Developing an Online Toolkit for Revitalizing the IUD Theresa C. Norton1, Roy Jacobstein2, Erin McGinn3, Ruwaida Salem1, Rebecca Gmach3 1Johns Hopkins/Center for Communication Programs, 2EngenderHealth, 3Family Health International I would also like to acknowledge the contribution of Roberto Rivera, who was instrumental in development of the IUD Toolkit. He is retired from FHI. 34th Annual International Conference on Global Health Global Health Council

Why do we need an IUD Toolkit? Provide positive evidence-based practices about the IUD Help fulfill women’s right to contraceptive choice Alleviate myths and misperceptions There are many concerns surrounding the IUD, including misperceptions and unfounded myths among providers and potential users. This toolkit was created to alleviate uncertainties while providing positive evidence-based practices about the IUD. It also provides guidance and tools to update, expand or develop IUD service provision programs. Expanding access to the IUD with high quality services helps fulfill women’s right to contraceptive choice and contributes to sustainable family planning programs.

What is in the IUD Toolkit? Information and resources to develop and expand IUD services Up-to-date research evidence and expert advice Case studies on IUD-related activities from several countries IUD information and tools in different languages The IUD Toolkit offers the best available knowledge and practices on how to develop and expand IUD services in reproductive health programs. It contains: Tools and resources to help implement a variety of IUD-related activities A compilation of the most up-to-date knowledge and best practices on IUDs Resources on the most up-to-date evidence from the World Health Organization and other international reproductive health organizations Case studies on IUD-related activities from several countries

Who created the IUD Toolkit? Maximizing Access and Quality (MAQ) IUD Subcommittee Committee is part of USAID's MAQ Initiative (www.maqweb.org) Experts in international reproductive health and family planning from 16 organizations Expertise: program planning, training, advocacy, marketing, research, policy, logistics One of the strengths of this activity is that it grew out of a coalition of organizations--the MAQ IUD Subcommittee--which created a separate identity and brand for the Toolkit and which encouraged collaboration among organizations and allowed the Toolkit to be the product of collective expertise. From the beginning of the planning process, the group sought to maintain neutrality, as evidenced by discussions of branding, logos, and housing of the Web site.

Where is the IUD Toolkit? www.k4health.org/toolkits/iud Access to the IUD Toolkit is free. It is available on the Web, and a limited number of CD-ROMs are available for users in low-resources settings with inadequate Internet access.

Development Process MAQ IUD Subcommittee formed IUD Toolkit conceived Secretariat, IT partner, content teams formed Content teams selected content: Collaborative inventory of IUD documents Review and selection of content by teams Addressed inconsistencies IUD Subcommittee reviewed Created promotion and dissemination plan Conducted formal launch Created CD-ROM version First, the MAQ IUD Subcommittee was formed, and defined its mandate/goal -- "What can an HQ based group do to help programs in the field?" Collecting and organizing state of the art knowledge and technical advice/tools seemed the most valuable service the MAQ IUD subcommittee could provide. Out of this was born the idea of the IUD toolkit. Development of content -- all organizations were encouraged to itemize all their IUD publications, then the subgroups selected/determined overlap. But overall, the content development was a highly participatory process.  

Designed Information Architecture Small teams divided by content areas Information technology partner Secretariat managed process (content selection, timeline, promotion, dissemination) Tool: Web-based collaboration system (IBP Knowledge Gateway) The content teams looked at IUD materials developed by their organizations and others. They also contacted their field contacts for contributions of content; e.g., Kenya MOH for FP service delivery guidelines. The IBP Knowledge Gateway is a collaboration website with community forums and on-line work areas and libraries developed by WHO, with support from USAID and UNFPA, and managed by Johns Hopkins Center for Communication Programs.

Content experts selected “the best,” “free” Selected Content Content experts selected “the best,” “free” Evidence-based Users free to adapt for local use Sought permission to include on site Minimize links to aid production of CD-ROM “Essential Knowledge” authority Addressed inconsistencies Selection of content -- there were certain guiding principles all the organizations subscribed to -- that the content provided by the organizations would be "copyright-free" in the sense that adaptation and use would be encourage. The only explicit permission we needed was for some IPPF and WHO documents. About the "essential knowledge authority“: we were going to populate the toolkit with the best documents we could find, and strive for internal consistency. However is some cases a document/tool might have been great but only 90% accurate, in which case the toolkit states that where any inconsistencies exist, the Essential Knowledge section takes precedence.

Selected Content (cont.) Wrote two-page overviews per section Tool: Master Tracking Sheet Each content team wrote a two-page overview of its content area to provide a context for the importance of the topic to revitalizing IUDs. With over 150 resources ending up in the Toolkit, the Secretariat needed a way to track the status of the review and writing process with the content teams. They developed a spreadsheet for the purpose.

