• In addition to its work on the introduction of Sino-implant (II) and the development of longer-acting injectable contraception, FHI 360 is working with the Bill & Melinda Gates Foundation to pursue a pipeline of new contraceptive technologies for support under the Contraceptive Technology Innovation Initiative. This initiative also includes advocacy for innovative regulatory approaches to reduce the time it takes for new products to reach women and development of a new online clearinghouse that will expand global access to resources on contraceptive research, development and introduction.

• With USAID support, FHI 360 is also working to develop a biodegradable contraceptive implant.

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

Jhpiego has contributed to advocacy for task-shifting to improve access to long-acting family planning methods by contributing to the global evidence in support of lower level health cadres to provide contraceptive implants.   

• As part of the Targeted States High Impact Project (TSHIP) funded by the United States Agency for International Development (USAID), Jhpiego and the State Primary Health Care Development Agency (SPHCDA) implemented a pilot intervention to increase access and utilization of long-acting reversible contraception (LARC) services among rural community members in Nigeria’s Bauchi and Sokoto states. The intervention focused on strengthening the capacity of Community Health Extension Workers (CHEWs) to insert implants and document the services provided through training and supportive supervision. The intervention also sought to improve commodity security and logistics systems, create demand, improve access to quality implant services, and strengthen the referral system. Evaluations of this intervention documented high quality of service provision and statistically significant increases in counselling skills for all methods by trained CHEWs. With proper training and continuous supportive supervision, Jhpiego’s work has demonstrated that CHEWs in Nigeria are able to administer contraceptive implants and provide adequate counseling for various contraceptive methods. A journal article highlighting the findings from this intervention has been accepted in the Global Health: Science and Practice Journal and will be published in an upcoming issue.
• Through the Maternal and Child Health Integrated Program (MCHIP) and Maternal and Child Survival Program (MCSP) funded by USAID, Jhpiego has supported the Ministry of Health of Mali to demonstrate the feasibility of matrones (auxiliary midwives) inserting contraceptive implants at rural community health centers. Evaluated through observation checklists for skills quality, the study demonstrated that matrones can insert implants satisfactorily up to one year after training. This study provides supporting evidence that matrones can be a key link to facilitate access of LARC services, especially for rural populations. The study results have been presented at a national event presenting best practices in maternal, newborn, and child health in 2014.

Jhpiego has continued to support with training matrons or auxiliary midwives to provide implants in these settings.

• As part of the TSHIP program in Nigeria, Jhpiego in partnership with SPHCDA trained 166 CHEWs in Sokoto and Bauchi states from September to December, 2013. Supportive supervision was conducted for nearly all trainees (95%; n=145). At the endline assessment six months later, a total of 3588 implants were inserted at 151 health facilities, and over 10,088 couple years of protection (CYP) were generated through implant insertion over a period of six months. In addition, the average number of family planning visits during the six months prior to the survey increased from 23 (n=157) to 28 (n=147) clients per month.
• In Mali, between August 2012 and February 2014, a total of 173 matrones across 160 sites in Diema, Kita, Sikasso districts were trained to insert implants. Between August 2013 and May 2015, 2362 clients received implants and 5020 clients were counseled and educated about Healthy Timing and Spacing of Pregnancy (HTSP).
• Of note, all of these lower level health workers were trained in implant insertion but not removals. Removals in both of these countries are referred to higher level health cadres.

Jhpiego’s initial commitment of $200,000 at the London Summit on Family Planning in July 2012 has turned into more than $7 million to increase the availability and utilization of postpartum family planning (PPFP) and postpartum intrauterine devices (PPIUDs) in Burkina Faso. In collaboration with Burkina Faso’s Ministry of Health, and after a review of the government’s revised strategy on FP, Jhpiego identified PPIUD services as a key entry point for increasing contraceptive use, along with integrating maternal health care and FP services. Read more about this financial update here. 

