Join FP2020 by Making a Commitment

IPPF shared the following update on progress in achieving its FP2020 commitments:

IPPF has committed to significantly increasing the number of family planning services—a trebling of services from 2012 to 2020. IPPF is on track to reach the FP2020 targets to enable 120 million more women and girls to use contraception by 2010. By 2020, IPPF will increase family planning services to save the lives of 54,000 women, averting 46.4 million unintended pregnancies and preventing unsafe abortion. Results from 2014 show significant progress towards achieving this ambitious target:

• Delivery of 60.2 million contraceptive services through 54,000 service delivery points. The number of contraceptive services provided in 2014 includes 8.9 million new users. Over 5.7 million contraceptive services were deliver to young people under 25 years of age.
• Averted 5.9 million unintended pregnancies and 677,000 unsafe abortions through a CYP of 14.6 million. The number of couple years of protection (CYP) provided in 2014 increased by 21 percent to 14.6 million, which averted an estimated 5.9 million unintended pregnancies and 677,000 unsafe abortions. In the Africa and Arab World regions, the percentage increases from 2013 were 83 and 37 percent, respectively. In Africa, the growth was predominantly due to injectables, intrauterine devices, and oral contraceptive pills. In the Arab World, it was due mainly to intrauterine devices and implants.
• Delivering an Integrated Package of Essential Services. IPPF remains committed to providing a range of contraceptive choices to service users. The services in the package are proven by WHO to deliver high impact in resource-poor settings and when combined these services have the ability to transform the lives of women, girls and other poor and vulnerable populations. Our Integrated Package of Essential Services requires IPPF Member Associations to provide short- and long-acting reversible methods, as well as emergency contraception. Within IPPF’s CYP for 2014 of 14.6 million, 44 percent was provided by short-acting methods; 42 percent by reversible long‑acting methods; 14 per cent by permanent methods.

By 2015, we expect to double the number of comprehensive and integrated SRH services annually by:

• Investing in countries with the greatest need. The majority of IPPF’s unrestricted investments are made in countries with the greatest need for SRH information, education and services. These countries, identified by the Human Development Index as having low or medium levels of human development, have disproportionately high levels of maternal and child mortality, unmet need for contraception, HIV prevalence, and early marriage and childbearing. In the 73 countries identified as having low or medium levels of human development3 and where there is an IPPF Member Association or collaborating partner, the total number of sexual and reproductive health services provided in 2014 reached 122.4 million, an increase of 13 per cent from 2013. The most common categories of services provided were contraception, maternal and child health, and HIV-related services;
• Reaching poor and vulnerable groups. In 2014, IPPF reached 52.6 million poor and vulnerable service users with sexual and reproductive health services, 3.7 million more than in 2013. The estimated proportion of all service users who are poor and vulnerable is 85 percent, the highest ever achieved by IPPF. These results illustrate IPPF’s commitment to serving those most in need of sexual and reproductive health services. IPPF has more than 54,000 service delivery points, and 59 per cent of them are located in peri-urban or rural areas. This enables Member Associations to provide information, education and services to people living in hard-to-reach areas where there are few, if any, other service providers. Member Associations provide services to under-served groups who are not reached by other public or private providers, due to a reluctance to work with such marginalized populations, the additional costs involved or an absence of the specialized skills needed. Such groups are often those with greatest need, and include young people, sex workers, men who have sex with men, people who inject drugs, sexually diverse populations and prisoners.
• Adolescents and young people. In 2014, IPPF provided 66.6 million sexual and reproductive health services to young people. This represents 45 percent of all services provided, and illustrates our commitment to the largest generation of young people ever. Over the last five years, IPPF has focused on the needs of young people, with the proportion of sexual and reproductive health services provided to youth rising from 35 per cent in 2010 to 45 per cent in 2014. The most common services accessed by young people in 2014 were contraception (37 percent), HIV-related services (22 percent) and gynecology (10 percent).

Throughout 2014, IPPF continued to invest in and strengthen organizational systems and business processes to support a strong culture of performance, effectiveness, learning and accountability. Being part of a large Federation means that many Member Associations have the opportunity to learn from and share their expertise with others. While IPPF Regional Offices provide technical support to Member Associations in their regions, there is a growing trend to promote capacity building directly between Associations. In addition, as experts in the field of implementing sexual and reproductive health and rights programmes, Member Associations are also asked by external private and public health organizations to share their knowledge and experience.

• Learning Centers in the Africa Region. The Africa Regional Office has supported nine Member Associations to become designated Learning Centers. These Centers offer training and other forms of technical assistance to organizations, both within and outside the Federation. Based at the Member Associations of Cameroon, Côte d’Ivoire, Ethiopia, Ghana, Kenya, Mozambique, Swaziland, Togo and Uganda, the Learning Centers promote peer-to-peer learning by transferring expertise in how to design innovative programmes. These Member Associations consistently demonstrate their capacity to provide quality SRH information and services, and have the expertise, skills and systems to provide technical support to other Member Associations. Each Centre reflects the acknowledged strengths of that particular Member Association.
• Engaging volunteers and staff. In 2014, volunteers and staff of the Member Associations with Learning Centers took part in refresher training in their core areas of expertise to strengthen their ability to provide support on topics in demand. These included family planning, with a focus on long-acting and permanent methods; public–private partnerships; and how to deliver integrated SRH including contraception. Member Associations were supported to convert areas within their facilities into meeting spaces, and to develop or adapt training modules based on national sexual and reproductive health policies and curricula. Exchange visits involving the Member Associations in Cameroon, Ghana and Uganda offered valuable opportunities to share experiences in the day-to-day management of running a Learning Centre.
• Member Association exchange. Reproductive Health Uganda (RHU) demonstrates one example of a Learning Centre building the capacity of multiple Member Associations across the region. RHU provided training to Member Associations from Ethiopia, Kenya, Malawi and Mozambique on how to design and manage surgical camps, as well as training for Member Associations in Ethiopia, Kenya, Malawi, Namibia, Swaziland and Tanzania on a parent-focused intervention exploring the sexual and reproductive health and rights of young people. In 2014, three Member Associations with Learning Centers were successful in generating income from training public or private health providers. The Family Guidance Association of Ethiopia trained 2,628 health professionals from public and private clinics, generating 16.7 million Birr (US$816,000); Family Health Options Kenya trained 300 service providers, generating 3 million Ksh (US$32,000); while Côte d’Ivoire’s Association Ivoirienne pour le Bien‑Être Familial trained nearly 200 service providers and generated 62.6 million FCFA (US$100,000).

