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• 959 prestataires formés en Technologie contraceptive  depuis 2015 jusqu’en juin 2016. La formation en TC est une  nouvelle approche basée sur les compétences pour dispenser toutes les méthodes contraceptives en générale et particulièrement la pratique humaniste de pose et de retrait de l’implant et DIU en utilisant les modèles anatomiques adaptés , la prévention des infections ,la gestion des effets secondaires et le counseling.
• Depuis 2015 Jusqu’en mai 2016, 49 003 DMPA ont été administrés au niveau communautaire par les Techniciens de promotion de la santé,
  • 487 646 personnes sensibilisées dont 207 646 femmes par les Agents de santé communautaires.
  • 6066 cycles de pilules et 137 739 préservatifs ont été distribués par les agents de santé communautaire en 2015.
  • 33 Postes secondaires ont été mis en place dans les zones inaccessibles géographiquement et à proximité des Centres de santé confessionnels   qui ne proposent pas de méthodes de contraception modernes pour  augmenter l’accès aux  services de planification familiale.
• Le gouvernement du Burundi s’est engagé à intégrer ces services à d’autres programmes, comme l’immunisation et le VIH :
  • Le renforcement des capacités des prestataires travaillant dans les services de maternité en technologie contraceptive.
  • 60% des femmes opérées des fistules obstétricales adoptent une méthode contraceptive avant la sortie du centre de traitement
• Le gouvernement du Burundi s’est engagé à augmenter les services communautaires en mobilisant la communauté et en fournissant des méthodes de planification familiale, y compris le transfert de tâches en formant des techniciens de promotion de la santé et des agents sanitaires de collectivité (ASC) pour proposer des injections :
  • 338 TPS ont été formé sur l’administration du  DMPA au niveau communautaire et 3940 Agents de santé communautaire ont été formés  sur la distribution à base communautaire des contraceptifs (Pilules et Condoms).
  • Depuis 2015 Jusqu’en mai 2016, 49 003 DMPA ont été administrés au niveau communautaire par les Techniciens de promotion de la santé,
  • 487 646 personnes sensibilisées dont 207 646 femmes par les Agents de santé communautaires.
  • 6066 cycles de pilules et 137 739 préservatifs ont été distribués par les agents de santé communautaire en 2015
• Des émissions radiophoniques sur la SR mettant un accent particulier sur la PF et la SSRAJ ont été récoltées au cours des réunions régionales de coordination, des campagnes sur la PF  et diffusées.
• Les campagnes de sensibilisation des leaders en planification familiale et l’introduction du DMPA dans la distribution à base communautaire des contraceptifs. Au total, plus 2750 leaders proches de la communauté ont été sensibilisés et vont disséminer les messages sur la PF jusqu'au niveau communautaire pour susciter l'adhésion et utilisation des services de PF. Selon les statistiques de service, le taux de prévalence contraceptive est passé de 34,3% en 2014 à 37,4% en 2015
• Elaboration de la stratégie Condom, campagnes zéro grossesse, intégration de la SSRAJ dans les curricula de l’école Fondamentale (8ème) 9ème pour 2015 et révision pour la 7ème en 2016.
• En collaboration avec les opérateurs des Téléphonies mobiles et avec l’appui des partenaires techniques et financiers ,le gouvernement a assuré l’information et la référence aux services de santé sexuelle et  reproductive en faveur des adolescents  et jeunes grâce aux nouvelles technologies de l’informations et de la communication .C’est notamment par l’envoi périodique des SMS média sur la santé .La promotion des groupes virtuels à travers les réseaux sociaux permettant à plus de  10000 Jeunes d’échanger et partager leurs idées et informations sur la  SSRAJ .Exemple : Adv4Youth sur facebook  et Watch up.
• Le Gouvernement vient d’initier, en 2016 et pour une période de 5 ans, un programme conjoint (regroupant 3 ministères clés : santé, éducation, jeunesse et mis en œuvre par 4 partenaires : UNFPA, CARE, CORDAID, RUTGERS en santé sexuelle et reproductive des adolescents et jeunes.
• Le MSPLS vient d’élaborer une stratégie nationale de financement de la santé et est entrain de cheminer vers la mise en place d’une couverture sanitaire universelle à l’horizon 2018, intégrant les différents mécanismes de financement de la santé dont le Financement basé sur la performance. Dans cette perspective, la mise en œuvre du FBP est en train d’être repensée pour s’orienter vers un FBP seconde génération centré sur le renforcement de la qualité des soins et la levée des principaux goulots d’étranglement du système de santé.

