Contraceptive Implants Learning Resource Package

Transcription

1 Contraceptive Implants Learning Resource Package Presenters Maryjane Lacoste, MA, Gates Foundation Ricky Lu, MD, MPH, Jhpiego Emmah Kariuki, BSN, Jhpiego Moderator Megan Peterson, MPH, Jhpiego Thursday, October 2nd

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3 Webinar Agenda Background Information - Context Implants Access Program Accelerating Scale-up of Implants Project Competency Based Training and the Learning Resource Package Program Learnings from Kenya Q&A 3

4 Webinar Objectives At the end of this hour long session, participants will be able to: 1. Articulate what the Implants Access Program is; 2. Explain the new Implants LRP and its focus; 3. Describe how country programs like Kenya are using the LRP s products for training; 4. List how they can use this LRP in their own setting. 4

5 Family planning and access to contraception including information, supplies, and services is an issue that I am passionate about, and it has become one of my personal priorities at the foundation. I believe it s one of the most urgent issues of our time. Melinda Gates

6 OUR GOALS Today to 2020 Beyond 2020 Bringing access to family planning to an additional 120M WOMEN without coercion or discrimination Progress toward UNIVERSAL ACCESS to voluntary family planning Bill & Melinda Gates Foundation 6

7 7 CRITICAL COMPONENTS TO SUPPORT ACCELERATION OF NATIONAL FP PROGRAMS Commitment: formal declaration of national goals, financing and policy commitments Data: routine collection, aggregation of data on FP performance Accountability: feedback loops and incentives that communicate sense of urgency and enable continuous improvement Analysis of data on performance of policies and solutions to guide planning and policy formulation Implementing solutions through highperforming public, social, and/or private sector platforms ensuring quality and voluntarism Leadership: federal, state & local government leaders as champions Platforms for scale Performance monitoring & accountability Political will Stakeholder alignment National plan and policy Funding Engagement: global and local stakeholder inputs are harnessed Coordination: formal or informal body to coordinate stakeholder actions Planning: robust, evidence-based, fullycosted national FP implementation plan with clear goals that address coercion and discrimination, linked with performance monitoring Policy formulation & adoption of federal, state and local policies that support FP Testing adaptation of existing solutions or new solutions to make products and services affordable, accessible, and client-centered Local adaptation Resource mobilization to ensure sufficient funding to execute national FP plan, including governments, donors and foundations Source: Adapted from Elements of Success in Family Planning Programming (USAID Series J, Number 57) based on team analysis & stakeholder input 2013 Bill & Melinda Gates Foundation 7

8 OVERVIEW OF FAMILY PLANNING STRATEGY INITIATIVES We develop & deploy a set of tools to drive change 3 Performance monitoring & accountability 4 Evidence to optimize service delivery 5 Contraceptive technology to meet users' needs 2 through country, regional, and global pathways Policy & Advocacy Strengthen global and regional architecture (e.g. Ouagadougou Partnership) and establish enabling environment to support change in all 69 countries 1 Accelerate country action Support selected countries* to achieve national FP objectives, demonstrate impact, and support national and regional-level scale-up to influence and support national FP programs Countries develop & execute costed implementation plans (CIP) to reach national FP goals which lead to reaching our goals and long-term impact Goals Additional 120M women in the 69 poorest countries use modern contraception Accelerated universal access to modern contraceptive methods, information and services Long-term impact Reduce maternal and child mortality and morbidity Increase equity and empowerment for women and girls Unlock the potential for countries to capture economic benefits Principles respect rights 1 ; promote equity; include youth; leverage partnerships 1. Defined as voluntarism, informed choice, participation, accountability, protection against coercion * India, Nigeria, Indonesia, Pakistan, DRC, Ethiopia, Kenya, and Ouagadougou Partnership (demonstrations in Senegal & Niger) 2013 Bill & Melinda Gates Foundation 8

