1. Closing the gap on missed opportunity for provision of family planning to post abortion care (PAC) clients in private sector clinics
Baker Lukwago, Dr. Mariam Luyiga, Peter Buyungo, Dr. Milly Kaggwa, Dr. Dorothy Balaba
FIG 1:Percentage distribution of PA client served by previous number of abortions experienced
BACKGROUND
In Uganda, about 8% of the maternal deaths are due to unsafe abortion [1]. Abortion complications remain a significant contributor to MMR, 14 % of unintended pregnancies end up in abortion [2]. Since fertility resumes early, comprehensive PAC across all service points must include provider-initiated counselling on family planning and provision of modern contraceptives to improve on the existing low uptake.
PSI Uganda through the Women’s Health Project, supports a franchise network of private clinics to offer integrated reproductive health services namely; family planning, PAC and cervical cancer screening. This support entails;
Trainings, on job mentorship of providers on PAC & Family planning
Supply of equipment & products at subsidized prices
Social behavior change and communication
Continuous Structured provider skill assessments & coaching
METHODS
Routine data from 196 social franchise facilities located in 62 districts for the period January 2015 to December 2017 was used to inform on the rate of family planning uptake among PAC clients overtime.
Variations in uptake were assessed across; age groups, marital status, education level and number of living children.
High uptake of PAFP was noted across women aged below 30 years (77%), marrieds at 75%, women with at most primary education (59%), and 59% among mothers with at most two living children. The same trends were depicted among women that accessed PAC services during the period.
RESULTS
PROGRAM IMPLICATIONS/LESSONS
Strengthening of provider counselling and client follow-up for family planning has improved on the low PACFP uptake.
Provision of equipment, products and continuous support to providers guided by the structured skill assessments ensures high quality service delivery, however, more emphasis and facilitation may be required to improve on client PAFP follow-up.
Timely onsite mentorship is critical to address provider knowledge & capacity gaps attributed to the high attrition rates in private sector clinics.
Incorporation of PACFP indicators in the national Health Management Information System (HMIS) improves monitoring of site level variations in uptake of PACFP through “the one national M&E system”.
Women aged below 30 years and the unmarried need to be targeted during counseling/follow-up because they were less-likely to take-up PAFP.
Over the period, 5,414 clients had accessed post abortion complication management services.
Majority (67%) were married/living together, 40% below 25 years
Majority (75%) of the PA had at least a child, 47% had at least secondary education.
55% of them had ever experienced an abortion (Fig.1)
Four in every ten (2,425) PA clients, received a family planning method (Fig.2).
Majority (75%) of the PA clients that accepted a family planning method, opted for a long-term method (999-IUDs & 824-Implants) and 25% a short-term method.
[1] Uganda Health Sector Strategic Plan III 2010/ /15
[2] Prada E, Atuyambe LM, Blades NM, Bukenya JN, Orach CG, et al. (2016) Incidence of Induced Abortion in Uganda, 2013: New Estimates Since 2003.
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