• Les programmes de planification familiale (PF) menés au Bénin depuis plus de 20 ans, ont permis à 82,4% des femmes et 90,2 des hommes sexuellement actifs de connaître les méthodes modernes de PF en 2012. Cependant la prévalence contraceptive demeure faible 8% en 2012, et les besoins non satisfaits (BNS) ont augmenté à 33% en 2012 (EDS 2011-2012).
• Pour inverser cette tendance, il a été proposé par l’Institut de Santé de la Reproduction (IRH) de Georgetown University en collaboration  avec CARE International et Plan International,  une nouvelle pratique basée  sur « les réseaux sociaux » pour réduire les BNS comme alternative à l’approche traditionnelle qui consistait à organiser au profit des communautés des séances d’informations et de communication pour le changement de comportements. Cette approche consistait à identifier les principaux réseaux sociaux au sein d’une communauté, ainsi que les détenteurs d’enjeux appelés « influents » afin de susciter des discussions sur les questions de fécondité, de planification familiale, de communication dans le couple et leurs impacts.  Avec des réseaux sociaux fiables déjà présents dans les communautés, la pratique amène les acteurs influents à réfléchir et à agir sur les normes sociales qui entretiennent les BNS en matière de PF. L’implication de la communauté dans  l’identification des groupements et personnes influentes est importante pour la réussite de la pratique. Le staff de mise en œuvre doit être formé sur l’approche de genre. Dans le même sens, l’appui de Heath Communication Capacity Collaborative (HC3) a permis de rendre disponible des manuels de communication sur le changement de comportement en santé sexuelle et reproductive destinés aux offreurs de ces services. Enfin sous le Project TRANFORM PHARE, c’est le développement des approches novatrices pour atteindre un groupe cible marginalisé et améliorer ses besoins en matière SR/PF.  Au Bénin, elle consistera à procéder à la segmentation de la demande de services par les adolescents. Cette initiative conduite par PSI ABMS au Benin permettra d’adapter les solutions pour plus d’efficacités des interventions.
• Le gouvernement a déjà procédé en 2015 à la dissémination du Plan National de Santé Familiale révisé en 2014. Elle a été suivi du processus de révision des protocoles des services de santé familiale : composantes communes prévues pour 2015 et reportée pour 2016. Actuellement les TDR ont déjà été élaborés et le processus de révision est censé être achevé d’ici la fin de l’année 2016.

During the London Summit on Family Planning, the government of Rwanda committed to ensuring the availability of family planning services in each of the 14,841 Rwandan administrative villages (Imidugudu) through delivery by the 45,000 community health workers already in service. In 2014, the government reported that family planning services had been scaled across the country through community health workers.

In 2015-2016, the government of Rwanda reported that family planning services were provided countrywide at community level by Community Health Workers (CHWs) and the following activities were undertaken in support of this commitment:

• Updating and procuring FP tools used at community level, related to the register, supply chain management, reporting, and referral forms for CHWs
• Training new CHWs to overcome the dropout among CHWs and additional CHWs (ASM)
• Refresher training of already trained CHWs
• Training and monitoring of the Supply Chain Management and Waste Management system.

The government of Rwanda engaged in the following activities to expand existing family planning communications programs to raise awareness of family planning choices:

• A communications campaign was organized countrywide to raise awareness of FP choices and provide clear messages on contraceptives, benefits of FP use, and management of side effects. All four provinces and Kigali City were reached and 10 districts out of 30 conducted a special mobilization through community events, dramas, and meetings with community leaders.
• Mass mobilization activities were planned and organized by the Rwanda Health Communication Center (RHCC) with regular talk shows on national and local radios and TVs
• Training of journalists and the creation of a network of journalists on reproductive health and maternal and child health (including family planning)

The Government of Rwanda engaged in the following activities to introduce LAPMS and high-quality integrated family planning services in hospital and health centers:

• Health care providers from hospitals and health centers were trained on the clinical FP focusing on long-acting Methods (Implants and IUDs) for two weeks per session, with one week for theory and exercises on anatomic models and one week for practice on clients
• Physicians and counselors were trained on FP permanent methods: In total 22 district hospitals were trained on Tubal Ligation on local anesthesia (MINILAP) and 10 district hospitals trained on No Scalpel Vasectomy (NSV). The validation of trained staff and the post training follow will continue across the 2016-2017 year.

