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PPIUD Newsletter Issue No. 5
July-September 2016

 
Dear Friends and Colleagues,
 
In this edition of the PPIUD newsletter, we showcase the incredible work being done by our teams who are this year's Innovation in Institutionalising PPIUD award winners. We also look to Kenya and the integral role that the facility nurses are playing in the provision of PPIUD. 


Country Focus
  • Doctor-Nurse Symbiosis in the Implementation of the PPIUD Initiative in Kenya
Innovation in Institutionalisation of PPIUD Award
  • An Integrated Success
  • Using Technology to Aid Provision
The Latest Stats

Resources

Country Focus
 
Doctor-Nurse Symbiosis in the Implementation of the PPIUD Initiative in Kenya

The PPIUD initiative is being implemented in six hospitals in Kenya, and the national team is headed by an obstetrician gynaecologist and a nurse/midwife (supported by a project manager, bookkeeper and data clerk). This structure is replicated in the facilities with the facility coordinators being obstetrician gynaecologists and the deputy facility coordinators being senior nurses in the maternity departments.
 
This leadership strategy is key in creating and maintaining a symbiotic working relationship between the providers in each facility, where there is often a large number of nurse/midwives. The experience in Kenya has been positive and the doctors and nurses work harmoniously, evident by the positive reception towards the initiative among healthcare providers across the six facilities.

Thika Level 5 hospital has a fantastic PPIUD champion, Nurse Alice Karuri, who has inserted 89 PPIUDs since the start of the initiative. At Thika, when a woman is delivering by caesarean section, the doctor performs the delivery and then hands over to the nurse who has counselled the patient on PPIUD who performs the insertion. The doctor then finishes the procedure.  

Through working collaboratively, this leadership strategy has empowered healthcare providers from all cadres to provide comprehensive healthcare to all clients in the Maternity units. It has also contributed to the continued progress and success of the PPIUD initiative in Kenya.
The Kenya Leadership Team
 

We are very happy to present the winners of our annual Innovation in Institutionalisation of PPIUD Award. This award is presented to groups or individuals who have shown evidence of innovation in their work leading to effective provision of services and contributing to the institutionalisation of PPIUD.

We will draw upon the good practice of both the winners and all the nominees for the award to ensure the initiative goes from strength to strength.


An Integrated Success
Government Medical College and New Civil Hospital, Surat, India

 
The team at Surat has worked hard to ensure that women are able to easily access their services. They have a walk-in single point delivery of care for ante-natal women which includes a separate registration window, provision of drug dispensing, blood sample drawing, investigation report provision and antenatal ultrasonography. This means that the women do not have to move to other parts of the hospital for these services.
 
Effective Training and Diffusion

Surat ensures that all health care providers involved in conducting deliveries and performing caesarean sections including obstetricians, medical officers, post-graduate and undergraduate students are trained in PPIUD insertion and counselling resulting in PPIUD services being available to the client on demand 24/7.
 
This training is on-going to cover all new entrants into the department. Regular sensitisation of nursing staff, technicians and housekeeping staff about PPIUD is conducted. PPIUD provision has been institutionalised further by being incorporated into the undergraduate teaching curriculum and through state level training provided by the department at Surat.
 
PPFP is integrated into the antenatal visits and conducted by doctors as well as the RMNCH+A counsellors and the specifically recruited FIGO-FOGSI counsellors. The FIGO-FOGSI counsellors are integrated into the existing counselling system within the hospital which enables them to focus on counselling new antenatal cases and conducting six week PPIUD follow-up both in the OPD and by telephone. They use customised flipcharts in the local languages to ensure full comprehension.
 
Surat ensures that all women are informed about PPIUD through the use of audio-visual aids in the out-patient area, outside antenatal, intranatal and postnatal wards, post-partum theatres, featuring well known film industry personalities like Mr. Amitabh Bachhan .
 
Furthermore, uptake of PPIUD has increased due to positive ‘word of mouth’ from satisfied Surat PPIUD clients.
 
Supportive Management

The management team is indispensable to Surat’s success. They conduct fortnightly meetings during which details of acceptors, non-acceptors and early removals are discussed and addressed. Counsellors and nurse-midwifes are encouraged to improve counselling services and priority areas.
 
In addition, monthly review meetings related to Maternal and Child Health Care are conducted by the Medical Superintendent of the Hospital during which all concerned staff review their performance and discuss other issues including client feedback.
 
