05_XXX_MM1 Introducing Medical Abortion: Thinking Strategically Peter Fajans MD MPH and Ronnie Johnson PhD UNDP/UNFPA/WHO World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) Department of Reproductive Health and Research World Health Organization

05_XXX_MM2 What do we mean by "Introduction"? Product introduction refers to "the integrated set of activities to prepare health systems to accept and manage the provision of new, improved, or underutilized technologies".

05_XXX_MM3 Begin with the End in Mind ICMA's mandate Promoting access to medical abortion in the context of safe abortion worldwide

05_XXX_MM4 Build Support for Introduction of MA in the Context of Safe Abortion Care Involve broad range of key stakeholders Inform, listen to concerns, build support Develop information materials for different target audiences Advocacy with gatekeepers and other stakeholders Conduct clinical or introductory trials to familiarize health professionals and prepare for regulatory approval

05_XXX_MM5 Assess Needs and Priorities for Introduction Review available in-country literature Conduct a field-based assessment of current abortion and related SRH services – Participatory process to provide multiple perspectives and build ownership and consensus – In-depth interviews with managers, providers, women seeking services, community members including youth – Observations of facilities and services as appropriate

05_XXX_MM6 Social, Cultural, Legal, Political and Resource Contexts PEOPLE SERVICESTECHNOLOGY Availability, Characteristics Policies, Programmes, Access, Availability, Quality of Care Women's Needs and Perspectives, Gender Issues The Strategic Approach: Conceptual Framework

05_XXX_MM7 Examples of Follow-Up Actions from Strategic Assessments Policy directives to increase access to contraception and safe abortion for at-risk groups Development/revision of national standards and guidelines and training curricula for CAC, including MA Introduction of MVA and MA for 1 st trimester abortion Introduction of MA and D&E for 2 nd trimester abortion to replace less safe methods Development of IEC/communication strategies for women and communities New models of service delivery

05_XXX_MM8 Importance of Local Evidence for Scaling Up Is the innovation feasible and effective in the local context? Learn what works before investing in wide-scale implementation Refine and improve the package of interventions Build ownership by involving stakeholders in design and implementation Opportunity for decision-makers to observe new services, to build support Provide input to development or revision of national standards and guidelines, training curricula, IEC materials, etc.

05_XXX_MM9 Sustainable Scaling Up Horizontal Scaling Up Expansion Expansion Vertical Vertical Scaling Up Institutionalization scale up

05_XXX_MM10 The Innovation User Organization(s) Resource Team TYPES OF SCALING UP DISSEMINATION AND ADVOCACY ORGANIZATIONALCHOICES COSTS/RESOURCEMOBILIZATION MONITORINGANDEVALUATION Scaling up Strategy A Framework for Scaling Up

05_XXX_MM11 Strengthening Capacity for Scaling Up Health Service Innovations

05_XXX_MM12 Overview of the Strategic Approach

05_XXX_MM13 Making Decisions about Contraceptive Introduction: A Guide for conducting assessments to broaden contraceptive choice and improve quality of care A practical guide for implementing Strategic Assessments

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05_XXX_MM15 Strategic Assessment Policy & Programme Strengthening Developing and Testing Programme Innovations Scaling-Up Successful Interventions STAGE I Reproductive Health Challenges Improved Reproductive Health Status and Programmes STAGE IISTAGE III The Strategic Approach Implementation Process

05_XXX_MM16 Strategic assessments on issues related to abortion Viet Nam (1997)* Romania (2001) Bangladesh (2002)* Mongolia (2003)* Ghana (2005)* Moldova (2005)* Macedonia (2007) Ukraine (2008)* Zambia (2008) Malawi (2009) Russia (2009) Guinea (2009) Collaborating partners: EngenderHealth, Ipas, Pop Council, RH Alliance, WHO * Follow up includes introduction of MA

05_XXX_MM17 Organizational Process environmental analysis; MoH leadership; strategic assessment; continuity and coordination; appropriate decisions on pace; scope Evidence-Based Approach only scale up a tested innovation Monitoring & Evaluation baseline data; achievement indicators; feedback to strengthen access and quality of care Resource Mobilization understanding costs; generating and sustaining funding Dissemination & Advocacy training; equipping; generating political commitment and user knowledge; marketing Systems Perspective broad focus on the innovation; providers; users; health system

05_XXX_MM18 Product effective; registered; competitively priced; good availability; sustainable supply; widely known Users/Communities good knowledge/well- informed; good access; sufficient demand Health System evidence-based standards and norms; strong capacity; good quality of care; outpatient and client focus Political Commitment high-level; multisectoral; good depth; continuously rededicated Providers multiple cadres; well- informed; well-trained; well- equipped; good incentives