IPPF is currently building on the work previously undertaken across the Federation to support client-centered, integrated, rights based quality family planning services within a comprehensive approach to SRH. IPPF is building a strong civil society response to strengthen national health systems. Member Associations are part of the grassroots movement in their respective countries. They play a critical role not only as service providers within the health system, but also as a significant contributor to strengthening the health system by disseminating new guidelines and technologies, building the capacity of other peers working within the health system, and advocating for supportive policies. Below are highlights from our work in 2014:

• IPPF is reinvigorating our International Medical Advisory Panel to respond with best practice and clinic based guidelines and to share our experience amongst communities of best practice, and provides timely guidance to IPPF on critical issues related to SRH and family planning. IPPF Medical Bulletins are produced to address gaps in bio-medical evidence or critical issues relating SRHR programming.

IPPF’s commitment to quality of care is demonstrated through our Quality Assurance Package which also guides Member Associations on establishing the Integrated Package of Essential Services (IPES). In 2014, quality of care was included as a key principle for Member Associations accreditation, underpinning our continual quest for quality. Evidence from our safe abortion and family planning programmes shows that satisfied clients are one of the top three sources of referral for new clients. IPPF’s Quality of Care Technical Working Group provides global technical leadership in quality of care, along with information and policy updates, sharing guidelines and best practice, training and resources.

IPPF remains committed to building the advocacy capacity of Member Associations in 40 countries to advance rights-based family planning, within a comprehensive approach to SRH. IPPF defines capacity building as development of IPPF’s core skills in order to enable the organization and individuals to address weaknesses, to bring about change and increase effectiveness. IPPF Regional Offices are the hub of capacity building activity in the Federation and provide technical assistance to Member Associations in every aspect of organizational life, depending on their needs–including advocacy capacity building.  Our Regional Offices provide on the spot assistance, regional training workshops, publishing toolkits and arranging south to south technical assistance. Specific examples in 2014 include:  

• IPPF worked to increase Member Association capacity to advocate on sexual rights—including access to contraception—through the Universal Periodic Review Mechanism. IPPF supported Member Associations to press their governments for change, including training for Member Associations from Austria, Albania, Bosnia-Herzegovina, Bulgaria, Estonia, Kazakhstan, Spain and Tajikistan to use the UPR process. Most recently, two Member Associations who participated in the workshop have submitted shadow reports that will be reviewed by the Human Rights Council over the next year. The Macedonian and Bulgarian Member Associations also attended the adoption of their respective country UPR reports in Geneva and made oral statements on the recommendations that were adopted or rejected.
• Advocacy with the UN. Every year, IPPF successfully advocates for progressive language to be included in UN documents, including the conclusions of the Commission on the Status of Women (CSW) and the outcome document for the Commission on Population and Development (CPD). IPPF supports Member Associations to participate in these UN processes, and hold their governments in capital to account on key issues related to SRH and rights-based family planning.
• Joining Voices. IPPF’s Joining Voices project plays an important role in supporting civil society advocacy on family planning to make sure commitments are delivered. As part of Joining Voices, Countdown 2015 Europe is a consortium of 15 leading European non-governmental organizations, of which over half are IPPF Member Associations, working to ensure funding for sexual and reproductive health and rights in developing countries. Coordinated by IPPF’s European Network and working with European Union institutions, Countdown 2015 Europe holds donors to account for their policy and funding commitments to achieve universal access to reproductive health and to address the unmet need for family planning.
• Tracking advocacy progress. In 2012, new questions on advocacy were included in the Global Indicators Survey to provide additional information on advocacy progress made by Member Associations. However, certain Member Associations suggested a new approach to gathering information on advocacy progress. Currently, we are providing support for Member Associations to assess their advocacy capacity better, through a tool based on a self-assessment checklist to identify strengths and areas that need improvement.

The Government of Myanmar provided new information on its progress in April 2017.  Read the revised update here.

In July 2016, the Government of Myanmar 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 policy and political commitment:

• In 2016, Myanmar has made some progress in the policy environment for providing clinical contraceptive methods by trained and skilled nurses and volunteered, such as the commitment for task shifting to Auxiliary Midwives (AMW) in FP services; some methods of family planning like OC pills and condom can be provided by AMW. Long-term methods of family planning (particularly, implant) training is scheduled to start in July 2016 for the public sector, with a nationwide roll out planned for 2016-2017 with the support of UNFPA, PSI, Jhpiego and ObGy Society/ MMA. There will be trainings of health care providers to give services targeted to peri-urban poor in the Yangon region (reaching 34 townships), in the Mandalay region (23 townships), and in the Magway region (25 townships), where maternal mortality is high and unmet need is high.
• Myanmar has developed a five-year strategic plan for reproductive health and developed a Costed Implementation Plan (CIP) in 2014 to meet the commitment on Family Planning 2020. All implementing partners are providing FP services according to the strategies and guidance of that plan, but the government plans on revisiting the CIP this year 2016 to explore the gaps in family planning.
• Lead Working Group on Family Planning and Lead Working Group on RH are being conducted quarterly in alignment with the Reproductive Health Technical Working Committee meetings and any recommendations are discussed at the Maternal Newborn and Child Health Technical Strategic Group. In addition, the FP commodity meeting and coordination meetings of the nationwide training effort are also occasionally conducted occasionally.