• En 2015, la proportion d’établissements de santé qui offre le service de planification familiale était de 82% .
  • Au plan communautaire, 779 Agents de Santé Communautaire (ASC) ont été formés à l’offre de service PF dans la communauté. Cependant, l’activité de l’ASC reste limitée aux conseils et à la référence des clients vers les points fixes de prestations. Pour susciter l’engagement constructif des hommes (sexe masculin) à la promotion de l’utilisation des services de SRPF, 47 nouvelles Ecoles de Maris ont été installées.
  • En 2015, 256 localités ont bénéficié de séances de consultations foraines (stratégie mobile) en direction des populations les plus éloignées des établissements de soins. Ces séances ont permis de sensibiliser 90 249 personnes et de fournir la contraception moderne à 24 381 femmes.
• L’étude de 2015 a révélé que 92% des établissements qui offrent le service de PF, proposent trois méthodes et 68% proposent au moins cinq (5) méthodes modernes de contraception.
• A travers le Programme National de la Santé Scolaire et Universitaire, les produits contraceptifs sont gratuitement offerts aux élèves dans des points de prestation dédiés aux élèves ou en stratégie mobile. En milieu scolaire, le ministère de l’éducation nationale a mis en place un projet « zéro grossesse». Des cours de « compétence de vie » sont dispensés à partir de la classe de CE2. Des campagnes d’information à travers les pairs éducateurs et les clubs santé sont réalisées au sein des écoles. Les élèves désireux d’utiliser la contraception moderne (hormonal ou condom) sont orientés vers les points de prestations.
• Des campagnes de sensibilisation baptisées « jeunesse saine » sont menées par le Ministère de la Jeunesse à travers le pays. Des produits contraceptifs, surtout les condoms, sont distribués au cours de ces campagnes.
• Intégration PF et VIH : L’intégration de l’offre de service de PF et le VIH est effective. En effet, 75% des points de prestation de PF proposent également le dépistage VIH.

WomanCare Global and PSI provided the following updates on progress in achieving its FP2020 commitments:

Expanding access to an array of reproductive health products and managing large-scale distribution: Under the USAID-funded, Expanding Effective Contraceptive Options (EECO) project, WCG and PSI are working together to introduce new methods of contraception. Large-scale pilots in Zambia, Malawi, Madagascar and India will provide women with greater choice to prevent unplanned pregnancy. New methods supported under EECO include four new product lines: a contraceptive gel; new barrier methods; a hormonal intrauterine system (IUS) and intra-vaginal rings (IVR).  

• Globally, 110 million women cite method-related reasons for non-use of contraception. Each product in the EECO project possesses important benefits that address one or more method related reasons for non-use, e.g., they are non-hormonal, appropriate for breastfeeding women, discreet. Additionally, because most are woman-initiated, these products have the potential to overcome access barriers related to the limited number providers and/or provider or partner bias against contraceptives.
• As of June 2015, the project has registered the PATH-developed SILCS Diaphragm and Woman’s Condom in Malawi and Zambia. A background research review was performed for all EECO products, and formative and market research were completed in Malawi and Zambia for the SILCS Diaphragm and the Woman’s Condom. Marketing plans and country-specific branding and packaging were developed for both products and countries.  Distribution and promotion of the Woman’s Condom will launch in Malawi and Zambia in Q3/Q4 2015.  Distribution and promotion of the SILCS Diaphragm will not take place until 2016.
• In April 2015, WCG completed a regulatory assessment for the SILCS Diaphragm and Amphora Contraceptive Gel in India. PSI will initiate market research in India in Q4 2015 and WCG regulatory activities are expected to commence in Q2 2016, pending U.S. FDA approval of Amphora Contraceptive Gel.
• Under the EECO project, WCG is also working closely with the Population Council and USAID to advance regulatory work with the progesterone contraceptive vaginal ring developed by the Population Council and currently on the market in eight Latin American countries.

Increasing the usage of long-acting, reversible contraceptives: In Q3 2015, under the USAID-funded Expanding Effective Contraceptive Options project, WCG and PSI will begin planning for the pilot introduction of Medecine360/Actavis’ levonorgestrel intrauterine system (LNG-IUS), Liletta.  WCG and PSI will commence regulatory activities for the product in Malawi, Zambia and Madagascar before the close of 2015.  Registration will take between six and twelve months, depending on the country. 