9 IAP BACKGROUND In 2012, the Foundation decided to partner with the Government of Norway, the Swedish International Development Agency, the Children s Investment Fund Foundation (UK) and the Clinton Health Access Initiative to form the implants access partnership (IAP). The group signed a volume guaranty with Bayer Pharma (Sept 2012) and then with Merck, Sharpe and Dohme (March 2013). Bayer has extended the agreement to make the price available globally The Merck agreement covers Implanon and their new product, Nexplanon, in the 69 FP2020 countries The purpose of the IAP is not only to increase access to implants and to support the volume guaranties, but to expand access to catalyze changes that create healthier market dynamics for all contraceptive commodities, in support of global family planning efforts spearheaded by FP2020 and the UN Commission on Life-Saving Commodities (UNCoLSC) Over the next five years, over $350M in savings is expected to be generated from these guaranties Bill & Melinda Gates Foundation 9

10 PROGRESS AND OUTLOOK : During the first two years of the volume guaranty, the foundation and partners have focused on setting the foundation for the implants access program Identified the opportunity and put the two guaranties in place with Merck and Bayer Brought together a consortium of purchasers, suppliers and technical assistance providers to support the overall program Developed a governance structure to support the program Successfully met the guaranteed minimums two years in a row 2014: During the second full year of the guaranty, we are focused on the execution at the country level to ensure that the implants ordered are available to women by competent and confident providers Put in place systems to enhance coordination of supply chain at global level Trained over 11K providers across multiple programs and countries Identified barriers to uptake in key focus countries Costed country plans with training plans that include implants in some countries Going forward, we want to continue to monitor the supply issues and build on the successes, while enhancing the coordination at the country level 2014 Bill & Melinda Gates Foundation 10

11 The IAP governance structure, goal, and objectives FP2020 Reference Group High level progress updates Supplier Oversight Boards Guaranty & Financing Group (BMGF, Norway, SIDA, DFID, USAID, CIFF, CHAI, UNFPA, RHSC) Governance Boards: - The Guaranty Group and two Supplier Oversight Boards provide direct program oversight - In 2014, meetings with the GG and supplier boards will shift to 2-3 times per year (In-person meetings once annually) Program implementation & monitoring (UNFPA, BMGF, CHAI, JSI, USAID) Goal: To increase access to quality family planning services and long-acting family planning methods, with a special focus on the delivery of implants Obj 1. Expand access to and use of implants Obj 2. Improve implant market dynamics Obj 3. Decrease frequency of implant supply chain interruptions Obj 4. Create enabling environment for all contraceptives 2014 Bill & Melinda Gates Foundation 11

12 ORIGINAL IAP PRIORITY COUNTRIES Tier criteria Tier one countries top ten in average of public sector procured Jadelle and Implanon quantities from Tier two countries countries frequently ordering over 40,000 units of Jadelle/ Implanon per year. Watch countries potential for growth, high unmet need, or Alliance country Tier 1 Countries Tier 2 Countries Watch list Countries Burkina Faso Ethiopia Kenya Malawi Mali Nigeria Tanzania Uganda Zambia Zimbabwe Bangladesh DRC Ghana Madagascar Mozambique Nepal Pakistan Rwanda Senegal Sri Lanka Bolivia Cameroon India Indonesia Niger South Africa Togo Note: countries in red are FP strategy focal countries. SOURCE: Bayer orders, CHAI Estimates, DHS, team analysis 2014 Bill & Melinda Gates Foundation 12

13 With the reduced cost of implants... There are introduction and expansion considerations, such as: Provider dependency capacity to deliver method appropriately 1. Update policies and guidelines 2. Equipment and facilities needed to provide implants 3. Staff trained to perform insertions and removals and to counsel both new and continuing clients 4. Functioning logistics system to track the supply of implants Need for an updated health information system for M&E Need for increased community education and mobilization 13

14 Accelerating Scale-up of Implants (ASI) Project Part of the Bill & Melinda Gates Foundation-led Implant Access Program to create enabling environment to expand access to contraceptive implants. Fast tracks national efforts to strengthen and improve family planning services through advocacy, quality service provision, scale-up and evidence-based programming. Active in Nigeria, Kenya, Zambia, South Africa 14

15 ASI s Key Areas of Work Country Level: Advocacy and strategy development (in collaboration with CHAI and host-country MOHs); Capacity building of trainers and providers; and Establishment of service delivery and quality assurance. Global Level: Coordination of global efforts with volume guarantee partners; Standardization of implants training materials and approaches (in collaboration with Bayer, Merck/MSD and others); and Dissemination of evidence-based experience and lessons learned.