In August 2015, Bloomberg Philanthropies shared an update on progress in achieving its commitments to FP2020. Below are updates on Bloomberg Philanthropies three-pronged investment strategy:

• Integration of Comprehensive Reproductive Health Services in Kigoma, Tanzania: Bloomberg Philanthropies are supporting the integration of family planning and comprehensive post-abortion care into the 17 health centers the Philanthropies has upgraded for comprehensive emergency obstetric care in Tanzania. The next phase of Bloomberg Philanthropies investment in Tanzania has a goal of increasing CPR in Kigoma Region by 3 percent annually over 4 years (total 12 percent increase). Our implementing partners, World Lung Foundation and EngenderHealth, are using multiple strategies to reach that goal, including: behavior change communications, partnership with local women’s groups, outreach to youth, training and deployment of community health workers, and partnership with local government to ensure sustainability. Bloomberg Philanthropies’ partner, EngenderHealth, has already begun providing family planning counseling and services in 17 supported health facilities. In 2014, nearly 50,000 clients, including about 10,000 clients aged 10-24, were able to access the contraception of their choice.
• Advocacy Grants in Nicaragua, Burkina Faso, Senegal and Uganda: Bloomberg Philanthropies’ partner Planned Parenthood Global has identified promising local organizations in the four target countries and convened them to select policy priorities. Planned Parenthood will provide technical expertise and build capacity to support them in conducting effective advocacy that leads to improved access to reproductive health services.
• Rapid Response Mechanism established and launched in partnership with FP 2020/UNF: To date, the Rapid Response Mechanism has supported 12 grantees in South America, Asia, and Africa.

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

• The 66^th meeting of the National (family planning) Technical Committee (NTC) held on 3 February 2016 approved the Implant and Progesterone-only pills (POP) as an immediate post-partum family planning (PPFP) method and as such Implants and POPs can be provided to clients immediately after delivery irrespective of parity. This is a major policy shift based on sustained advocacy from FP2020 partners, which would expand the method mix for post-partum women nationwide.

• Other key policy level changes that have happened in the reporting period.
  • Relaxation in the required age of the last child to one year for two child couples who want sterilization;
  • Allowing trained and skilled staff nurses to insert IUDs;
  • Allowing trained and skilled Female Sub-Assistant Community Medical Officers (SACMOs) to insert IUDs
  • A joint circular was issued by both DGFP and Directorate General of Health Services (DGHS) informing program managers and service providers on: 1) counseling pregnant women about family planning in all ANC; 2) providing FP counseling and services including pills, condoms, injectables, and implants in all PNC and immunization visits; and 3) providing PPFP methods for women undergoing home delivery which included: LAM (Lactational Amenorrhea Methods), Condoms, ECPs and Progestin-only Pill (POPs).
  • Relevant section of the National Family Planning Manual is being revised as per latest WHO MEC for contraceptive use.

• A key strategy that the Government developed to address discontinuation was to decentralize service provision by further capacitating domiciliary workers (the family welfare assistants or FWAs) to both initiate and provide follow up family planning services to clients

• 34 district and Upazila level trainers (ToT) of Brahmanbaria were trained in August 2015 to conduct cascade training to lower cadres. Local level trainers further trained 147 FWAs for providing 1^st and subsequent doses of injectable, previously allowed to only provide the 2^nd and subsequent doses. 258 FWAs who had received an earlier round of training and 84 Family Welfare Visitors (FWVs) of the same district received refresher training. By June 2016, two other districts, Cox’s Bazar and Dhaka have completed training of FWAs including required refreshers.
• Immediately after the training FWAs of all three districts have started providing the 1^st dose of injectables in the community. These efforts have helped the clients to save travel time and costs which may lead to increased acceptance and reduced discontinuation rates with regard to injectables.
• To complement the above initiative, DGFP has also completed training to community health care providers (CHCPs) for provision of the second and subsequent doses of injectable contraceptives at the Community Clinics in the same districts; a cadre which was previously not allowed to provide injectables. Based on positive feedback from the field, DGFP has started implementing the activity in another three districts (Laxmipur, Noakhali and Chandpur) and subsequently plan to scale up to all 64 districts.
• The USAID-funded Mayer Hashi Project has worked with the DGFP and the Bangladesh Garments Manufacturer and Export Association (BGMEA) to train health providers in family planning and to ensure a supply of contraceptives in BGMEA clinics and has already ensured availability of temporary contraceptives in 10 BGMEA clinics. Clinical providers of the BGMEA clinics have been trained on Implant and Injectable. Approximately an additional 40 garment factory clinics are providing condoms, orals and referrals for long acting and permanent methods.  Workplace FP services efforts will help to decrease discontinuation rates of temporary contraceptives by the garments workers.

