DELIVERING HIGH-QUALITY AND RIGHTS-BASED SERVICES
DELIVERING HIGH-QUALITY AND RIGHTS-BASED SERVICESDELIVERING HIGH-QUALITY AND RIGHTS-BASED SERVICES | FP2020 THE WAY AHEAD 2016-2017 /en/fp2020-in-countries/delivering-high-quality-and-rights-based-services
The heart of any family planning program is service delivery: providing contraceptive information, services, and supplies to the women and girls who need and want them.
A high-quality rights-based family planning program:
- Implements a client-centered approach to care, treating clients with dignity and respect and ensuring their privacy, confidentiality, and consent.
- Offers a full range of contraceptive methods, including emergency, short-acting, long-acting, reversible, and permanent methods.
- Provides clients with information and counseling and supports method switching if desired.
- Expands access to family planning through a variety of service delivery platforms beyond private and public sector facilities. These include community distribution channels, mobile outreach, drug shops, and pharmacies.
- Addresses health worker training needs and shortages, capacity building, and quality of care at facility and community levels.
- Promotes health systems strengthening, including health information systems, governance, and leadership
In March 2017, the World Health Organization issued an updated guidance statement on the use of progestogen-only injectables (DMPA and NET-EN). For women at high risk of HIV, the recommendations for use of progestogen-only injectables changed from category 1 (no restrictions on use) to category 2 (the advantages of using the contraceptive method out-weigh the theoretical or proven risks).
WHO issued the new guidance in response to evidence of a possible increased risk of acquiring HIV among progestogen-only injectable users. Uncertainty exists about whether this is due to methodological issues with the evidence or a real biological effect. WHO will continue to monitor research evidence on hormonal contraception and HIV risk in order to inform policies and programs.
WHO advises that women should not be denied the use of progestogen-only injectables because of concerns about the possible increased risk. Women considering progestogen-only injectables should, however, be advised about this, about the uncertainty over a causal relationship, and about how to minimize their risk of acquiring HIV.
EXPANDING METHOD CHOICE
When women and girls have access to a full range of contraceptives, they are more likely to find a method that meets their needs and preferences. Expanding method choice was a key theme at the Summit: more than two dozen FP2020 countries announced plans to expand the range of contraceptives included in their family planning programs, with the goal of ensuring that a comprehensive mix of methods is available to meet the needs of women and girls throughout their reproductive lives.
Innovative public-private partnerships can expand method choice by increasing the range of high-quality contraceptives that are available and affordable, including among hard-to-reach and vulnerable populations. In 2013 a group of FP2020 partners collaborated to make implants from Bayer HealthCare and MSD available at half-price in the world’s poorest countries. Shanghai Dahua, the manufacturer of Levoplant, announced at the 2017 Summit that it would offer its product at a similar price point.
GLOBAL GOOD: DMPA SubQ Collaboration
Pfizer Inc. and a consortium of donors have launched a public-private collaboration to broaden access to Sayana Press (DMPA SubQ), Pfizer’s innovative injectable contraceptive. Sayana Press contains a reformulation of depo medroxyprogesterone acetate that allows it to be administered subcutaneously (subQ). The product’s design means that community health workers, pharmacists, and even women themselves can be trained to administer it (where approved by national health authorities). Sayana Press is currently being introduced, scaled-up, or piloted in more than 15 FP2020 countries, with Pfizer continuing to support additional country registrations.
In settings where doctors and nurses are in short supply, task-shifting is an important strategy for expanding service delivery. Task-shifting (also called task-sharing) is the process of delegating tasks to less-specialized health workers. Community health workers, for example, can be trained to provide injectable contraceptives and even implants. Task-shifting makes good use of the existing healthcare workforce, lowers costs, and increases the availability of family planning services. WHO recommendations on task-shifting to improve access to contraceptive methods were issued in 2013.1
- Burundi is overwhelmingly rural, and relies on task-shifting and community-based distribution as the cornerstone of its family planning program.
- Ghana has identified task-shifting as a key strategy to build service delivery capacity in the country’s resource-constrained setting. Ghana’s costed implementation plan calls for task-shifting to be instituted so that family planning methods are available from the lowest levels of the health system, relieving the burden at higher levels of care.
- Malawi announced at the Summit that it plans to design a task-shifting service delivery model to bring the full range of short-acting contraceptive methods within reach of more young people.
