Enhancing Emergency Contraception Distribution via Community Health Workers

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Distribution of emergency contraception by community health workers is explored through the Cascade Training Implementation Model in Uganda, aiming to improve access and awareness among potential users. Challenges include gaps in provision, supply inconsistencies, and stock shortages, highlighting the crucial role of VHTs in increasing ECP awareness and accessibility.

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THE DISTRIBUTION OF EMERGENCY CONTRACEPTION BY COMMUNITY HEALTH WORKERS THROUGH THE CASCADE TRAINING IMPLEMENTATION MODEL Beatrice Bainomugisha, WellShare International Panel Discussion CHW symposium 22nd February 2017 Hotel Africana, Kampala , Uganda (Rwizi Hall) 1

Background-Current Programs WellShare is a sub-grantee to Advancing Partners and Communities (APC) project in 15 sub-counties of two districts--Iganga and Kumi (2014-2017) WellShare builds capacity of districts to implement Community Based Family Planning services through Village Health Teams (VHTs) 2

Cascading training model for CBFP MOH Master trainers trained 10 District health Teams who in turn trained and supervise 43 Health Facility staff who in turn trained and supervise 257 VHTs. MoH CBFP training Manual for VHTs for short term methods (pills, condoms, Depo IM, Sayana Press, ECP) 3

Identification of gaps in ECP provision by VHTs Conducted continuous quality improvement identified low distribution and uptake of ECP Few VHTs were distributing ECPs Most Health centers had ECPs expire in August 2015 No steady supply of ECPs at community level 4

Evidence for the ECP gaps Conducted an ECP assessment in 4 CBFP Districts of Iganga, Arua, Kanungu and Mubende in December 2014 to January 2015 Goal: Understand dynamics of ECP distribution by VHTs to improve integration of ECPs into existing community-based FP programs Objective: To assess current knowledge, use, supply and barriers to uptake of ECPs in districts where community-based FP programs are operating 5

VHT: Familiarity & Provision of ECPs Heard of ECPs (22/23) Refer for ECPs (6/23) Counsel on ECPs (4/23) Provide ECPs (2/23) = 1 VHT 6

Summary of Key Findings Most VHTs know ECPs, only about half the potential users were aware of the method VHT provision of ECPs would increase awareness of, demand for, and greater access to ECPs Inconsistent Supply and Stock outs challenges Radio, VHTs, and health center staff recommended as information sources on ECP Respondents emphasized need to adequately train VHTs in ECP provision Bulk of ECPs are dispensed through Public Sector-Government HCs 7

Response to ECP gaps: Advocacy Along with other IPs, WellShare shared assessment results, and advocated for provision of ECP to facilities and VHTs UNFPA procured and dispensed to the districts in September 2016 via UHMG/ADS 8

Response to ECP gaps: Cascade implementation model Additional training & support to VHTs in 2016 WellShare adapted an ECP training module for DHTs, Heath Workers and VHTs (integrated with all FP) Topics: what are ECPs , types of EC (IUD, Yuzpe/COC, Levonorgestrel), mechanism, side effects, counseling, referrals Refresher training and integration of module to train new VHTs 9

Cascade Training continued VHT practicum key messages and provision of all FP methods including ECPs under the supervision of Health Workers Health Centers received ECPs through ADS (UHMG) and distributed to VHTs WellShare developed and pre-tested an ECP Job Aide and Fact sheet to support VHT service provision 10

Monitoring and Continuous Quality Improvement (CQI) HWs continuously support supervise the VHTs in the use of ECPs using an ECP direct observation checklist Counseling checklist for ECP Project Health Center Support Supervision Checklist including ECP Revised project VHT registers and data collection tools to integrate ECP 11

Results 34% (189) of ECPs in Iganga and 46% (39) of ECPs in Kumi were dispensed at community level Community market share increased as expected ECP is an entry point for counseling on routine FP use, more women will be expected to transition from ECP to routine methods. 12

Results continued VHTs conduct Community dialogues on FP including ECPs Increased interest in and demand for ECPs Two Radio Talk shows and 84 Radio spot messages on ECPs Radio Monitors receive daily questions on ECPs 13

Impact Women and girls are empowered to access ECP at their convenience, in their communities ECP as an entry point to routine FP methods VHTs have the knowledge and skills to provide immediate ECP and refer survivors of rape and defilement for further SGBV services 14

Impact Availability of ECPs at community level is increasing Reproductive health service-seeking behavior of people in rural remote areas Access to ECPs can decrease unwanted pregnancies as well as teenage pregnancies in the two Districts Access to ECPs can reduce the number of women and girls dying as a result of abortions Increased interest in ECP among males as an entry point to involvement in Family Planning 15

Challenges Inconsistent ECP supply to Health Facilities by NMS/ADS Lingering provider bias at HC level-whole system needs strengthening(in-service CMEs or Pre-service training, etc) Current System relies on IPs or pull from Health Centers Program Advocacy strategies quite costly Relies on presence of trained VHTs 16