Expanding FP Method Mix with FAM Tonny Tumwesigye

Uganda Protestant Medical Bureau Expanding the FP Method Mix with Fertility Awareness Methods (FAM)

30th CCIH Annual Conference 2016 Baltimore, Maryland

19TH June 2016

Dr. Tonny Tumwesigye EXECUTIVE DIRECTOR

www.upmb.co.ug Health in Totality

Content of Presentation

• Why this presentation?

• Who we are

• Brief Introduction

• Project goal & objectives

• What has been done

• Results

• Baseline Vs Current

• Challenges

• Briefs on Activities carried out under the CCIH grant

• Next steps/Why the presentation


Why this presentation?

• To give an update on the project as it winds up

• To work with MoH & other partners to increase awareness of and access to FAM in Uganda

• To seek support especially for sustainability (CycleBeads procurement, VHT training and facilitation)

• To work with you to disseminate this information to all the relevant stakeholders

• To get feedback on the project implementation


Who we are

• Uganda Protestant Medical Bureau (UPMB) is a Christian national umbrella organization for Protestant, Adventist and Pentecostal Church founded member health facilities.

• UPMB was founded in 1957 by a Government notice No. 672

• Currently supports 290 health facilities in Uganda affiliated to the Protestant Churches and 11 health training institutions (for nurses, midwives and laboratory cadres)


Introduction: A3 Project

Uganda Protestant Medical Bureau (UPMB) Institute for Reproductive Health (IRH) at Georgetown University

1st January 2014 to 30th September 2015

8 sites across the UPMB network

Partners

Timeline Location

‐ Chrisco Hospital (Manafwa) ‐ Rugarama Hospital (Kabale) ‐ North Kigezi Health Centre IV

(Rukungiri) ‐ Azur Health Centre (Hoima)

‐ Kagando Hospital (Kasese) ‐ St Paul Health Centre IV (Kasese) ‐ Rwesande Health Centre IV (Kasese) ‐ Kolonyi Hospital (Mbale)


Project Goal & Objectives

GOAL: Expanded access to and use of family planning, including Fertility Awareness Methods (FAM), thus improving healthy timing and spacing of pregnancies

Objectives: • Increase the availability of quality family

planning services

• Strengthen the capacity of health units to integrate simple Fertility Awareness Methods (FAM) methods into family planning services

• Generate and disseminate knowledge and evidence‐based tools for faith‐based organizations working in family planning


What Are Fertility Awareness Methods (FAM)?

CHWs (VHTs) demonstrate how SDM, TwoDay Method, and LAM are used during a quarterly support supervision visit to some of the implementing facilities in Kasese district.

Standard Days Method with CycleBeads

TwoDay Method Lactational Amenorrhea Method (LAM)


Standard Days Method®

• Identifies days 8-19 of the cycle as fertile

• Is appropriate for women with menstrual cycles between 26 and 32 days long

• Helps a couple avoid unplanned pregnancy by knowing which days they should avoid unprotected sex

• >95% effective with correct use; 88% effective with typical use

• Used with CycleBeads®

[Source: Arevalo M., V. Jennings and I. Sinai. 2002. "Efficacy of a new method of family planning: the Standard Days Method.“ Contraception: (65):333-338]


• Track her cycle days • Know when she is

fertile • Monitor her cycle

length • Communicate with her

partner

CycleBeads help a woman to:


Did I note any secretions

today?

Did I note any secretions yesterday?

YES

YES

NO

NO

I can get pregnant today.

I can get pregnant today.

Pregnancy is not likely today.

• Uses cervical secretions as the indicator of fertility

• Women check everyday for the presence of secretions

• If a woman notices any secretions today or yesterday, she considers herself fertile today and avoids unprotected sex today to prevent pregnancy

• Can start using the TwoDay Method at any time, regardless of where she is in her menstrual cycle

• >96% effective with correct use; 86% with typical use

[Source: “Efficacy of a new method of family planning: the TwoDay Method” Fertility and Sterility, 2004]

TwoDay Method®


Family planning method for postpartum women who meet

the following criteria:

Menstruation has not returned

Mother is only breastfeeding Baby is less than 6 months

Lactational Amenorrhea Method

LAM is >98% effective as a temporary method of family planning.


Expanding the Method Mix

To ensure women and men have access to the full range of FP methods, FAMs were added to the basket of options which UPMB was already providing (e.g. pills, injectable, IUD, etc.)


Achievements since 2014

• 31 facility‐based health workers trained in family planning – Refresher on all FP methods,

introduction to FAM

• 117 VHTs trained in family planning – Offering pills, condoms, SDM,

TwoDay, LAM; refer clients to facility for all other methods

• 80 religious leaders participated in sensitization workshops on family planning

• Over 5000 awareness raising events conducted by VHTs and religious leaders

• Over 50 radio spot messages on FP

• Zero stock‐outs of FP commodities, including CycleBeads


Baseline Vs Project Implementation (FP uptake per method)

Methods Baseline (January – December 2013)

Project Implementation (Jan 2014 – June 2015)

Injectable 1,446 1,961

IUDs 269 586

Natural 42 SDM – 3,445

LAM – 1,635

TDM ‐ 376

Total 42 5,456


Baseline Vs Project Implementation (FP uptake per method)

Methods Baseline (January – December 2013)

Project Implementation (Jan 2014 – June 2015)

Condoms 2,695 82,880

Pills 580 1,919

Implants 1,270 951

Permanent 146 38


Statistical Report (Jan 2014 – June 2015)

Facilities No. of people reached

FP methods (CHWs & Facility)

