PSI/Tanzania Presentation Private sector role in Family Planning By Dr. Nguke Mwakatundu,RH Director

Some Abbreviations CPR: Contraceptive Prevalence Rate CYP: Couple Years of Protection FP: Family Planning IPC: Interpersonal Communication IUCD: Intrauterine Contraceptive Device LTM: Long Term Method MWRA: Married Women of Reproductive Age OC: Oral Contraceptive PA: Public Announcement

PSI/Tanzania Non-profit organization specialized in disease prevention programs Registered in Tanzania since 1993 Employing over 210 people Areas of work: HIV/AIDS, Malaria,Diarrhoea Disease, Reproductive Health Strong field network – national coverage Zonal teams (manager, DM,MDC,STC) Regional teams (manager, DPO, RH staff)

National Reach Zonal Offices Regional Offices National Coverage

Background and Geographical Coverage-RH Program Familia RH program was initiated in 2007,and started services provision in January 2009 Sales of RH products cover the whole of Tanzania with exception of IUCDs and Implants which cover 13 regions in Tanzania. PSI/Tanzania distributes six FP products and offers service delivery in 17 regions of mainland Tanzania (Network facilities in 13 regions and outreach activities in 12 regions). Distributes one safe motherhood product and will start limited distribution of another one in Q2 2013

RH Program Objectives Family Planning To contribute towards increase of national CPR target (target 60% use among MWRA by 2015) and reducing total fertility rate from 5.4 to 3.1 by 2015 To promote usage of FP methods especially long-term methods (Implants and IUCD’s). Maternal mortality To contribute towards reducing maternal mortality to 193/100,000 live births by 2015(Currently at 454/100,000) To reduce maternal deaths due to post partum haemorrhage (PPH) and incomplete abortions using misoprostol. To increase access to safer delivery -Clean delivery pack

Program Components Product procurement, packing and distribution Social marketing of 6 FP products,1 safe motherhood product, and another safe motherhood product from Q Distribution at national and regional level in all authorized outlets. Increased access to services (esp LTM) Comprehensive partnership with private sector facilities Service provision through outreach teams Behaviour Change Communication Inter Personal Communication in communities Medical detailing to health facilities and pharmacies Community events Public Announcements

Program Components Supportive environment Curriculum revision TOT’s Working with universities, professional associations (e.g. AGOTA) Working with the Ministry of Health at national and local level to improve the environment for better access to FP and safe motherhood services Integration FP / HIV : Counselling, referral for testing and free condom distribution Treatment of Incomplete abortion / FP Postpartum FP

Familia Products Range Family Planning Products: IUCD’s Implants Condoms(male and female) Injectables Oral Contraceptives Emergency contraceptives(supplier brand) Safe Motherhood Products Misoprostol (supplier brand) Clean Delivery Pack

page 10 Pharmaceutical Regional Distributor Urban retailer District/Rural Centers wholesaling outlets Urban wholesaling outlets Rural retailer Institutions, NGOs, CBOs etc Health facilities PSI/Tanzania Current distribution model Target Groups Clinics, VCT, HBC, CHWs, Peer educators MDCs

Behavioural Change Communication Activities IPC activities: Household Visits, Neighbourhood Meetings, Clinic meetings Women groups meetings : Markets places, Saloon s visits, kitchen parties IEC materials: posters, brochures Public Announcements (PA) Mass media: radio spots, newspapers page 11

Private Sector Partnership Service Delivery

Approach Social franchising model Selection of health facilities based on specific criteria Signature of MOU Comprehensive training in clinical skills for LTM Equipment for LTM provision Access to products, expendables and job aids Monthly event days post-training for capacity building On going coaching and mentoring for quality Branding and local promotion of services through posters, wall paintings, PAs Referral system to facility using IPC agents

Branding of Facilities

Wall Paintings

Public Sector Approach 10 outreach teams supporting the public sector in 12 regions. Each team is of 2 nurse midwives partnering with public sector providers trained in LTM Selection of location / health facilities driven by district authorities Demand creation prior to the event using posters; public announcements; local leaders; facility providers Equipment, supplies and IP material brought by PSI team All FP clients are screened for HIV and referred for testing if they are at risk Free condoms offered to all clients in need

Major Achievements in 2012 More than doubling in provision of LTM’s(102,778 insertions in 2012 Vs 48,518 in 2011) Increased provision of LTM’s in private sector by 92%(58327 combined IUCD’s and Implants Vs in 2011) Increased provision of LTM’s in the public sector by 145%(44451 combined IUCD‘s and Implants Vs in 2011) Over 317 providers in the private sector network as of Dec 2012 from 255 at end of 2011, 24% increase in number of providers in the private sector network. 250 IPC workers supporting the private sector network as of Dec 2012 Over 300,000 women reached through IPC in 2012

Major Achievements cont. Increase in number of outreach teams from 5 to10 teams supporting the public sector in 12 regions. Increase in number of women counselled for HIV during FP counselling by 55% (82,891 in 2012 from 53,593 in 2011) Increase in number of women referred for testing for HIV by 66%(16,849 in 2012 from 10,134 in 2011) Increase in number of free condoms distributed by 98%(486,315 in 2012 from 245,541 in 2011)

LTM’s Insertions-Private Sector

LTM’s Insertions-Outreach

IUCD’s and Implants Distribution

OC’s distribution

Injectables distribution

Familia condoms distribution

Misoprostol distribution

CYP’s growth

2013 Priorities Integrating other services to be delivered in the Familia social franchise Increasing productivity of private network providers and IPC workers Increasing sales of FP products Introducing Clean Delivery Pack

THANK YOU