Join FP2020 by Making a Commitment

• Le Sénégal dispose désormais d’un plan de communication SR/PF et Survie de l’Enfant et son plan fait budgétisé mais l’accent sur la création de la demande. De même un plan de communication spécifiquement adressé aux jeunes est en cours d’élaboration. Les deux premiers seront validés au cours du mois d’aout 2016. Les religieux sont aussi parties prenantes du plan PF 2016 -2020. Présentement ils organisent des émissions à la radio pour soutenir le programme PF.
• L’IPM est généralisé dans le pays et les ruptures de stocks sont très rares et la durée est très réduite. Le Ministère à travers la PNA est entrain de s’en appropriée. Le passage du témoin entre le projet et la PNA débute cette année selon un scénario proposé par le Ministère
• La quantification des besoins se fait régulièrement au niveau national (2 fois par an). Avec l’appui des partenaires les régions seront formées sur le Reality Check afin de faire leur propre quantification.
• Dans le nouveau plan PF, les propositions faites multiplient le nombre de cliniques mobiles et les services franchisés. Ceci permet d’atteindre les populations les plus éloignées qui sont en général les plus vulnérables. Le programme cherche aussi à acquérir des kits d’insertions retraits pour les méthodes de longues durée afin d’éviter les prescription faites aux femmes.
• Le Sayana Press est offert sur l’ensemble du territoire national. Le programme insiste beaucoup sur les services de PF offerts aux jeunes notamment la communication sur les méthodes disponibles, la contraception d’urgence et surtout la nécessité de leur donner les connaissances nécessaires afin de les préparer à leur futur statut.
• L’offre de service à base communautaire est généralisée pour les pilules, les injectables en IM et en sous cutanée. L’intégration de la PF aux services de vaccination n’est pas encore généralisée mais est commune et est considérée comme une pratique prometteuse. Il est encore tôt d’évaluer son intégration avec le VIH.

In September 2016, the Government of Tanzania shared an update on progress in achieving its policy, financial and program and service delivery commitments to FP2020.

The government reports performing the following activities in support of its program and service delivery commitment:

• The government of Tanzania in collaboration with family planning partners continued to provide family planning services through outreach. Forty-four mobile outreach teams provided FP services in all regions across the country and 14 bajaj teams operated in peri urban areas. For the period of July 2015 to June 2016, the total number of clients served through outreach services were 357, 244.
• A total number of 4,539 young people accessed sexual and reproductive health services in 16 selected referral public facilities after being referred by youth peer educators in their communities.
• The number of facilities that are reporting on stock status increased from 4,654 in last year to 4,840 this year. Central and zonal quarterly RMNCH commodity security meetings continued to be conducted. A youth campaign focusing on adolescent girls was conducted to Accredited Drug Dispenser Outlet sellers to be able to provider family planning education and services to young girls. The campaign was conducted in four regions of Dar es Salaam, Mwanza, Mbeya, and Shinyanga.
• In June 2016, the Ministry of Health Community Development Gender Elderly and Children launched One Plan II and disseminated to 16 regional authorities.
• In strengthening the quality of community based family planning service provision, the government in collaboration with family planning partners developed a five-day Community Based Family Planning (CBFP) refresher training package that will be used to update existing community health workers (CHWs). Forty-six CHWs and 17 CHW supervisor were refreshed using the developed training package. The post-partum family planning and post abortion family planning training packages were also developed; they are now in the pre-testing stage.
• The regional relaunching of the Green Star Campaign was conducted in the Central Zone (Singida), Southern Highlands (Katavi), and Eastern Zone (Dar es Salaam) in September 2015. These campaigns were accompanied with TV and radio spots using national and local media to increase family planning awareness.
• The government committed to improving method mix through public-private partnerships. To this end, some family planning partners have partnered with private health insurance companies, and one of them—AAR Insurance—integrated family planning services in their health benefit package, over and above their outreach initiative (called AAR Wellness Services Program).
• In the 2015 to 2016 time period, the government procured Microval, male condoms, and Injectable Depo-provera. In supporting the government to improve Tanzania’s methods mix, other family planning partners, including USAID and UNFPA, supported public facilities in procuring other commodities like Microval, male condom, circle beads, microgynon, implants, Depo-provera, emergency contraceptive pills, female condoms, and Copper T 380A.
• In fostering partnership through social marketing, private FP partners improved methods mix through social marketed FP products, such as Dume Condoms and Flex P COC Pills (TMARC), Familia brand of products such as pills, injectables, and condoms by PSI, and Trust brand of FP methods by DKT.  

