Scaling up PPIUD services across India while ensuring quality of services. Bulbul Sood, Jhpiego/India

Transcription

1 Scaling up PPIUD services across India while ensuring quality of services Bulbul Sood, Jhpiego/India

2 Why Postpartum Family Planning is Crucial for Family Planning? Huge unmet need (73% in first 3 months) JSY Beneficiaries: 2005 to 2014 Birth-to-birth interval (57.6 % of births had birth interval of less than 36 months) Source: SRS 2011 High vulnerability to unintended pregnancy (Due to low awareness) JSY was bringing women to facilities - are more receptive to accept FP methods Source: HMIS, MOHFW, GoI

3 Rapid Expansion of PPFP/PPIUCD Services: Impact at Scale ~ 450,000 PPIUCDs inserted States >20 Training Sites 75 Service Providers Doctors 3121 LAD Nurses 6161 LAD Service Delivery Sites Medical Colleges 44 District Hospitals 300 * till March-2015 Sub District Facilities 673

4 Phased Expansion of PPFP/PPIUCD Services

5 PPIUCD Experience in India Total Reported PPIUCD Insertions Feb-10 to Apr-15 N = 487, Intracesarean 21% Postpartum (within 48 hrs) 22% Postplacental (within 10 min) 57% Data as on 01/06/2015 Source: PPIUCD Monthly reports

6 Number of Facilities Number of PPIUCD Insertions Trend of Number of Facilities Reporting PPIUCD Insertion Service Impact at Scale * Year 250, , , ,000 50,000 0 *April

7 PPIUCD Acceptors Proportion of PPIUCD Acceptors Among Institutional Deliveries (Jan-11 to Apr-15) 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% Total deliverie s: 51,52,47 9 Jan Mar May Jul Sep Nov Jan Mar May Jul Sep Nov Jan Mar May Jul Sep Nov Jan Mar May Jul Sep Nov Jan Mar Month

8 % PPIUCD acceptors Trend of PPIUCD Acceptors among Institutional Deliveries 6-HFS (Nov 14 to Apr 15) Bihar Chhattisgarh Jharkhand Madhya Pradesh Rajasthan UP 40% 35% 30% 25% 20% 15% 10% 5% 0% Data as on 01/06/2015 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 Month Total deliveries=10,08,689

9 Follow-up Findings 10.0% 9.0% 8.0% (Based on Jan 11 Apr 15 Data) N=262, % 6.0% 5.8% 5.0% 4.0% 3.0% 2.0% 1.0% 3.1% 2.1% 0.0% Data as on 01/06/2015 Expulsion Infection Removal Source: PPIUCD Monthly reports

10 Strategies for Successful Scale-up Aggressive, continued and inclusive advocacy Decentralizing institutional training capacity Standardization of processes (SOPs) for each program component Implementation through the system Using NRHM Funds System Based Approach Policy shifts FP as MNCH intervention Focus on spacing Task shifting Government led initiative Insertion: Drs to SNs Dedicated counsellors Contextualization of program strategies

11 Investing in Quality during Scale-up Focus on PPFP Competency based training Use of customized clinical standards Emphasis on counselling - hiring of dedicated counsellors Strong follow-up systems, including robust data collection systems Generation of local evidence through studies Structured supportive supervision visits

12 Annual Explosion Rates Expulsion rates have remained at acceptable level even after rapid scale-up and withdrawal of external TA from all but 6 states of India 4.41% 2.22% 1.99% 3.35% 3.23% 3.32% 2010 (n=521) 2011 (n=10,056) 2012 (n=25,564) 2013 (n=46,184) 2014 (n=1,28,916) 2015 (n=52,146) * Till Apr-15

13 Millions $ Buy-in of All Stakeholders for Successful Scale-up and Sustainability (PPFP) USAID BMGF Norway Packard Foundation Govt of India BMGF TSU LAD 25 **GOI funding converted from INR to US $ as per current exchange rate i:e INR per US $ ($3,370,360) ($4,428,112) ($8,134,230) ($11,711,962) ($19,326, 771)

14 THANK YOU