• The five-year strategic plan for reproductive health has been developed through a consultative process and launched in the second week of July [2014]. Regional disparities and inequalities will be addressed through:
  • Review of policies on deployment and retention of service providers for hard-to-reach areas
  • Ensure reproductive health commodity security as Myanmar is supported by Global RHCS
  • Develop, print and disseminate [Reproductive Health/Birth Spacing] IEC materials for diverse populations and in different dialects, [at varying] literacy levels
  • To conduct outreach activities using specific approaches for hard-to-reach and marginalized population sub-groups

• A National Implementation Plan to meet commitments to FP2020 which will complement the strategic plan for reproductive health is being developed through a consultative process with NGOs and UN agencies [(These NGOs also provide services in the private sector)]. The goal of the implementation plan to meet FP2020 commitments is to contribute to:
  • improved reproductive health of women, men, and adolescents and
  • reduce maternal and infant mortality and morbidity through scaling up the provision of quality integrated [Birth Spacing] services.

• In collaboration with UNFPA, Country Office training is planned in 2014-2015 for:
  1. Proper warehousing, distribution, inventory control system
  2. Supply chain management system
  3. Projection of required contraceptive commodities – by each township (from 2016 - 2017)

• A Facility Assessment for Reproductive Health Commodities and Services has been conducted nationwide with UNFPA support in 2014; the draft report is expected at the end of August 2014. These assessments will be conducted annually and will assist in the monitoring of activities to strengthen quality of care.

• The Logistics Management Information System (LMIS) is being set up with assistance from UNFPA Country Office. Completed activities in 2014 include:
  1. Training on SOP for RHLMIS: Master trainers, multiplier training
  2. Pilot in 12 townships in four states/regions
  3. Planned activities 2014-2015
  4. Continue training to cover all townships in four states/regions
  5. Training of central and state/regional master trainers on forecasting, procurement
  6. Multiplier training to basic health staff on strengthening of supply chain management systems in pilot 12 townships
  7. Web-based LMIS

• Training on long acting methods, namely IUD has been accomplished for the state/regional obstetricians and gynecologists and will be carried out for township medical officers in a phased manner. In collaboration with PSI, one of the INGOs working for family planning, trainings on Intra dermal Implant insertion were conducted for specialists ObGy in a PPP (Private Public Partnership) approach. To create demand, the pamphlet on IUD for clients has been updated and a pamphlet on postpartum family planning and implants will be developed. Training on interpersonal communication and counseling for doctors, nurses and midwives in the public sector will include these methods.

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 program and service delivery commitment:

• In an effort to implementing a monitoring system to strengthen quality of care, the government of Myanmar agreed to—during the discussion for nationwide Implant training—the Lead FP Working Committee agreed to use a post training assessment form and quality control checklist with technical support from JHPIEGO and PSI as part of monitoring effectiveness. An assessment study on implant removal will also be conducted by MOHS and JHPIEGO to highlight the quality of care in service provision.
• Myanmar is working continuously on strengthening its logistics management information system to ensure reproductive health commodity security. Since 2014, RH Commodity Logistic System was being implemented in 12 townships. In 2016, with technical support from JSI and financial support from UNFPA, 55 townships under Shan (South) and Mandalay regions are having the LMIS expanded. To cover all other State/ Region, The funding gap to cover all other states and regions still exists and is under the negotiation of the MOHS with 3MDG fund.
• Nationwide Implant Training will be provided to health care providers in public in 2016 through a public-private partnership approach. The Total Market Approach for FP is being conducted by PATH in collaboration with MOHS and UNFPA. Introduction of Sayana Press in Myanmar is still going on in collaboration with UNFPA and other private partners. UNFPA will be supplying 0.8 million doses of Sayana Press in 2016 and, with the MOH’s lead to get pre-registration waiver, Sayana Press initiation program begin in the second quarter of 2016. This will increase additional users of modern method of contraception.
• To improve the monitoring system of family planning, the capacity building of M&E officers was carried out with the support of the Track 20 team and Consensus Building Workshops were conducted since last year to get consensus among stakeholders and discuss data utilization, data monitoring, private sector involvement, and other monitoring issues.

• Village Health Volunteers and Auxiliary Midwives provide information to the community on contraceptives and where supplies can be obtained. In the updated guideline for Auxiliary Midwives, they will be dispensing oral contraceptive pills and condoms under the supervision of the Midwives.

• Future plans include PPIUD insertion by midwives under the supervision of the Township Medical Officer in townships that have received training on postpartum family planning and supplies and equipment are in place.