• The National Partnership to Promote Maternal-Child Healthcare is being revitalized, whereby its launch is scheduled for November 2014. The government, via the Ministry of Health, is working with its partners to make this event a moment of mobilization for everyone to speed up the actions that contribute to reaching MDG 4 and 5. An internal working group led by the public healthcare sector was established and involves senior sector levels, whose goal is to monitor all the acceleration processes involved in the reduction of maternal and infant mortality.

• With the approval in 2010 of the integrated package of services offered to adolescents and youth by the National Healthcare Service (SRH/STD/HIV/AIDS, Mental Health, Nutrition and Hygiene/Sanitation of the area), a space opened to discuss adolescent and youth issues in a holistic manner, which has contributed to the improvement in access to information, especially family planning, among the various services.

• In 2013, a National Adolescent and Youth Meeting was held, where participants from different sectors in the government and partners discussed the situation of adolescent healthcare and the means of improving access to information by that specific group. This meeting defined the guidelines for the adolescent and youth healthcare strategy which is being drafted. On the other hand, the revitalization of areas in public schools where a student has access to healthcare information and education is underway.

• In collaboration with UNFPA, a partnership was established with DKT International, focused on training healthcare providers in the public and private sector. Since 2012, 511 public sector and 28 private sector providers were trained in this partnership.

• Considering the primary network, the current coverage of healthcare centers offering at least 3 methods of contraception in the country is 89 percent. The country is focused on increasing that coverage, however, the lack of human resources has been the main limitation.

• The number of technicians trained in postpartum counseling, family planning, and contraception for 2012/2013 was 3,633, listed in the table below:

• In order to increase community access to FP, the following interventions are underway, namely:
  1. District-level training of community healthcare agents in promoting and offering contraceptives (birth-control pills and condoms), in partnership with non-governmental organizations (NGOs). By 2013, 3,323 community healthcare agents were active promoting FP and distributing birth control pills in communities.
  2. Offering complete family planning services (with exception of IUD insertion) in communities via Mobile Brigades and National Healthcare Weeks.

The process of revising the curriculum for training Elementary Multi-Task Agents is underway to ensure that the latter are the permanent agents offering information, education, and anti-conception methods at the community level.

• The intensification of community involvement ... in education activities related to family planning will be invigorated by the healthcare and co-management committees, respectively. Between 2012 and 2013, 1,283 new healthcare committees and 302 new co-management committees were created.

• The healthcare committee members are the community reference agents, that is, religious leaders, community leaders, traditional midwives, traditional medicine practitioners, healthcare providers, among others. They are the beneficiaries of a holistic training package in community healthcare, so they can support healthcare-promoting activities, specifically in relation to the disclosure of services, community education via lectures, the identification of healthcare problems in the community and their reference. These groups have played a fundamental role in family planning education and the need for an institutionalized delivery.

• Mozambique continues to offer integrated sexual and reproductive health services in all health facilities in the country, as an approach to increase access to these services. This commitment is evident in the Health Sector Strategic Plan 2014-2019, recently approved at the highest government level.

• Under the scope of the implementation of the family planning (FP) strategy, the offer of providing counseling in FP in all sexual and reproductive health services (SRH) was introduced, including the bureaus of HIV counseling, testing and Care and Treatment Services. Providers of other services (not just maternal and child health) were also included in ongoing training as a means of ensuring service provision to women in a "one stop" approach, where a package of SRH/FP services are offered, including at the pre-natal, postpartum, child at risk, and child vaccination visit.

• The implementation of offering long-term methods (IUD) immediately [following] postpartum are underway. The integration of offering modern contraceptive methods in the HIV program is also in the discussion phase.