16 High quality clinical training for providers conducting contraceptive implant insertion and removal is essential to ensure safe and effective expanded access to implants. 16

17 Clinical Training Principles The goal of clinical training is to help health professionals gain the knowledge, skills and attitudes to provide high quality clinical services. Competency-based training focuses on the ability of the service provider to perform the skill, not simply know about the skill For trainers to be effective they must be clinically proficient, interested in training and humble.

18 Competency Based Approach Focused on Competencies Knowledge Skills Practices/Behaviours Behaviour Modeling Trainer models the expected behaviour Talk the Talk/Walk the Walk Humanistic Approach Use models for simulation of clinical practice Safe guard client/patient Adult Learning Principles

19 Competency-Based Training and Learning Materials 19

20 New Implants Training Material Development Existing Materials Bayer s Jadelle Training Manual for FP Merck/MSD Training Materials Jhpiego Norplant Implants Guidelines for FP Service Programs FP Training Resource Package, including Implants Toolkit Various insertion/removal videos, flipcharts, posters, instrument kits, client communication materials Country-specific materials from Kenya, Nepal, etc Modifications Needed Reflect the latest WHO s Medical Eligibility Criteria Apply to WHO pre-qualified contraceptive implants Include MSD s newer NXT product Consider a wider audience of providers (apply to tasksharing) Adapt for low-resource settings Include only essential, need to know information Address balanced counseling for voluntary, informed choice Apply practical IP practices NEW Standardized Training Package 20

21 Components of the Contraceptive Implants Learning Resource Package Training Text Reference Manual Learner s Handbook Trainer s Notebook Digital Materials Video Clips Presentations Job Aids BCS+ Counseling Training Kit Training arm Instrument Kit 21

22 Content of the Learning Resource Package Training Texts REFERENCE MANUAL Organized need-to-know information: Chapter 1: Introduction Chapter 2: Counseling Chapter 3: Eligibility and Client Assessment Chapter 4: Infection Prevention Chapter 5: Implant Insertion Chapter 6: Follow-up Care Chapter 7: Management of Bleeding Problems and Other Side Effects Chapter 8: Implant Removal Chapter 9: Organization and Management for High Quality Services LEARNER & TRAINER NOTEBOOKS How to learn/train providers Course Description Curriculum Schedule Knowledge and Performance Assessment Tools Comprehensive Checklists for one- and two-rod implants Course questionnaires and answer keys Course Feedback Tips for Trainers 22

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25 Experiences in Kenya In Kenya a LAPM scale up strategy already existed at the time of project start-up. The Ministry of Health recognized the gap in skills for LARC provision among service providers. There is a training package for LARC in the country. 25

26 Experiences in Kenya, cont d The guidelines allow implants to be provided by nurses and clinical officers, who are the ones working at the primary healthcare facilities. The KDHS report of showed the need to promote method mix by providing a wide range of methods 26

27 Experiences in Kenya, cont d The LRP was disseminated to MOH and partners in Family Planning. The national training package does not include information or guidance for Implanon NXT, but the global LRP includes this information. The LRP also has video clips for insertion and removal of Jadelle, Implanon and Implanon NXT. 27

28 Experiences in Kenya, cont d The checklists have a summary which makes it easier for the trainers to summarize the scores for the participants. The LRP includes BCS counseling in the content and there is a counseling checklist. 28

29 Experiences in Kenya, cont d The Kenyan team did an addendum to the existing MOH training package. The addendum included: Introduction to Implanon NXT Instructions for Implanon NXT insertion Checklists for Implanon insertion. Checklists for implants removal. Revised IUCD checklists. Video clips 29

30 Experiences in Kenya, cont d The Kenyan team has put together a job aid for NXT Implanon insertion and removal which is in draft form with reference to the resource package. 30

31 Summary of Experiences in Kenya The LRP is resource for trainers and providers. It gives information and instructions in the administration of the implants. The counseling chapter employs the BCS strategy. The checklists are easy to use in pre-training assessment and the post-training assessment. The video clips are additional resource materials. 31

32 Wrap-Up 32

33 Question and Answer Session 33