Developed Prototype Web-based, branded domain name Static web pages (not database) Custom content management system Password-protected Field tested with a few participants of meeting Refined for unveiling to larger subcommittee The group considered whether to have the site be database-driven and updated through a larger bibliographic database that Hopkins maintains (One Source). The group decided that after careful screening and selection of the content to form the Toolkit, it would not be wise to open it up to possible inconsistencies of information by having it automatically updated through a database-driven process. Another benefit of the static web pages was that it has made the site easier to be spidered and indexed by search engines. We believe this has resulted in more traffic to the site than a database-driven Toolkit with only a few static pages.

Promotion and Dissemination Promotion plan created Fliers, banner, bookmark Decentralized promotion Listservs, Web sites, meetings 32 listservs Targeted e-mails 45k+ recipients Tool: Promotion Tracking Sheet ·    IUD Toolkit launch press release was sent to 32 list-serves and e-newsletters outlined on the Reproductive Health Gateway between December 06 and February 07. It is estimated that these e-mails reached at least 34,000 recipients. ·    Press release was also disseminated through our CAs with an estimated 600 US based staff, 2100 field staff, and 8500 colleagues receiving the launch message.  ·    A link to the IUD Toolkit can be found on IPPF’s website and 10 of our CA's websites. We are still working to get the IUD Toolkit linked on every CA’s website. ·    There have been about 90 individual CD-Rom requests all from international colleagues. SAVE is also distributing 45 CDs in Uganda at a meeting with program managers.  We also received a request for 100 CDs to be sent to India to distribute to participants of the INSA India core group. ·    Approximately 400 IUD Toolkit promotional materials have been distributed at various conferences.

Outcomes Web statistics (Apr 06-Apr 07)1: Visits: 47,747 Visitors: 42,372 Countries: 175 Increase in visits since launch (Nov 06): 114% 1000 CDs produced; 235 pre-requests In April 2006, the password was removed from the website, making it technically open to the public and accessible through search engines, so here I show the web traffic from that time to almost present. However, the formal launch of the website at the MAQ Mini-University in October 2006 marked the beginning of promotion of the site, so I show statistics since that time to indicate success of the promotion efforts. 1Source: WebTrends. Stats since password removed.

Use of the IUD Toolkit “… use it [IUD Toolkit] in our 'continued technical updates' for the providers in our network. We have over 500 doctors and 8000 nurse/paramedics in the network directly involved in IUD service delivery…I would like the CD version so that I can use that to address policy issues with the local Government authorities as well.” — Sadia Dilshand Parveen, Director, Quality Improvement, NSDP, Gulshan, Dhaka, Bangladesh We have been receiving e-mails requesting the Toolkit on CD-ROM since we first announced its upcoming availability at technical meetings in Africa and elsewhere. Here are excerpts from e-mails that show use of the Toolkit.

Use of the IUD Toolkit (cont.) “We are an NGO running several Primary Health Centres in 2 states of India and [the IUD Toolkit] would be an invaluable resource for us in our programs.” — Dr. Prashanth N S, Coordinator (Health & Biodiversity), Karuna Trust

Use of the IUD Toolkit (cont.) “Papua New Guinea has a very low overall uptake/service provision of contraception, something we are about to address nationally as part of a Safe Motherhood Initiative. I anticipate making IUCDs a big player … but will need to train some core personnel in their use... Thanks for your great and informative site...and all the work it represents.” Dr. Miriam E. O'Connor ILTA Safe Motherhood, Capacity Building Service Centre

Lessons Learned Small teams of content experts effective, but: Work “in spare time” a challenge Long timeline (1+ years) Need dedication to overcome Secretariat steering the process important Decentralized promotion helps grow awareness Group model creates ownership, but challenges consensus Product brand separate from organizations also helps ownership I do think the process took a lot of time -- the secretariat was basically a year/year and a half, of maybe half-time work. However it has obviously paid off. One of the delays, or things that contributed to the length of time it took to develop, was the fact that all the individuals on the content team were reviewing/developing documents almost in their "spare" time -- they were all busy, senior level people/technical experts, with programs/projects to run, and they were committed to this toolkit and passionate about the IUD, so they did do the work. But it was a challenge to establish and meet deadlines with the decentralized process. I still think it was an excellent process, but I guess if we were advising others thinking about replicating this process, those would be my cautionary thoughts -- that the members, and their organizations/supervisors, have to be VERY committed to the work, and even then, it takes some extra time.   But that being said, I think the participatory approach did contribute to ownership, so on balance, I think it was a good process.

MAQ IUD Toolkit www.k4health.org/toolkits/iud Thank you! MAQ IUD Toolkit www.k4health.org/toolkits/iud Contact us: toolkits@k4health.org We invite you to link to the IUD Toolkit from your organizations’ websites!