• In the context of integrating SRH services, the capacity of screening Breast and Cervical Cancer (BCC) expanded from 31 US [Unidades de Saúde (Healthcare Centers)] in 2012 to 83 US at the moment, via training more than 670 healthcare professionals (530 - SMI [Saúde Materno-Infantil (Maternal and Child Healthcare)] nurses, 113 - general physicians, and 27 - gynecologists-obstetricians) and the allocation of the respective screening kits. During this period (2012 to July 2014), 203,110 women took the screening exam for cervical cancer. To accommodate these structural changes , all the registration instruments for Maternal and Child Health were reviewed, involving several sectors and institutions linked to the program, for the purpose of harmonizing said registration. The implementation of these instruments is set forth for January 2015, and they are being reproduced at this time.

• The government has focused on establishing a legal framework that permits the upholding of individual sexual and reproductive rights, with a particular emphasis on risk groups. The Assembly of the Republic approved the Law of Decriminalizing Abortion, the implementation of which is awaiting promulgation. In addition to laws, the Government approved strategies such as the Prevention and Treatment of Obstetric Fistula in 2012, as a means of increasing access to the treatment of fistula that affect women in low income families. With this action, a basic right is given back to these women that enables their social and familial re-insertion.

• To improve coordination, a family planning technical sub-group [has been] established; [its] mission is to review the policies, strategies, norms, and plans set forth in SRH/FP, as well as monitor family planning on a national level and mobilize human resources and materials for the implementation of activities. This working sub-group is lead by the Ministry of Health [Ministério da Saúde] and currently co-lead by UNFPA and meets regularly once a month and extraordinarily whenever necessary. As a result of this group's work, the following instruments were established:
  • The family planning consultation norms
  • The family planning acceleration plan
  • Emergency contraception norms
  • The quality standards of RH/FP consultations
  • The criteria for family planning in the mobile brigades and National Healthcare Week.

• The family planning sub-group, in coordination with other areas, will be performing various research/evaluations, namely:
  • The evaluation of availability of modern contraceptive methods at Healthcare Centers;
  • The evaluation of Elementary Multi-Task Agents' follow-up in the community of women using DEPO as a method of contraception; and
  • The evaluation of the integration of SRH and HIV services.

• To further improve coordination and ensure better logistical management, a technical sub-group for materials and products for RH/FP lead by MISAU (FP Program and Central de Medicamentos e Artigos Médicos - CMAM) exists, with the support and contribution of Cooperation and Implementation Partners. This sub-group, among other activities, is responsible for analyzing and revising requirements on a provincial level to avoid errors, given that one of the weaknesses is the rigor in accounting for needs at all levels.

In July 2016, the Government of Indonesia shared an update on progress in achieving its policy, financial and program and service delivery commitments to FP2020.

The government reports performing the following activities in support of its program and service delivery commitment:

• Strengthening the Inclusion of Family Planning in the Universal Health Coverage (UHC) Program/ Program Jaminan Kesehatan National (JKN): Based on the current Presidential Decree No.19 Year 2016 Article 21, FP package under the UHC scheme now covers all types of contraceptive methods includes interval tubect Individuals who are enrolled in the Universal Health Coverage (UHC) Program/JKN will be able to access all types of contraceptive methods provided through family planning services for free; from primary health care facilities to secondary and tertiary health care facilities that have the MOUs with the Social Insurance Board (BPJS). As follow up action, the government is working to:
  • Expanding access to accredited Family Planning Service Delivery Points by increasing the total number of Family Planning Service Delivery Points to be registered under the Social Insurance Board (BPJS)’s network; and
  • Facilitating the existence of private midwives in the UHC Scheme as sub health facility contracted by the Social Insurance Board (BPJS).
• The government has provided policy briefs for recommendations to improve the family planning component in UHC Scheme particularly related to the provision of postpartum family planning services. This is based on the case found at district level that family planning services providers tend to delay the provision of postpartum family planning services due to UHC Scheme regulations, which put no difference rates between cesarean procedure with or without tubectomy – Ministry of Health Regulation No.59 Year 2014.
• BKKBN has released policies to increase Long Acting Permanent Method (LAPM) use:
• Service/Supply side activities include ensuring the provision of LAPM contraceptive commodity to support of LAPM services and improving the competency of LAPM service providers.
• Demand creation activities include providing promotional and IEC materials, promotion at service delivery points, and grassroots empowerment.
• In order to support these policies, BKKBN has released decrees consisting of 1) BKKBN Chairperson Decree No. 78/PER/E3/2011 on provision of free contraceptive medicine and devices in FP services to all childbearing age couples which has brought positive results in increasing FP participation including LAPM; 2) BKKBN Chairperson Decree No. 151/PER/E1/2011 -- aimed at increasing access, quality, and assuring post-partum FP service in all service delivery points; and BKKBN Chairperson Decree No. 165 year 2011 on FP LAPM services -- aim at assuring sustainability and increasing achievement of LAPM service for all childbearing age couples.
• The Government of Indonesia committed to improving 23,500 family planning clinics between 2006 and 2014, and increasing mobile family planning services in remote areas. Activities in support of this commitment include:
• Improving supply chains, systems, and service delivery models: In 2015, three models in supply chain management representing different geographic backgrounds were developedto address some challenges and in ensuring family planning commodity security at the district level, including remote areas.