Female Male SDM LAM TDM Injectable Condoms

Kagando 7939 3827 506 101 28 1135 23563

Rwesande 9199 3984 270 171 53 247 7119

St Paul’s 6884 3287 1008 760 270 72 5709

TOTAL 24022 11098 1784 1032 351 1454 36391


0 1000 2000 3000 4000 5000 6000

Oral Contraceptives

Female condom

Male condom

SDM

LAM

TwoDay Method

Injectable

IUD

Implant

Tubal Ligation

Vasectomy

TOTAL

Comparison of FP uptake at baseline vs. Year 1

2014

2013

# people sensitized by VHTs & RLs

FP services offered by VHTs at community level

Project Quarters

Female Male SDM LAM TwoDay Method

Condom Pills Referrals

Quarter 1 (project start up)

0 0 0 0 0 0 0 0

Quarter 2 1766 1092 266 167 79 1277 322 62

Quarter 3 14172 5777 1109 409 74 22580 647 502

Quarter 4 11116 6312 676 520 89 23102 129 205

Quarter 5 19694 6227 923 316 90 29384 550 198

Quarter 6 7488 3124 471 223 44 6537 271 194

TOTAL 54236 22532 3445 1635 376 82880 1919 1161


0 1000 2000 3000 4000 5000

Oral Contraceptive

Female condom

Male condom

SDM

LAM

TwoDay

Injectable

IUD

Implant

Tubal Ligation

Vasectomy

Total

Facility uptake v. Community uptake in 2014

CHW

Facility


Challenges & Solutions

Challenges Solutions Delayed reporting & accountability of funds from the facilities

Close monitoring by UPMB central level

Lack of male involvement (leading to clandestine FP use, difficulty negotiating condom use and some FAM)

Targeted sensitization conducted with men by VHTs, nurses, and religious leaders

VHTs are not volunteers but need motivation to do their work

Offering small stipends to turn in monthly reports and attend supervision meetings


Challenges & Solutions

Challenges Solutions Myths and misconceptions about FP, including new FAM options

Conducting sensitization through VHTs, religious leaders, and radio

Weak commodities supply chain – particularly with CycleBeads which are not yet available in the national pharmacy

UPMB intervened at central level to ensure sufficient supply of commodities for facilities AND community level, IRH donated CycleBeads for project sites

Reporting and integration of data into HMIS particularly for FAM options

MoH to integrate data on FAM into HMIS including the FP register at facilities.


UPMB’S FP work with CCIH

Activity Dialogue meeting Trainings on HTSP

Community sensitizations by Religious leaders

Dates May 2015 October 2015&November 2015

Jan-March 2016

Target/ Coverage

Selected Faith leaders(all denominations)

Faith leaders who participated in the dialogue meeting

4 UPMB facilities 2 UMMB facilities


Activity 1: Dialogue meeting

GOAL:

The participants will contribute to advancing constructive dialogue about family planning within faith communities and/or organizations.

Objectives:

• Raise awareness of the health challenges facing women and families in Uganda and discuss how faith communities can address them.

• Explore the role of faith leaders and their communities in promoting healthy families

• Identify opportunities for a continued dialogue and the interest of faith leaders in addressing these challenges


Activity 1: Dialogue meeting • 46 participants participated in the two days meeting. • Dialogue meeting held in May 10th‐11th 2015. • Participants signed commitments to promote HTSP/FP



Activity 2: Trainings on HTSP

GOAL:

Develop aptitudes of Religious leaders to enable them promote healthy Timing and spacing of pregnancies and FP Services so as to maximize availability, accessibility of FP services at communities.

.

Objectives:

• Explain key HTSP messages and understand their links to family planning

• Identify and clarify rumours about contraception

• Identify the family planning methods available in the local context and where to receive them

• Support couples to improve communication and shared decision-making


Achievements :Trainings on HTSP

• Two trainings were conducted

• Interfaith leaders participated

• 39 interfaith leaders were trained on HTSP.

• Participants drafted their post training tasks R promoting HTSP..


Activity 3: Community sensitizations using religious leaders

GOAL:

. Reduced unmet FP needs and improved maternal and child health outcomes in the catchment area of the program implementation

Objectives:

• The capacity of faith-based health networks and workers is strengthened to provide high quality, sustainable FP information, counseling and services.

• The capacity of religious leaders and

other community stakeholders is built and strengthened to increase demand for FP


Achievements: Community sensitizations with Faith Leaders. (March –April 2016)

• 6 Project sites identified,

assessment done ( 4‐UPMB & 2 UMMB)

• Baseline data collected and report compiled.

• Project Reporting tools reviewed and finalized and shared with facilities.

• Debriefs with UMMB and Mityana diocese held with CCIH’s Mona.

• UPMB held planning meeting with CCIH’s Mona.

• Activity list (work

plan)drafted (May‐Sept 2015)

• Budget drafted and submitted for approval

.


Pending activities :

• Budget approval from CCIH for follow on activities.(May –Sept 2016)

• To conduct trainings for other

community based providers such as VHTs & Faith leaders

• Create, translate and

disseminate simple IEC materials with factual messages on FP

• Community outreaches by VHTS

• Community sensitizations

by Religious leaders

• Reporting on activities carried

.


Considerations • Update HMIS and FP registers to reflect SDM, LAM, and

TwoDay Method

• Strengthen training for health workers in permanent methods

• Procure Cycle Beads alongside other family planning commodities

• Develop an FP curriculum and service protocols for VHTs allowing them to offer a wide range of FP methods to clients

• Involve religious leaders in FP/HTSP sensitization and encourage their participation as champions

• Improve male involvement in FP programs


Acknowledgement


THANK YOU 33

Expanding FP Method Mix with FAM Tonny Tumwesigye

Health & Medicine