materials through its own channel PROSAF: finance the training + supply each trainee with the essential 21 item Norplant insertion/removal kit Source: PROSAF phase transitoire/presented by Susan ARADEON # 9

Mobilizing Government Support PROSAF relied on a variety of approaches letters preliminary meetings follow-up meetings with key personnel at the DSF informal meetings with other influentials in order to exert effective pressure Source: PROSAF phase transitoire/presented by Susan ARADEON # 10

Agreement on Training Site Strong pressure to send trainees to an existing site in Cotonou Dept of Health Director and PROSAF insisted that Norplant introduction be fully decentralized and sustainable at the department level. PROSAF financed transformation of ABPF clinic into a Norplant training center URC financed cost of bringing Cotonou trainers for the training and post-training supervision. Source: PROSAF phase transitoire/presented by Susan ARADEON # 11

Pro-Active Service Providers Service providers in Alibori advocated with their zonal health management teams (ZHMT) for inclusion of Norplant training in the PBA (German) Project activities PBA funded training for 7 service providers Source: PROSAF phase transitoire/presented by Susan ARADEON # 12

Maintaining Momentum While Resolving Supply Problems ABPF did supplement the MSP start up supplies Service Providers purchased their initial service delivery supplies (5 implants) their health center’s community fund. PROSAF provided kits to 4 district-level health centers where the midwives had been trained with PBA funds. Source: PROSAF phase transitoire/presented by Susan ARADEON # 13

20 Norplant Providers Trained by ABPF Staff three 10-day sessions during the second half of 2002 limited to seven participants, given the supervision and coaching requirements during the practice sessions reinforced by one supervision visit by the training team Source: PROSAF phase transitoire/presented by Susan ARADEON # 14

Trainer’s Kit and Learner’s Kit with 15 Training Modules 1.Recap of Other Contraceptive Methods and Preliminary Questionnaires 2.Norplant 3.Norplant Counseling 4.Clients’ Rights 5.Client Assessment 6.Norplant Service Organization and Management 7.Infection Prevention 8.Norplant Insertion and Removal Techniques 9.Managing Norplant Side Effects 10.Insertion/Removal with Clients (Clinical Practicum) 11.Completing Forms 12.Norplant Stock Management 13.Mid-term Questionnaire 14.Participants’ Action Plan 15.Participants’ Course Evaluation Source: PROSAF phase transitoire/presented by Susan ARADEON # 15

Distribution of the Trained Norplant Service Providers Trained by Facility Type Training Session Date Departmental Hospital Zonal Hospital Maternity Center 13 rd Quarter th Quarter Total Service Providers 2612 Source: PROSAF phase transitoire/presented by Susan ARADEON # 16

Annual Monitoring of Norplant Use Couple Years of Protection (CYP) calculations: factor of 3.5 = 1 insertion Integrated into the Dept. of Health National Routine Health Information System (SNIGS) Source: PROSAF phase transitoire/presented by Susan ARADEON # 17

Results of the Synergy Among the Collaborators A significant 53% increase in the CYP between 2002 in 2003 Rapid appropriation by the Health Zone Management Teams (HZMT) –budgeted the re-supply of the entrants for the continuation and the sustainability of Norplant. Source: PROSAF phase transitoire/presented by Susan ARADEON # 18

Graph 1: CYP evolution and comparison between CYP pre and post introduction of Norplant in Borgou and Alibori Source: PROSAF phase transitoire/presented by Susan ARADEON # 19

Graph 2 : Comparison between the CYP provided by Norplant and the total CYP: 2003 and 2004 in Borgou and Alibori Source: PROSAF phase transitoire/presented by Susan ARADEON # 20

Norplant Impact on CYP in 2003 and 2004 Without Norplant, the CYP would have stagnated near the 2002 level. 29% of the CYP in 2003 and 30% in Even though purchases doubled for short- term methods (oral contraceptives and Noristerat injectables), Norplant’s greater conversion factor resulted in a greater CYP for Norplant than the combined CYP for both these methods. Source: PROSAF phase transitoire/presented by Susan ARADEON # 21

In 2002, Benin already had local and international partners commited to enhancing health systems and FP expertise to introduce Norplant services financial resources for Norplant introduction Source: PROSAF phase transitoire/presented by Susan ARADEON # 22

However, Without Leadership from PROSAF and ABPF Norplant services would still be minimal Constant networking and feedback was essential to generating and maintaining the synergy among the partners that kept the program on track. Partner commitment had to be mobilized and remobilizedPartner commitment had to be mobilized and remobilized to face each hurdle along the road to provision of Norplant in the farthest corners of the nation. Source: PROSAF phase transitoire/presented by Susan ARADEON # 23

Source: PROSAF phase transitoire/presented by Susan ARADEON # 24 Synergy generated through leadership that sustained partner commitment NORPLANT P E R MSP/UNFPA COMMUNITY ABPF SERVICE PROVIDERS PBA DDSP HZMT PROSAF P ARTNERS E XPERTISE R ESOURCES

Lessons Learned 1.the existence of a latent demand for Norplant (acceptance of side effects) 2.the capacity of Norplant to rapidly and durably increase couple protection 3. the power of leadership to generate synergistic collaboration among agencies to mobilize and share resources for significantly greater FP coverage. Source: PROSAF phase transitoire/presented by Susan ARADEON # 25

What’s Next Resolve stock-out problems Carry out cost analysis Increase promotion of Norplant Source: PROSAF phase transitoire/presented by Susan ARADEON # 26