In line with these efforts, the central government also continues to provide funding assistance to the local governments through the Special Allocation Funds (DAK). The assistance is provided to the low-to-medium fiscal capacity local governments to cover expenses for infrastructures; procurement of vehicles and; materials for IECs; and medical supplies that will support better access to family planning services and family planning information. Total allocation of DAK Fund is Rp. 603,3 billion for 508 districts/ municipalities in year 2016.

In addition, starting in 2016 the central government also provides additional allocation for Family Planning Operational Funds (Bantuan Operasional Keluarga Berencana/BOKB) to support distribution cost of contraceptives and drugs from warehouses at district level to health facilities/FP clinics. Total allocation of BOKB Fund for year 2016 is Rp. 215,6 billion.

In order to integrate these efforts, in year 2016, BKKBN in collaboration with UNFPA Indonesia will develop policy advice to readjust/strengthen Supply Chain Management (SCM) to be in line with UHC (JKN) Scheme implementation and be integrated with Family Planning Operational Funds (Bantuan Operasional Keluarga Berencana/BOKB) and Special Allocation Funds (DAK) at district level particularly at Kampung KB locations.

• Improve distribution of capable health providers in providing a wide range of contraceptive methods: CTU training conducted by BKKBN with support from related stakeholders has not yet fulfilled the need of adequate distribution of capable health providers in providing a wide range of contraceptive methods particularly LARCs. As a result, BKKBN in collaboration with the Ministry of Health and related strategic stakeholders will improve skill retention of trained providers by reformulating effective CTU Training through the ‘on the job training’ method.

• Strengthening public-private partnerships to address issues related to more accessible FP service by:
  • Providing refresher training, particularly on LARCs, for private midwives;
  • Distributing LARC IEC Materials at private midwife clinics; and
  • Advocating for promoting the use of LARCs through Public Service Advertising (PSA) on various mass media outlets, including radio, TV, print, and online media.

In August 2015, the Government of India shared an update on its commitment to FP2020. Here are the government's responses. 

• All the family planning commodities in India are being manufactured indigenously and no donor support is being sought for the same. All the commodities are procured centrally and distributed to states. Annual forecasting is being done for commodity estimation in the country. In 2014-15 FP commodities worth Rs. 254.3 crore (USD $42.3 million) were budgeted.

• All the family planning services are being provided free at public health facilities and accredited private health facilities in India. Family planning services are being rendered by 0.18 million primary level public health facilities, more than 6000 secondary level facilities and 755 tertiary level facilities besides a large pool of accredited private health facilities.

• India has a pool of 0.87 million community health workers (ASHA), acting as depot holders for contraceptives at the village level and 0.64 million villages across 670 districts are being covered under the scheme. ASHAs are an important source for accessing contraceptives in rural areas by eligible couples in the privacy of their homes. The Government of India believes ASHAs are also helping reduce the gender differentials for contraceptive usage as ASHAs distribute contraceptives to male beneficiaries too. Another scheme has been designed for the high-fertility states and is operational in 18 states covering 0.4 million villages across 410 districts. 0.59 million ASHAs are involved in counseling the beneficiaries on the advantages of spacing, delaying the first birth by two years and maintaining the birth interval of at least three years between the two children. In addition, more than 1,600 positions of RMNCH+A counselors were created in 2014 to ensure counseling for family planning at high case load facilities.