The Government of Bangladesh/MOHFW committed to increasing the availability and accessibility of Long Acting and Reversible Contraceptives (LARCs – IUD and Implant) and Permanent Methods (PMs – Tubectomy and Vasectomy) in order to help shift their share of the method mix from 8% to 20% by 2021, the revised target. Following activities are ongoing to achieve this goal:

• Increasing availability of FWVs: The MOHFW has recruited 1,320 FWVs, of which 805 have already been trained to provide IUDs and assigned to vacant positions and the remaining 415 are in training. The MOHFW is recruiting an additional 638 FWVs.
• Increase availability of family planning medical officers: The DGFP received MOHFW approval to recruit of 535 Medical Officers (MCH-FP) which is in process.  Once recruited and trained, these physicians will be assigned to vacant positions, enabling increased NSV, Tubectomy and Implant service provision.
• Private-sector partnership: The DGFP has allowed the local Social Marketing Company (SMC) to market over-branded IUDs and Implants. Approximately 400 trained physicians have been trained with USAID support to provide the over-branded IUDs and Implants in private chambers, clinics and hospitals.  The DGFP initiated a Technical Committee to support the Private Sector Initiative on LARCs and PMs under the leadership of the Line Director, Clinical Contraceptive Services Delivery Program (CCSDP), DGFP.
• Creation of mobile service delivery care teams: Two NGOs funded by USAID as well as Marie Stopes Bangladesh are supporting DGFP through roving teams to provide LARC/PMs during Special Service Delivery Days, especially in government Union Health & Family Welfare Centers (UHFWCs) and NGO facilities.
• Creating an enabling environment: Certain policies have been changed as indicated above, including:
  • Relaxation in the required age of the last child to one year for two child couples who want sterilization;
  • Allowing nulliparous married women to accept Implant;
  • Allowing trained and skilled Staff Nurses to insert IUDs;
  • Allowing trained and skilled Female Sub Assistant Community Medical Officers (SACMOs) to insert IUDs;
• Demand creation and community mobilization: The IEM Unit of DGFP has initiated several BCC activities with support from UNFPA and USAID’s funded Bangladesh Knowledge Management Initiative (BKMI) Project including direct distribution of BCC/counseling materials and orientation of the providers on use of those materials in 38 out of 64 districts.
• Motivation of prospective clients: As a part of this intervention, orientation sessions of satisfied NSV acceptors with support from USAID-funded Mayer Hashi Project been carried out in more than 350 upazilas and in 40 upazilas with satisfied IUD acceptors.
• Mobilizing religious leaders as prompters of LARC/PM in Bangladesh: A book published by DGFP in Bangla titled, ‘Family Planning in the Eyes of Islam’, is used widely to orient Islamic religious leaders in training funded by USAID through the Mayer Hashi Project.  This booklet is accompanied by a smaller FAQ booklet.

The Government of Bangladesh committed to increasing training and workforce development by engaging in the following activities:

Recruitment:

• In 2015: 382 Medical Officers, 530 FWVs and 72 SACMO recruitment is completed.
• In 2016; 153 Medical Officers, 108 FWVs and 68 SACMO recruitment process is ongoing.

These technical cadres provide family planning and MCH services under the DGFP/MOHFW.

Training:

• In 2015-2016: 70 Medical Officers and 632 Paramedics were trained on Postpartum Family Planning (PPFP), much of it funded by USAID through the Mayer Hashi Project.
• In 2015-2016; 120 Paramedics received basic training on LAPMs.
• 761 participants (Deputy Director, Assistant Director, Medical Officer – Clinic, Upazilla Family Planning Officer and Medical Officer-MCH-FP) were trained on Progesterone-only Pill (POP).
• 1770 Field Staff (FWA, FWV, FPI and SACMO) received refresher training on Progesterone-only Pill.
• Government & NGO coordination workshops were held in all districts to increase demand for FP services.
• 929 service providers received training on injectable. Service providers targeted include FWV, FWA, CHCP in Noakhali, Laxmipur and Chandpur districts.
• 30,000 service providers such as FWA, FPI, SACMO and FWV attended trainings on newly revised FWA register (8^th edition) and reporting forms.
• 800 managers received training on LAPM users track and bottom-up projection related software.

The Government of Bangladesh committed to increasing adolescent-friendly sexual and reproductive health and family planning services and to providing adolescent sexual and reproductive health services at one-third of maternal, newborn, and child health centers.

• The MCH Services Unit of the Directorate General of Family Planning has started implementing Adolescent Friendly Health Services(AFHS) in 128 service centers (13 MCWCs & 115 UH&FWCs) in 13 districts. To increase demand of seeking care from these centers, DGFP recently conducted 5 advocacy meetings at the union level with the participation of adolescents, Community Health Care Provider, local leaders (Chairman of Union Parisad with 2 women members) and members of UH&FWC management committees.
• Three batches of three days-long training of the supervisors, service providers have been conducted and establishment of the AFH Corners are now going on. Soon these centers are expected to function fully. The MCH Services Unit of the DGFP is developing IEC materials (for display and for take away) for these AFH Corners. Messages for IEC materials have already been developed through 4 days-long workshop, technically supported by BCCP and attended by the expertise from different UN organizations, Government and NGOs.
• The Adolescent Sexual and Reproductive Networking Forum developed in 2015 and convened its’ regular meetings to discuss approaches to scaling up ASRH programmes in the country. A review of 32 Adolescent Health Programs of different NGOs has been completed by Population Council with USAID funding in partnership with DGFP and was shared with different stakeholders at the divisional level through consultative meetings to share knowledge. An Adolescent Health Newsletter providing programmatic and policy updates has been developed by DGFP with partners and will be regularly published on a quarterly basis.

• One of the milestones of Adolescent Health Activities of MCH Services Unit of the Directorate General of Family Planning is the creation of a website for adolescents with the support of UNFPA. The website will build awareness among adolescents by providing accurate and relevant information on their health related issues. This website has a mobile friendly version also as most of the adolescents use internet on their mobile phone.

The Government of Bangladesh committed to monitoring to ensure that quality of care is strengthened, including informed consent and choice.

• DGFP has extended the FP quality improvement teams from 8 to 10 and is planning to increase more teams to cover all districts in the next sector program period which will start in 2017. FP QI teams are working closely with national QI secretariat to ensure clients rights (availability, affordability, privacy, confidentiality etc.) at different level of facilities. FPQI teams are accountable to ensure rights based volunteer family planning services through their physical monitoring and exit interview of clients. DGFP is following up feedback from FPQI teams and addresses them accordingly. USAID-funded Mayer Hashi Project provides technical assistance to the DGFP on FP quality and compliance with informed choice requirements and provides a FP QI and Compliance Team for each of the seven, soon to be eight, Divisions.

