Shifting the Family Planning Method Mix Needle Authors: Namwinga Chintu1,2, Felix Tembo 1, John Phiri 1, Doris Mwape,Gertrude Silungwe 1, George Kateteye 1, Loyce Munthali 3 , Masauso Nqumayo 1, Gina Smith 1,2 1Population Services International; 2Society for Family Health-Zambia; and 3USAID Zambia November 2018, ICFP, Kigali, Rwanda “YOUTH POWERED” can be removed if needed.

This presentation is made possible by the support of the American People through the United States Agency for International Development (USAID). The contents of this presentation are the sole responsibility of PSI/SFH Zambia and do not necessarily reflect the views of USAID or the United States Government.

Background Rural Urban 39.5% 60.5% Area Source: ZDHS 2014 Age % Fertility Fertility rate: 5.3 Average mothers age at first birth: 20.3 Delivery by adolescents: 141/1,000 Total population 14,075,099 Modern Contraceptive Prevalence Rate (mCPR): 45% Unmet need for family planning: 21% Pregnancy and delivery by adolescents is at 141/1000 Pregnancy and delivery by Pregnancy and delivery by adolescents is at 141/1000 Pregnancy and

Background mCPR 45% - predominant use of short-term methods FP Method mix in Zambia mCPR 45% - predominant use of short-term methods Low use of Long term Acting Contraception(LARC) Zambia FP 2020 commitment-increase CPR to 58% Zambia Integrated Family Planning Scale-Up Plan 2013 - 2020

Goal: Increase mCPR by 2% per year Funder: USAID Project period: 2015 - 2020 Goal: Increase mCPR by 2% per year Supports 88/303 (29%) public facilities in 15 supported districts Catchment area population for women in childbearing age (WCBA) – 731,054 SARAI covers 47% of population of WCBA Kanchibiya Lavunshi Manda

Program Interventions Aim: To support expansion of LARC Services Specific Interventions Dedicated FP Providers. Off Duty Providers Community based Distributors *Project offers voluntary FP Services

Program Interventions Placement Role Trained FP providers dedicated to training and mentorship One dedicated provider per province Mentorship of newly trained providers Provide Technical support to strengthen logistics and supply chain Support minimum standards of FP service delivery Midwives trained in FP service delivery (engaged while off duty to provide services during non clinic days) At least two providers per Health Facility Increase access to Family planning through increase in FP hours and days provided at facility level Generate demand for FP services and provide FP counselling Community volunteers trained to create demand and provide services Community level (598 community distributors) Demand generation and service delivery (oral contraceptives and DMPA SC)

Methodology Period: October 2016- September 2017 Sites: Muchinga, Luapula and Copperbelt (88/303 public sector facilities) Population Total WCBA: 731,054 Intervention sites 300,404 (41%) Control sites 427,650 (59%) Data Collection: Routine HMIS collection using public sector systems Dedicated FP providers, off duty providers and CBDs were deployed to above sites during study period

Results SARAI Contribution to FP Services 492,252

Results Uptake of FP Services 88 OF 303 FACILITIES= 29%

Results Increased Contribution to CYPs 96,797 82,558 88 OF 303 FACILITIES= 29%

Results Shifting the Family Planning Method Mix Intervention Control Sites

Conclusion Sustained monitoring, mentoring and supervision of FP providers facilitates increased LARC uptake Engagement of trained community workers for demand generation and service delivery is an integral part of shifting to LARCs A consolidated holistic approach involving leadership, facilities, communities an supply chain of commodities is key to sustainable FP approaches It is feasible to shift the FP needle toward more LARCs methods in a public sector setting while leveraging existing public health systems

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