• The Government of Myanmar committed to expanding the forum of family planning under the umbrella of the Health Sector Coordinating Committee and creating a Lead Working Group on Family Planning as a branch of the Reproductive, Maternal Newborn and Child Health Technical and Strategy Group. It was formed and the 1st meeting was held on 31st July 2014.

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.

• From October 2012 to July 2014, FHI 360 has contributed $783,000 of its own resources in support of the development and introduction of new contraceptive technologies. This includes support for work towards the introduction of Sino-implant (II) and the development of longer-acting injectable contraception.

• The implementation of the community strategy for the dispensation of contraceptive products has been initiated. Approximately 260 community health workers from six hospital districts have undergone training. This is a new strategy which has been integrated in the new National Budget Action Plan for family planning for the years 2015-2020. In order to raise awareness for the use of family planning) services, 18 Ecoles des Maris (EdM) [Schools for Husbands] were opened, with an average number of 10 model husbands per school.

• The following family planning methods are offered in Cote d'Ivoire:
  • Oral contraception
  • Emergency oral contraception
  • Intrauterine device
  • Implant
  • Injectable contraception
  • Condom (male and female)
  • Sterilization*

• At least three methods of family planning are offered at 81.4 percent of the healthcare institutions (ENSEA, 2014. p.34) versus 36 percent in 2010 (INS, SONU survey, 2010. p.76)

*There is no precise legislation on sterilization. However, a few sterilization cases were notified by the 2012 Demographic and Health Survey and during the development of the first follow-up report of the FP2020 undertaking.

• The offer of family planning services has been extended to specialized healthcare centers for teenage students through the Programme National de la Santé de la Scolaire et Universitaire [National Health Program in Schools and Universities], Direction de la Mutualité et des OEuvres Sociales (DMOS) [Division of Reciprocity and Social Work] of the Ministry of National Education. In each of the 20 hospital areas, the Ministry of Youth opened a listening center for young people, focused on sexual and reproductive health.

• Integration of family planning in HIV services has proved effective. Emergency contraception and ARV prophylaxis in cases of rape are in their pilot stage in one hospital area. In HIV services, contraception is proposed to women and men in order to avoid pregnancies but also for positive prevention purposes. In family planning services, the proposal of HIV screening tests is systematic. The level of integration of the PF and HIV activities will be evaluated by way of a national survey.

Source:

1. Government of Côte d'Ivoire
2. Ecole Nationale Supérieure de statistiques et d’Economie Appliquée (ENSEA) [National School of Statistics and Applied Economics] / Abidjan/RCI (2014) National survey on reproductive health services and products. Provisional final report. Abidjan. ENSEA. p.23
3. INS, SONU survey, 2010. p.76

In August 2015, the Government of Côte d'Ivoire shared an update on progress in achieving its policy and political, financial and program and service delivery commitments to FP2020.

• At a community level, 147 Community Health Workers have been trained to distribute short-acting contraceptives in the community, 10 new Ecoles Des Maris [Schools for Husbands] have been set up to educate families about using maternity services and the involvement of men in reproductive health, 25 national trainers have been trained in the strategy of community dialogue and 20 religious leaders have participated in a community awareness campaign through use of local radio stations. In schools, 779 peer educators have been trained in life skills.
• In 2014, 217 mobile consultation sessions for people living the furthest away from health facilities enabled 203,180 women to be provided with short- and long-term hormonal contraceptive products.
• The following family planning methods are available in Ivory Coast: oral contraception, emergency oral contraception, intrauterine device, implant, injectable contraception, condom (male and female), and sterilization.
• The 2014 survey revealed that 71% of healthcare establishments offer three different types of modern contraceptives versus 69.9% in 2013. On average, 50.2% of these establishments offer at least five (5) modern methods of contraception, versus 44.7% in 2013. Source: ENSEA/Abidjan/RCI. 2015
• Through the National School and University Health Program, contraceptives are freely available to students. The service provision is carried out at dedicated delivery points for students or via a mobile strategy.
• Awareness campaigns known as "healthy youth" campaigns are conducted by the Ministry of Youth across the country. Contraceptives, especially condoms, are distributed during these campaigns.
• The government reports that the integration of FP into HIV services is effective.  Indicators on the offer of contraceptives as part of HIV services have been integrated into the national dictionary of routine indicators.

• 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.