• In 2013 and 2014 India updated the national standards in sterilization services and technical guidelines for IUCD and sterilization for equipping the service providers with latest protocols. It has been widely disseminated by state level workshops in all 36 states of India.

• Government of India developed the RMNCH+A strategy, which included family planning as the first pillar. The country has witnessed an increase of 9.2% from 2012 to 2014 in secondary and tertiary care public health infrastructure.

• Almost 5,000 new primary level facilities, 567 secondary level and 33 tertiary level public health facilities were created in a short span of two years. More than 10,000 female and more than 3,500 male health workers were added to the workforce in the same period. A new cadre of RMNCH+A counselors were recruited in all the states to ensure counselling services in high-case load facilities. To ensure skill building of the providers certain innovative steps were taken recently which included onsite training model especially for the high-focus states which face a huge human resource crunch. Another strategy includes mobile teams for the provision of family planning services. The team is equipped with necessary logistics, medical and paramedical staff.

• The initiatives are being taken to launch social franchising and social marketing scheme in the country which will address the service delivery gaps as well as demand generation.

• Every year, the states are being supported through central and state budgets for procuring equipment and drugs. All drugs are provided free of cost in all public health facilities across the country. Few states have already operationalized logistic management software for family planning supply chain management. The national government is advocating that other states do the same (the guidelines have already been shared with the states). Besides this a gap analysis is being undertaken for further strengthening of supply chain. Additionally for strengthening service delivery, all sterilization clients are being offered free transportation back to their homes after the procedure in public health facilities.

• Programmatically there is a focus on increasing birth spacing and discouraging teenage marriages. The Rashtriya Kishor Swasthya Karyakram (RKSK( strategy was launched in 2013-14 to address the needs of adolescents, including the reproductive health. ASHAs are being utilized for providing field level counseling in the community for these issues.

• Plus de 22 centres de santé intégrés organisent une sortie de clinique mobile de 10 jours par mois.
• Le contraceptif injectable est distribué au niveau de 1231 cases de santé sur 2500 que compte le Niger. 2380 utilisatrices auprès des agents DBC au niveau de 2 districts sanitaires et plus de 24614 utilisatrices au niveau des 1231 cases de santé. Le Niger a décidé en 2015 de porter à l’échelle des 2500 cases de santé l’utilisation de ce contraceptif.
• Le plan PF est en cours de révision pour prendre en compte des stratégies innovantes pour couvrir les besoins de jeunes. Et un plan stratégique spécifiquement sur la santé des adolescents et jeunes est en cours d’élaboration.
• En fin 2015 le Niger compte 1241 écoles des maris avec plus de 14800 maris modèles qui sensibilisent leurs pairs et la population entière à l’utilisation des services de santé notamment la planification familiale et les accouchements au niveau des services de santé.
• La planification familiale est intégrée dans le cursus de l’enseignement secondaire. Les enseignants sont formés.
• Le Niger n’a pas encore conduit d’enquête triennal sur la prévalence contraceptive. La prochaine enquête est prévue pour 2017.
• L’enquête annuelle RHCS sur les indicateurs de la sécurité contraceptive a été conduite chaque année et cela depuis 2012. Les résultats indiquent :
  • 100% des points de prestations de services offrent 5 méthodes de contraception moderne
  • 5% des points de prestation de services n’ont pas connu de rupture de stock au cours des 6 derniers mois.
• Le suivi semestriel du niveau central au niveau des 44 districts et 8 régions se sont poursuivis en 2015 et 2016. Chaque Direction Régionale de la Santé organise un suivi trimestriel vers les districts sanitaires relevant de sa région. Chaque district sanitaire effectue une mission de suivi trimestriel vers les centres de santé intégrés de son district.
• Channel est utilisé au niveau de toute la chaine d’approvisionnement jusqu’au niveau district. Ainsi l’ONPPC (central et zonal), les 8 DRSP et les 44 districts utilisent Channel pour la gestion logistique et pour collecter les informations de gestions en vue de décisions rationnelles d’approvisionnement. Le Niger vient de former le personnel à l’utilisation du Channel 2 (version améliorée de Channel).