DGFP conducted two days training on total quality improvement for Family Planning Clinical Supervisor Team/Quality Assurance Team (FPCST/QAT) in November 2015. As part of the training teams had to visit a model clinic (Narshindi) for “5S” intervention for hands on training. 5S concept was introduced in another two DGFP clinics to improve quality of FP-MCH services to learn implementation challenges and for scale up.  Biannual meeting were also organized at national level to review the FP performance in terms of quality of services.

The Government of Bangladesh committed to working with leaders and communities to delay early marriage and childbirth.  Please kindly provide an update on this commitment here.

• The IEM Unit of the DGFP has already implemented different innovative approaches to engage community leaders, gate keepers, local elites, religious leaders, school teachers, adolescent groups under the last sector program HPNSDP. These are as follows.
• Conducted 670 workshops on adolescent reproductive health, discourage child marriage, improve adolescent nutrition, and hygiene in all the upazilas of Sylhet and Chittagong Divisions with the students of Class VII to Class X, teachers and parents/guardians.
• Conducted workshops on the importance of population dynamics, importance of small family norms, ANC, PNC, institutional delivery, and neonatal care with the print and electronic media journalists in all 64 districts of the country.
• Organized workshops to advocate family planning methods in the light of Islam, discourage early marriage, importance of ANC, PNC and institutional delivery with local public representatives, religious leaders including Imams, Madrasa teachers and marriage registrars at 326 upazilas.
• Conducted 350 workshops with low parity couples, newly wed couples, young married couples to delay space and limit family size.
• Conducted training on interpersonal communication for the newly recruited field workers i.e. FWA, FWV, SACMO to motivate clients.

The following innovative service delivery activities were carried out by the DGFP:

• A digital archive for all FP SBCC materials was developed with the technical support of USAID-funded BKMI Project. Regular updating and uploading of the produced materials is ongoing.
• An e-Toolkit for frontline health workers and program managers was developed and is available in an Android version both in online and offline for fieldworkers, with the support of BKMI.  It is in the digital archive and updated annually. This e-Toolkit is now in use on pilot basis in Comilla and Tangail district’s front line workers through electronic tablets.
• An e-learning course on SBCC for frontline workers, program managers and planners were developed with support from BKMI. Program Managers and Planners are now using this e-learning course to improving their knowledge on SBCC regularly.

A dissemination and distribution guideline of IEC/BCC materials was developed.  Through the USAID-funded SIAPS, Mayer Hashi and BKMI Projects, the DGFP system to order and distribute SBCC materials is being strengthened, including integrating IEC/BCC materials into the DGFP’s eLMIS dashboard.

• Aman Foundation, through the Sukh initiative is committed to share best practices and research to aid evidence based decision making. The intention is to share the best of time practices for family planning project scale ups and sustainability with potential users of the information. The Department of Community Health Sciences, Aga Khan University as a measurement partner for Sukh Initiative, is to provide an external and independent measurement of program impact through a cross sectional survey of a sample population within the 1 million intervention population in the form of a baseline and an endline. Program impact will be measured as per the objectives and program goals outlined and agreed upon in the Sukh program framework. The measurement partner will conduct a mid-term assessment of program progress towards identified goals and also an independent analysis of progress monitoring and PMIS data on an annual basis and participate in an annual review of program progress. A dedicated position of Manager Research and Metrics has been introduced to the Sukh initiative with sole responsibility of identifying and developing research questions and hypotheses and with program data to identify best practices and evidence based impact studies. The activity is to commence from 2015 when field level service data becomes available for a meaningful and effective sample study.   

• To increase the ambit of Sukh strategy and build on the success of different models implemented in the country, Sukh Initiative has evolved an exclusive technical body which is widely represented by the Sindh Government, development partners, technical experts both from public and private sector. This body aims to create synergy between different stakeholders including the government departments in Sindh. Sukh is also working at the community level through more than 200 community base organizations. To create an enabling environment for family planning services, Sukh is working in close collaboration with the provincial Departments of Health, Population Welfare, Education and Youth Affairs, to strengthen the existing systems in the intervention areas and play a leadership role in advocating for the sustainability of its objectives.

• [Aman Foundation's family planning] program will promote longer term, more effective contraceptive methods. Sukh through increasing MCPR will motivate new users to adopt family planning for the first time, and encourage users of traditional methods to switch to more reliable modern methods. The connection between increased MCPR and reduced maternal mortality rates is well established, as is its direct contribution to lowering the total fertility rate. To improve quality of services to increase access to family planning, Sukh strengthens the quality of services locally available and will develop capacity of maternity homes to offer quality post-partum and post abortion family planning services. Jhpiego as implementing partner will work with public sector facilities to improve access to FP services (by method) and with improved quality of service.

• One of the multiple service provision levers for the Sukh project is Family Life Education through Aahung, a local organization with previous experience in working with young girls and boys in communities on the sensitive issues related to maternal health, marriage rights and communication. Sukh will include door to door counselling and service delivery through Aman Community Health Program, to educate and inform the family planning clients on importance of family planning, choices available for family planning supplies, health hazards and other healthcare topics. In addition, Aman TeleHealth a 24-hour round the clock, 26-desks Health Helpline services over 3 shifts with medical advisors, counselors and doctors, will provide health advice and referral information over the phone. This will empower and encourage women and youth in particular, to avail the widely used mobile phone services to seek timely medical counseling that otherwise would not be accessible to them.

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.  

• 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.

