Integrating Family Planning with Obstetric Fistula Services: Achieving Reproductive Intentions Bethany Cole, Global Projects Manager, Fistula Care Plus Dr Adamu Isah, Deputy Project Manager, FC+ Nigeria ECOWAS Forum on Good Practices in Health Ouagadougou, Burkina Faso | 31 July 2015

Fistula Care Plus Goal: To strengthen health system capacity for fistula prevention, detection, treatment, and reintegration in priority countries Bangladesh, Democratic Republic of Congo, Niger, Nigeria, and Uganda

Five-Step Approach Integrating FP and Fistula Care Services STEP 1* STEP 2* STEP 3 STEP 4 STEP 5 Identify/ refine level of integration that can be adopted Assess fistula center’s capacity to support FP** Build or strengthen systems to support new services Identify resources to support integration Phase in FP methods to expand mix w/o stressing center’s capacity * Steps 1 and 2 interchangeable depending on stakeholders’ pre-existing desires for level of integration. ** Includes orientation of stakeholders to staff tasks and system functions required to support levels of integration. SYSTEMS Supervision Logistics Referral Training Record-keeping Policy RESOURCES Partnerships Capacity-building

Integration in Action: Zamfara, Sokoto, Kebbi

Levels of FP Integration * If facilities or programs providing Level A functions are not immediately prepared to provide oral contraceptives for ongoing uses, they may provide emergency contraceptive pills with referral for ongoing FP management. If the facility or program already provides oral contraceptives (Level B), it can also offer emergency contraceptive pills.

IEC Materials to Support Integration

Results Strengthened contraceptive logistics management system Task-shifted delivery to Community Health Extension Workers Developed champions from Ministries of Health and community levels

Challenges Limited awareness by providers on FP messages including prevention Perceived resistance to FP services Biased providers against offering IUD to women post-fistula repair Dropped commitment from government

Recommendations Make FP an integral element of repair services Promote on-site supervision Secure commitment from nurses and midwives Informed and voluntary decision-making, counseling, delivering FP Involve men in RH

FP Integration Guiding Principles Provide comprehensive services relevant to clients’ desires/needs Integrate to the capacity of the core service Support service delivery modification Explore roles of the community and men

Summary