- Zambia’s renewed 2017 commitment calls for strengthening task shifting to community-based volunteers to improve the availability of family planning in hard-to-reach communities. This will include the scale-up of DMPA SubQ to reach all parts of the country by 2020.
In June 2017, the 18th Assembly of Health Ministers of the Economic Community of West African States (ECOWAS) adopted a resolution to promote good practices in task-shifting in family planning and reproductive health programs. The resolution calls on ECOWAS member states to mainstream the principle of task-shifting into their national plans for health human resources, integrate community health workers into their national health systems, and scale-up task-shifting as a means of building health system capacity.
All nine countries of the Ouagadougou Partnership approved the resolution, and task-shifting was included in OP’s renewed regional commitment to FP2020 announced in concert with the Summit. The OP countries pledged to “implement and/or scale up promising strategies for task-shifting for long-term and permanent methods, injectables, introduction of contraceptive pills, etc., with a view to strengthen community-based Family Planning services delivery through a full range of modern contraceptive methods.”
POSTPARTUM AND POST-ABORTION FAMILY PLANNING
Postpartum and post-abortion family planning (PPFP/PAFP) is the prevention of unintended pregnancy during the first 12 months following childbirth or abortion (spontaneous or induced). Pregnancies that are spaced too close together don’t give a woman’s body enough time to recover, and raise the risk of labor complications, premature birth, low birth weight, and infant and maternal mortality2. Rapid repeat pregnancies are especially risky for young adolescent girls.3
Many postpartum women and girls don’t want to become pregnant again soon, yet the use of contraception in this period is low. Studies suggest that more than 60% of postpartum women and girls in 21 FP2020 countries are not using a family planning method despite reporting that they do not want to have another pregnancy in the next two years.4
EXPANDING ACCESS TO PPFP/PAFP
WHO issued the pivotal fifth edition of the Medical Eligibility Criteria for Contraceptive Use (MEC) in 2015. This edition of the MEC changed the guidance on the use of hormonal contraceptives, recommending that these options be considered suitable for postpartum women who are breastfeeding.
The revised WHO guidance opened the door for a new approach to postpartum family planning in countries with a proven gap for this service. Jhpiego and FP2020 co-hosted the PPFP Global Meeting in June 2015 in Chiang Mai, Thailand, where 16 FP2020 countries developed action plans to accelerate the implementation of PPFP within their family planning programs. The meeting inspired strong interest from other countries and growing integration with the maternal and child health community. In November 2016, 8 more FP2020 countries (all from the Ouagadougou Partnership) announced their intention to incorporate PPFP/PAFP priorities into their existing action plans.
When women and girls have access to a full range of contraceptives, they are more likely to find a method that meet their needs and preferences.
THE NEXT PHASE
FP2020 assumed the secretariat of the PPFP/PAFP partnership in 2017. A key focus going forward will be on building PPFP/PAFP support, advocacy, and tracking into our existing country engagement structure. Where an unmet service need for PPFP/PAFP exists, our approach will be to ensure that it is integrated into the continuum of care. FP2020 will also work to improve coordination among the global PPFP partners with regard to resourcing PPFP/PAFP needs in priority countries:
- The secretariat will routinely convene the global PPFP/PAFP steering committee to coordinate PPFP/PAFP efforts and identify opportunities to advance the global PPFP agenda.
- Each FP2020 focal point workshop will be followed by a day devoted to PPFP/PAFP, beginning with the Anglophone Africa Regional Focal Point Workshop in Malawi in November 2017.
- A new PPFP/PAFP webinar series will be launched.
- A portion of RRM funds will be earmarked for PPFP/PAFP projects.
Postpartum Family Planning Annotated Bibliography 2008–2014, compiled November 2014. https://www.k4health.org/sites/default/files/compiled_bibliography_2014.pdf
World Health Organization. Adolescent Pregnancy: Issues in Adolescent Health and Development. Geneva, Switzerland: World Health Organization, 2004; 36–37.
Moore Z, Pfitzer A, Gubin R, Charurat E, Elliott L, Croft T. Missed opportunities for family planning: an analysis of pregnancy risk and contraceptive method use among postpartum women in 21 low- and middle-income countries. Contraception. 2015;92(1):31–39.