Ipas provided the following updates on progress in achieving its FP2020 commitments:

Training new cadres of health care workers—4,000 per year—to provide a wider range of sexual and reproductive health services, including post-abortion family planning services: Ipas-supported programs, in partnership with national/regional/state health systems in 17 countries, train clinical providers in safe abortion care and postabortion care, postabortion contraception, including long-acting reversible contraception, and referral for other sexual and reproductive health services.   Depending on country strategies, training may be integrated with other SRH training, such as Emergency Obstetric and Newborn Care, gender-based violence, or postpartum family planning.  

Number of providers clinically trained by Ipas annually since the FP2020 commitment:

• July 2012 – June 2013: 7,710  
• July 2013 – June 2014: 5,825
• July 2014 – June 2015: 7,277 (data pending validation)

Globally, approximately 45% of clinically trained providers are midlevel providers (i.e., nurse-midwives, auxiliary nurse-midwives, clinical officers), with 68% clinically trained providers in Africa being midlevel providers.  Globally, over 75% of the facilities in which clinically trained providers are working are primary level facilities, helping to bring abortion and contraceptive services closer to women in their communities.

From July 2012 – June 2013, 75% of women receiving abortion services received a contraceptive method at the time of care in health facilities to which Ipas provided support and 77% of women received a contraceptive method from July 2013 – June 2014.  Contraceptive service data from July 2014 to June 2015 is currently being validated.

In addition to building the capacity of health systems to train providers and ensure women receive postabortion contraception, in select countries, Ipas-supported programs also train clinical providers to provide contraception for all women needing services in Ipas-supported facilities and/or to provide postpartum contraception.  For example, in Ethiopia, beyond women who receive postabortion contraception, an additional 500,000 women a year receive contraceptive services through an Ipas-supported project.

Supporting research on post-abortion family planning service delivery: Ipas staff conducted extensive research, monitoring and evaluation of post-abortion family planning (PAFP) service delivery in nine countries in Africa and Asia. Completed and ongoing research in this area includes factors that affect acceptance and continuation of long-acting reversible contraceptives (LARC) post-abortion, operations research on interventions to improve PAFP and evaluations of innovative models to improve PAFP using mobile health (mHealth).  Completed and ongoing research is in Ethiopia, Ghana, Kenya, Nigeria, Uganda, Cambodia, Bangladesh, India and Nepal.  All of Ipas’ research studies are listed below.  Some studies utilize Ipas monitoring and evaluation data to better understand women’s experiences with PAFP while other research studies utilize data collected (usually prospectively) to answer specific research and evaluation questions.  Please contact the study authors for additional information.

Global

• What factors contribute to contraceptive uptake among young women seeking abortion care in health facilities in Africa and Asia? (Authors:  Janie Benson, Kathryn Andersen, Dalia Brahmi, Risa Griffin, Joan Healy, Alice Mark)

Africa

• Contraceptive method mix in post-abortion family planning (PAFP): Opportunities to address women with unmet need for long-acting reversible contraception (LARC) (Ethiopia) (Authors:  Melaku Samuel, Tewodros Tolossa, Ashenafi Alemayehu)
• An examination of the characteristics and modern method acceptance of post abortion clients in Ethiopia in 2014 (Authors:  Tamara Fetters, Yohannes Dibaba, Hailemichael Gebreselassie)
• Post-abortion contraceptive uptake and continuation among abortion clients in primary, secondary and tertiary facilities in Ghana.  (Authors:  Samuel K. Antobam and Heather M. Marlow)
• Stigma’s impact on post abortion contraceptive uptake: Women’s experiences from high and low incidence of unsafe abortion in Kenya (Author:  Erick Yegon)
• Evaluation of intrauterine device and implant provision by Ipas-trained providers and their clients in Nigeria (Authors:  Kristen Shellenberg, Sikiratu Kailani, Nkiruku Okwesa, Alice Mark, Amy Coughlin, Risa Griffin)
• Increasing access to post abortion family planning among women in Eastern Uganda (Author:  Erick Yegon)

Asia

• Determinants of contraceptive acceptance among Cambodian abortion patients (Authors:  Janna McDougall, Tamara Fetters, Kathryn Andersen Clark, and Tung Rathavy)
• Predictors of modern contraceptive use four months post-abortion: Findings from a prospective study of uterine evacuation clients in Bangladesh (Authors:  Erin Pearson, Kamal Biswas, Rezwana Chowdhury, Kathryn Andersen, Sharmin Sultana, SM Shahidullah, Michele Decker)
• Ongoing:  mHealth feasibility study to promote PAFP use (Bangladesh) Findings: Using mHealth is feasible among post-abortion clients.  Need to look into options for low literacy populations, and linking with call center to discuss/receive personalized information.
• Ongoing:  Using mHealth to support PAFP use: A randomized controlled trial (Bangladesh) Findings: Interactive voice response system preferred by women (this is what is currently being developed), need to focus on information on method women selected so that they see the messages as relevant, identified key barriers to long-acting methods (mainly myths, fear of side effects/infertility, fears about not being able to get LARCs removed)
• Post-training mentoring support to influence postabortion contraceptive uptake: A critical analysis of 402,096 women who received abortion services in six major states of India (Authors:  Sushanta Kumar Banerjee, Sumit Gulati, Kathryn Andersen, Avindra Mandwal)
• Lessons learned from the postabortion contraceptive improvement model in Rautahat district of Nepal (Authors:  Indira Basnett, Parash Prasad Phuyal, Mukta Shah, Om Narayan Jha, Erin Pearson)
• Association between postabortion contraceptive acceptance and sociodemographic, facility and procedure characteristics: Analysis of hospital-based data in Nepal (Authors:  Swadesh Gurung, Deeb Shrestha Dangol, Indira Basnett)

 Advocating for improved medical service delivery protocols: From 2012 to July 2015, Ipas has contributed to 9 national or state standards, guidelines, protocols or national training curricula that include service delivery protocols, incorporating guidance represented in the WHO Safe abortion: technical and policy guidance for health systems, Second edition (2012) and the WHO Clinical practice handbook for Safe abortion.  This includes updated guidance on provision of hormonal contraception at the time of administration of the first pill of a medical abortion regimen.  Most of these national guidance documents include provision of contraceptive information and services at all levels of the health system including community level. Ipas has widely disseminated over 4,000 copies of the WHO Safe Abortion guidance to policymakers, program planners and health care providers in addition to supporting regional dissemination meetings of both documents.  Additionally, Ipas annually updates evidence-based guidance on abortion care and postabortion care, including postabortion contraception, through its Clinical Updates in Reproductive Health.