The dedicated team at Surat have learned that success in Post-partum Family Planning comes if they remain client centric and respect the women’s individuality and rights, utilise the Plan-Do-Check-Act cycle of audit and ensure that all healthcare workers have support for and feel part of the initiative.
Using celebrities such as Mr. Amitabh Bachan in the counselling videos has helped to promote PPIUD.


Using Technology to Aid Provision
Rift Valley Provincial General Hospital, Nakuru, Kenya


The team in Nakuru led by Dr. J. Ogindo and Sarah Mbote has come up with a unique organisational structure. The trained staff have formed semi-autonomous teams focusing on specific service delivery points consisting of the counselling team, maternity team, ANC, PNC team and theatre team. In the absence of any team member in the clinical areas, the ones who are available cover the service delivery points to ensure that the services continue uninterrupted.

Each semi-autonomous team have formed virtual groups using whatsapp which enable them to conduct regular consultations and provide updates on the progress of the project at Nakuru. Through these groups, they have also been able to identify issues such as providers not inserting and offer encouragement and support to one another.

This model has been found to be effective as it does not demand additional resources and, with proper coordination by the facility coordinator and deputy facility coordinator, can be easily replicated in other facilities.

The Latest Stats

These statistics are representative of the first 6 months of 2016
Bangladesh
56% of women counselled on PPIUD
1,489 PPIUD insertions achieved
265 doctors trained in PPIUD insertion and family planning counselling

India
89% of women counselled on PPIUD
3,880 PPIUD insertions achieved
168 doctors trained in PPIUD insertion and family planning counselling

Kenya
24% of women counselled on PPIUD
293 PPIUD insertions achieved
370 doctors trained in PPIUD insertion and family planning counselling
Nepal
26% of women counselled on PPIUD
418 PPIUD insertions achieved
55 doctors trained in PPIUD insertion and family planning counselling
588 female community health volunteers trained in family planning counselling

Sri Lanka
38% of women counselled on PPIUD
1,765 PPIUD insertions achieved
93 doctors trained in PPIUD insertion and family planning counselling
296 community midwives trained in family planning counselling

Tanzania*
5%
of women counselled on PPIUD
121 PPIUD insertions achieved
86 Doctors trained in PPIUD insertion and family planning counselling
116 providers trained in family planning counselling
*Implementation in Tanzania began in 3 of 6 facilities in March 2016 due to the research component. The remaining facilities began implementation in September and so are not including in these statistics. 
 
SODJE, J. D. K. et al (2016) Feasibility, acceptability, and uptake of postpartum intrauterine contraceptive devices in southern Nigeria. Available from: http://dx.doi.org/10.1016/j.ijgo.2016.05.005 [Accessed: 27th September 2016]  

A prospective analytical cohort study of PPIUD uptake in an area with existing low contraceptive utilization in Nigeria. The study found that PPIUD was safe and acceptable to Nigerian women. Increasing the education of patients
and training of healthcare providers is recommended to scale-up PPIUD use in Nigeria.



RAHMAN, M. et al (2016) The Mayer Hashi Large-Scale Program to Increase Use of Long-Acting Reversible Contraceptives and Permanent Methods in Bangladesh: Explaining the Disappointing Results. An Outcome and Process Evaluation. Available from: http://www.ghspjournal.org/content/4/Supplement_2/S122.full [Accessed: 27th September 2016]

The Mayer Hashi program resulted in a modest increase in use of long-acting reversible contraceptives and permanent methods in Bangladesh, but less of an increase than in comparison nonprogram districts, which appears to have been the result of weaknesses in the health system environment in the program districts. Addressing system issues to support providers beyond training might have led to better results.


PLEAH, T. (2016) Increasing Use of Postpartum Family Planning and the Postpartum IUD: Early Experiences in West and Central Africa. Available from: http://www.ghspjournal.org/content/4/Supplement_2/S140.full [Accessed: 27th September 2016]

Competency-based training in postpartum family planning and postpartum IUD (PPIUD) service delivery of antenatal, maternity, and postnatal care providers from 5 francophone African countries generated an enthusiastic response from the providers and led to government and donor support for expansion of the approach. More than 2,000 women chose and received the PPIUD between 2014 and 2015. This model of South–South cooperation, when coupled with demand promotion, supportive supervision, and reliable collection of service outcome data, can help to expand PPIUD services in other regions as well.

Do you have something you would like to share with the PPIUD team? Just email ppiud@figo.org with additions to the 'updates', 'peer-learning', 'research', 'events' or 'resources' sections.
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