Introducing Norplant at the Periphery Aguima Tankoano, MD, MPH, Chief of Party

Resource Mobilization and Partnership to

Increase FP Coverage Through

Access to Quality Services Introducing Norplant at the Periphery

Aguima Tankoano, MD, MPH, Chief of Party Marcel Sagbohan, MD, MSC, Deputy Chief of Party

Susan B. Aradeon, Ph.D., BCC Advisor PROSAF Transition Phase/Benin

Conference on Repositioning Family Planning in West Africa organized by Advance Africa in Accra, Ghana

February 15-18, 2005

Source: PROSAF phase transitoire/presented by Susan ARADEON # 1

Collaborators Introduce Norplant at the Periphery in Benin

• PROSAF and USAID – the major Benin family health project

• ABPF and IPPF – the Benin family planning association

• MSP: the Ministry of Public Health,– The Family Health Directorate and UNFPA

• Department of Health of Borgou/Alibori in northern Benin (DDSP)


Three Objectives for the Introduction of Norplant Services

• increase availability of FP services in BA by broadening the range of contraceptives

• increase the potential of the health system in BA to protect more couples each year from too closely spaced and unwanted pregnancies

• reinforce collaboration between the principal actors in the health sector


The Norplant Case Demonstrates the Power of Synergy

• synergy to reinforce the capacity of the health services and providers

to organize and offer family planning services

• synergy to secure and finance contraceptive products


Synergistic Collaboration in Stages

1. Preliminary discussions on necessity and feasibility of offering Norplant in BA.

2. Negotiations with the MSP Directorate of Family Health

3. Memorandum of Understanding between PROSAF and ABPF

Source: PROSAF phase transitoire/presened by Susan ARADEON # 5

Synergistic Collaboration in Stages(continued)

4. Mobilization of resources and Norplant supplies

5. Training and supervision of 20 Norplant providers

6. Annual monitoring of Norplant use


Preliminary Discussions Reached a Consensus

• approach to follow

• roles and responsibilities of each party

• sites that would house the Norplant services

• number of providers to train


Negotiations with the MSP Family Health Directorate

• MSP approval to introduce Norplant at the peripheral level

• Norplant kits supplied by UNFPA

Source: PROSAF phase transitoire/presentrd by Susan ARADEON # 8

Memorandum of Understanding between PROSAF and ABPF

Assured close and effective collaboration

ABPF: transfer skills using their staff expertise and training materials

+ provide back-up Norplant and materials through its own channel

PROSAF: finance the training + supply each trainee with the essential 21 item Norplant insertion/removal kit


Mobilizing Government Support

PROSAF relied on a variety of approaches• letters • preliminary meetings• follow-up meetings with key personnel at

the DSF • informal meetings with other influentials

in order to exert effective pressure


Agreement on Training Site

• Strong pressure to send trainees to an existing site in Cotonou

• Dept of Health Director and PROSAF insisted that Norplant introduction be fully decentralized and sustainable at the department level.

• PROSAF financed transformation of ABPF clinic into a Norplant training center

• URC financed cost of bringing Cotonou trainers for the training and post-training supervision.


Pro-Active Service Providers

• Service providers in Alibori advocated with their zonal health management teams (ZHMT) for inclusion of Norplant training in the PBA (German) Project activities

• PBA funded training for 7 service providers


Maintaining Momentum While Resolving Supply Problems

• ABPF did supplement the MSP start up supplies

• Service Providers purchased their initial service delivery supplies (5 implants) their health center’s community fund.

• PROSAF provided kits to 4 district-level health centers where the midwives had been trained with PBA funds.


20 Norplant Providers Trained by ABPF Staff

• three 10-day sessions during the second half of 2002

• limited to seven participants, given the supervision and coaching requirements during the practice sessions

• reinforced by one supervision visit by the training team


Trainer’s Kit and Learner’s Kit with 15 Training Modules

1. Recap of Other Contraceptive Methods and Preliminary Questionnaires

2. Norplant

3. Norplant Counseling

4. Clients’ Rights

5. Client Assessment

6. Norplant Service Organization and Management

7. Infection Prevention

8. Norplant Insertion and Removal Techniques

9. Managing Norplant Side Effects

10. Insertion/Removal with Clients (Clinical Practicum)

11. Completing Forms

12. Norplant Stock Management

13. Mid-term Questionnaire

14. Participants’ Action Plan

15. Participants’ Course Evaluation


Distribution of the Trained Norplant Service Providers

Trained by Facility Type

Training Session

DateDepartmental

Hospital Zonal

Hospital Maternity

Center

1 3rd Quarter 2002 1 3 3

2 4th Quarter 2002 1 0 5

3 4th Quarter 2002 0 3 4

Total

Service Providers 2 6 12


Annual Monitoring of Norplant Use

• Couple Years of Protection (CYP) calculations: factor of 3.5 = 1 insertion

• Integrated into the Dept. of Health National Routine Health Information System (SNIGS)


Results of the Synergy Among the Collaborators

• A significant 53% increase in the CYP between 2002 in 2003

• Rapid appropriation by the Health Zone Management Teams (HZMT)– budgeted the re-supply of the entrants

for the continuation and the sustainability of Norplant.


Graph 1: CYP evolution and comparison between CYP pre and post introduction of Norplant

2001-2004 in Borgou and Alibori

7875

7122

51465439

YEAR 2001 YEAR 2002 YEAR 2003 YEAR 2004

CYP Pre Norplant CYP Post Norplant


Graph 2 : Comparison between the CYP provided by Norplant and the total CYP:

2003 and 2004 in Borgou and Alibori

2247 2111

7875

7122

YEAR 2003 YEAR 2004

Norplant CYP Total CYP


Norplant Impact on CYP in 2003 and 2004

• Without Norplant, the CYP would have stagnated near the 2002 level.

• 29% of the CYP in 2003 and 30% in 2004. • Even though purchases doubled for short-

term methods (oral contraceptives and Noristerat injectables),

• Norplant’s greater conversion factor resulted in a greater CYP for Norplant than the combined CYP for both these methods.


In 2002, Benin already had

• local and international partners commited to enhancing health systems and FP

• expertise to introduce Norplant services

• financial resources for Norplant introduction


However, Without Leadership from

PROSAF and ABPF Norplant services would still be minimal• Constant networking and feedback was essential to generating and maintaining

the synergy among the partners that kept the program on track.• Partner commitment had to be mobilized Partner commitment had to be mobilized

and remobilizedand remobilized to face each hurdle along the road to provision of Norplant in the farthest corners of the nation.



Synergy generated through leadership that sustained partner commitment

NORPLANTP

E

R

MSP/UNFPA

COMMUNITY

ABPF

SERVICE PROVIDERS

PBA

DDSP

HZMTPROSAF

PARTNERS

EXPERTISE

RESOURCES

Lessons Learned

1. the existence of a latent demand for Norplant (acceptance of side effects)

2. the capacity of Norplant to

rapidly and durably increase

couple protection

3. the power of leadership to generate synergistic collaboration among agencies to mobilize and share resources for significantly greater FP coverage.


What’s Next

• Resolve stock-out problems

• Carry out cost analysis

• Increase promotion of Norplant


Documents

Introducing Norplant at the Periphery Aguima Tankoano, MD, MPH, Chief of Party