Promoting increased participation of women and other stakeholders in health policy and decision making: Ipas promotes increased participation of women and other stakeholders, including youth, in a wide range of our initiatives including policy and decision making. Some country-level examples include:

• Pakistan:  With Ipas’s advocacy and support, the Sindh Government is adopting the consultative policy model of the Punjab Reproductive Health Technologies Assessment Committee (PHRTAC) and will review policies such as RH commodities to be added to the essential drugs list, provider authorizations for certain procedures, and other RH/FP issues.
• Malawi:  Ipas Malawi serves as Secretariat for the Coalition for the Prevention of Unsafe Abortion (COPUA) through which is has facilitated activities that bring non-traditional voices into the policymaking arena, including young health professions and young people in general, traditional leaders, CBOs, etc.  COPUA engages with parliamentarians and government bodies to highlight and share the perspectives offered by these community stakeholders and will continue to work to link policymakers directly with these public advocates.
• Nigeria:  Ipas worked with partner NGO Women Aid Collective (WACOL) to conduct a Mock Tribunal on sexual violence that involved the participation of nine direct survivors and two family members of victims of sexual violence and provided an interface between Lawmakers & victims of SGBV and increased the demand for a law that allows comprehensive medical and psychological treatment for victims of rape. The Violence Against Persons Prohibition Act was signed into law in June 2015.
• Nigeria:  Ipas Nigeria sensitized and built the capacity of several faith-based organizations, including the Federation for Muslim Women Association of Nigeria (FOMWAN), Catholic Women Organization (CWO), Evangelical Church Win All (ECWA), and Young Women Christian Association (YWCA). The nature of this engagement included sensitizing and mobilizing these (and other) faith based groups and professional organizations to support the Violence Against Persons Prohibition bill during its Public Hearing
• Nigeria:  Ipas Nigeria supported the National President of Medical Women Association of Nigeria to attend meetings on the abducted Girls in Chibok and Borno State Chapter to develop plans to work with Internally Displaced Persons (IDP) and increase access to reproductive health services.
• Sierra Leone:  Ipas partnered with a number of women’s groups to increase debate about policy change related to comprehensive abortion care, including postabortion family planning.  Examples include Women in the Media, which engaged the public through text messaging and phone-in programs to gather public input about the need and process.  Women Response to Ebola in Sierra Leone conducted an assessment with Ipas support of the impact of Ebola on women and girls, looking at access to abortion and family planning services, among other issues.   At more of a community and institutional policy and practice level, Ipas Sierra Leone brought together community leaders involved in running community health facilities with young people from their communities who joined the facilities’ quality improvement team to bring a youth perspective to service improvements.
• Zambia:  Ipas Zambia in collaboration with the Zambian Parliament and the Zambia All Party Parliamentary Group on Population and Development (ZAPPD) held a Youth Parliament which brought together Youth Parliamentarians from all the provinces of the country. The Youth Parliamentarians debated comprehensive abortion care, including postabortion family planning, and then urged the GOZ to scale up interventions to address unsafe abortion, and developed resolutions for further debate by the main Parliament. The resolutions were presented to the ZAPPD and the Minister of Youth and Sport who will lead further debate on these resolutions. These resolutions will also form part of the discussion and development of a communique and work plan with the Members of Parliament in the upcoming Youth-Policy Maker Dialogue. 
• Other: In several countries, we have advocated for removal of barriers to safe abortion care, which includes post-abortion family planning, from laws and policies. Ipas has developed resources for lawyers and policy-makers on removing policy and regulatory barriers to abortion care, specifically addressing adolescents, privacy and confidentiality and who can provide abortion. We launched an online storehouse for lawyers and policymakers on removing legal and policy barriers to abortion.

Increasing support for SRHR, including family planning and the prevention of unsafe abortion, among religious and community leaders: We commissioned a report incorporating a literature review and recommendations on the experiences of Ipas and other organizations in engaging faith-based organizations (FBOs) and religious leaders on sexual and reproductive health issues, particularly abortion. Results from the review and report will inform planning for meetings and country-level work in Asia and Africa that will take place in 2016 and beyond.

Ipas is planning to convene a side meeting on faith, stigma, and abortion at the forthcoming 2015 International Conference on Family Planning. This will include a panel and media event.

In Bangladesh, as part of our community outreach activities, we are engaging with FBLs and other community leaders through stakeholder meetings and community dialogue meetings (CDMs) in two rural districts. In this coming year, Ipas Bangladesh will scale up and intensify local-level FBLs activities through conducting a situation assessment, holding a central level stakeholder meeting of leading Islamic activists and scholars, and engaging local FBLs at girls’ religious schools (private and public madrasas). 

We are planning to hold a regional FBO knowledge sharing meeting in Nairobi in February 2016 of staff from Kenya, Malawi, Ghana, Ethiopia, Nigeria, Sierra Leone, and Zambia to identify current and promising practices for working with faith-based leaders, opportunities for future work, and action planning for individual country teams.