Monitoring the quality of products and evaluating programs: Under the USAID-funded, Expanding Effective Contraceptive Options project, WCG is responsible for quality assurance/quality control for each of the project’s focus products, including: a contraceptive gel; new barrier methods; a hormonal intrauterine system (IUS) and intra-vaginal rings (IVR).  

• In 2014, WCG and USAID established the QA requirements necessary for the first set of products to be launched under EECO. As part of this agreement, WCG performed an on-site cGMP compliance audit with three product manufacturers, established an agreement with an ISO-certified, independent test laboratory for pre-acceptance testing of all lots procured under EECO and reviewed evidence of compliance with manufacturer specifications.
• In addition, as launch of the first product (the Woman’s Condom) approaches, WCG and PSI are working to establish agreements pertaining to pharmacovigilance, including monitoring, managing and reporting adverse events and complications.

Providing training and other forms of support: Under the Expanding Effective Contraceptive Options (EECO) project, PSI and WCG will commence medical detailer training and provider/retailer orientation for the first product launch (the Woman’s Condom) in Malawi and Zambia in Q3/Q4 2015. Additional product training will take place in 2016 and 2017 in Malawi, Zambia, Madagascar and India prior to the launch of the other EECO products (e.g. the SILCS Diaphragm, Amphora Contraceptive Gel and the LNG-IUS). 

Utilizing existing wholesale and retail distribution infrastructure to make products widely available, supplemented by outreach events and the engagement of community-based health workers: As of June 2015, under the USAID-funded Expanding Effective Contraceptive Options (EECO) project, WCG and PSI have registered the PATH-developed SILCS Diaphragm and Woman’s Condom in Malawi and Zambia. The Woman’s Condom will launch in 2015 via private sector outlets (pharmacies, clinics and select fast moving goods outlets) in Malawi and Zambia.  In both countries, PSI and WCG will promote the EECO products via interpersonal communication agents acting at the community level and via medical detailers who will target providers and retailers.

Focusing on an integrated pilot effort in four markets in Africa: Under the USAID-funded Expanding Effective Contraceptive Options (EECO) project, WCG and PSI are working together to introduce new contraceptive methods via integrated pilots in three African countries—Malawi, Zambia and Madagascar—as well as in India.

In August 2016, the Government of Kenya 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 voucher system, originally committed to as part of the Government of Kenya’s 2012 commitment to Family Planning 2020, has been replaced by the free maternal health care which is provided in all public health facilities.
• No new youth empowerment centres have been established, and information and communications technology services have been scaled up in these empowerment centres; however, provision of reproductive health services is still quite weak due to the lack of youth-friendly services in these centers.
• With the change in governance structure, devolution has increased participation of local communities in decisions at the local level. Health services are devolved and county health managers are directly involved in formulating their priorities. Public participation is ensured through representation by the members of the county assemblies as well as in public hearings during budgeting process. The national government continued to provide resources to health facilities through the Health Sector Services Fund which is managed by local committees.

Advocacy continues to encourage more women to use family planning as well as to dispel myths and misconceptions. This was done through the media, peer groups, mobilization for out-reach services and by observance of global days e.g. the World Contraception Day.

• Contraceptive services are part of the essential service package of provinces and task shifting suggested in the HSS and costed operational plans do take care of the inclusion of these services in various ways.

• With USAID support, Pakistan has received more than $147 million in the form of soft and hardware support around supply chain and health commodities; as well as contraceptive commodities alone worth $52 million in the last three years. The USAID has now pledged financial support to the tune of $44 million for the years 2013-14, thereby enabling Pakistan to meet 50 percent of the national requirement. The Planning and Development Division too has allocated Rs2.8 billion ($30 million) for the procurement of contraceptives till June 2015.

• Local supply chain managers have been trained and a web based program has been rolled out to all 143 districts, allowing for much improved data visibility into contraceptive use at the lower levels of the health system.

• The government of Sindh province is working with Pop Council on developing a training program for lady health workers; other provinces are exploring.

• There has not been progress made on working more intensively with religious and community leaders to promote benefits of birth spacing.

• Population Council has recently carried out research on involvement of men in family planning decisions. The study was carried out in Punjab and it was found that men in Punjab are showing greater concern than hitherto about the size of their families and spacing between children.

• The country has been running family planning initiatives and interventions for years, but the fact is that there is still insufficient societal knowledge about the subject.

• 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.