1. 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

2. 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

3. Five-Step Approach Integrating FP and Fistula Care Services
STEP 1* STEP 2* STEP STEP 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

4. Integration in Action: Zamfara, Sokoto, Kebbi

5. 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.

6. IEC Materials to Support Integration

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

8. 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

9. 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

10. 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

11. Summary