Ipas provided the following updates on progress in achieving its FP2020 commitments:

Removing policy and regulatory barriers which limit access to family planning and increase recourse to unsafe abortion

• Globally: Ipas engaged in advocacy at UN global level processes such as ICPD beyond 2014 and Beijing+20 and more recently in post 2015 debates on SDGs to make sure governments recognize that SRHR, including family planning (FP) and safe abortion, is a central component in the global sustainable development agenda.
• Myanmar:  The basic Health Staff Manual for midlevel providers has been updated with technical content from Ipas on family planning counseling/referral. These documents now standardize the training and provision of services for PAC in the country.
• Pakistan:  Development of IEC materials for young married couples on post-abortion care-family planning (PAC-FP) includes a poster for awareness regarding family planning and safe Uterine Evacuation/PAC, a desk flip chart for providers, and a take-home hand out/brochure for women.
• Ethiopia:  New national standards and guidelines for safe abortion care were finalized and issued by government. The new standards authorize health extension workers (HEW) to offer family planning/abortion care education and referrals, which will extend these services to more rural areas. As part of the National FP Technical Working Group, a national platform for continued advocacy for contraceptive commodity security and increased local government funding for family planning supplies and services, Ipas is working to ensure more coordinated planning and increased availability of IUCD and implants at Ipas-supported facilities.
• Ghana:  Ipas Ghana is providing guidance and recommendations to the ongoing review of the National Reproductive Health Policy to ensure greater access to safe abortion and contraceptive services.
• Zambia: Ipas was part of advocacy by reproductive health partners with the Ministry of Health that has resulted in an allocation of $11 million for family planning commodities in the GOZ fiscal year 2015.

Increasing the frequency and improving the quality and effectiveness of education and behavior change programs on family planning

Ipas has been systematically strengthening the capacity of our staff and partners to improve social and behavior change communication (SBCC) programs related to abortion and contraception.

• In late 2012, Ipas dedicated a full-time senior staff position to SBCC to provide a methodological platform upon which Ipas programming can come together in a more holistic and strategic manner in this area. We subsequently held a mini-learning lab pilot in Bangladesh in 2013 followed by more robust learning labs: one for staff and partners in Latin America (Mexico, Bolivia, Nicaragua), one for staff and partners from our West and South Africa programs (Ghana, Nigeria, South Africa); in 2014 one for Nepal and Bangladesh staff, one in Uganda that included a focus on stigma reduction; in 2015 one for India, Myanmar and new colleagues from Nepal, and one for East Africa programs (Ethiopia, Kenya, Uganda, Malawi, and Zambia). Second generation learning labs were held in 2014 in Nigeria and Bangladesh which were tailored to community partners.
• In learning labs, Ipas meaningfully integrates a human rights-based approach with the commitment to building capacity of staff and partners to get women quality information in a way that is framed from a human rights lens. The process of engagement in Ipas’ SBCC work is in and of itself an opportunity for transforming power dynamics between the seekers of services, the providers and intermediaries. Ipas emphasizes the need to give comprehensive contraception information based on needs of individual women and the range of needs women have that can be met by the method they choose.
• Ipas also launched an internal knowledge sharing platform on SBCC which is accessible to all of Ipas staff globally which includes SBCC literature, guidance and tools. Efforts are also underway to document and evaluate select interventions being implemented in various Ipas countries.

Integrating advocacy, quality improvement and effectiveness efforts with other sexual and reproductive health and rights programs

In every country where Ipas have presence, the organization works with ministries of health and public sector clinical facilities at every level – tertiary, secondary, and primary.  In most cases, abortion and contraception are provided alongside other maternal and child health services.  In addition, in community-based work, Ipas and partners are implementing activities in a broader SRHR framework. 

In July 2016, the Government of Ghana 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: 

Community based nurses are presently used to deliver family planning services in rural areas including Implant services

• A total of approximately 2,100 auxiliary nurses have been trained in FP services, including contraceptive implants in line with the government’s task shifting policy (introduced in 2013) since the beginning of 2015. This has been achieved largely with support from partners (DFID, UNFPA, DANIDA, WAHO). This has led to a significant uptake of implant services.
• Training materials and job aids have been developed for auxiliary nurses across the country.
• Research is presently being conducted on the feasibility of task shifting in IUD insertion and removal.

The government of Ghana is working involve men in family planning in the various communities.

• The use of chiefs and male community leaders in community outreaches on family planning is ongoing. Reproductive health briefings have been carried out for the national houses of chiefs.
• Males who accompany their spouses for service are attended to promptly to encourage their continuous support.
• Workplace services, particularly condom distribution, continue to be supported.

The Government of Ghana is working to improve workforce training and options for task shifting:

• The training of auxiliary nurses is ongoing in all regions. Regional Resource Teams for FP have been established in all regions since 2015 to provide training and supervision. These teams have contributed to more than 2,100 auxiliary nurses being trained between 2015-2016.
• All the Regional Resource Teams have been trained in counselling, and they are rolling out the training of family planning service providers in the regions. All trainings include customer care.
• RHCS Facility survey was conducted in collaboration with UNFPA to assess FP service delivery in health facilities including customer care and client satisfaction. Findings will be used to improve customer care.

Postpartum and post-abortion care services are provided in all facilities that have trained personnel.

• In collaboration with IPAS and MSI comprehensive abortion services have been scaled up from 2 regions to 8 out of the 10 regions since 2015.

The Government of Ghana committed to offering expanded contraceptive choices including a wider range of long acting and permanent methods. Presently the method mix includes condoms, pills, implants, IUD’s/IUS, vasectomy and bilateral tubal ligation.

• Implanon has been introduced with a smooth transition to Implanon NXT in 2015.
• Sino implant has been introduced in the private sector by MSI Ghana.
• Limited quantities of IUS have been re-introduced in a few centers in the country.

The Government of Ghana committed to provide adolescent-friendly services for sexually active young people.

• All facilities are encouraged to offer adolescent friendly services.

Ghana has 218 fully functional adolescent friendly corners and 54 were built in 2015-2016.