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page 1
Are public health facilities ready to provide IUCD
services?
A survey of public facilities in Uganda
Authors: R. Twesigye, Peter Buyungo and H. KaulaResearch Department
Uganda Poor Maternal Health Numbers
page 2
Why Family planning in Uganda?
6.2 - Total Fertility Rate
– Third highest in the world
438 deaths per 100,000 (MMR)
- Way off 2015 UN MDG target of 131
Source: UDHS, 2011
6.2
438
Contraceptive use in Uganda
Spacing and limiting births reduces the risk of maternal mortality
Uganda Family planning unmet need is at 34%
Total demand for family planning is at 64.3%64.3%
34%
Use of modern FP methods among married women in Uganda, UDHS 2011
Overall
IUD
Implants
Pills
Injectables
0 5 10 15 20 25 30
26
0.5
2.7
2.9
14.1
CPR method mix is currently
dominated by short term methods
Use of Modern FP methods among women (15-19yrs) in Program area, Uganda (n=2040, 1510),
2012-2014
Currently use IUDs Currently use Implants Currently use Injectables0
5
10
15
20
25
30
35
40
45
1.24.5
20.5
2.9
16.3
412012 2014
Rationale
To reduce the high TFR and MMR
improved access to a wide range of modern FP methods
including long acting and reversible contraceptive (LARCs) like IUCDs that are most
effective
Public health facilities (PHFs) are a key source of modern contraception
47% of current users
One of the tenets of good FP is to ensure ‘choice’ – any source must be ready to
offer this choice
Why Public Health facilities?
Research conducted
• A study was conducted in 2013 to establish the level of readiness of PHFs to provide IUCDs services so as to guide interventions to improve their capacity
• Study Specifically aimed at assessing– Availability of IUCDs – Availability of a provider trained to insert IUCDs– Availability of functioning equipment for inserting IUCDs– Availability of required supplies for IUCD insertion in PHFs
Methodology
• Sampling: • 30 districts representative of all regions • All public health facilities eligible to provide IUCDs (i.e level
III and above) • 356 facilities were surveyed
• Respondents: in – charges of family planning sections • Methods: Face to face structured interviews and observations• Fieldwork: November 2013
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Outlet characteristics
Hospital5% Health Centre IV
13%
Health Centre III83%
Type of facility (%) n=356
Family planning services available (%) n=356
Male condoms
Progestin only injectables
Progestin only pills
Implant
IUD
Combined injectable
Cycle beads
Male sterilization
Female sterilization
78.1
75
50.4
48
34.8
26.1
4.8
3.9
3.7
IUDs in stock
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Hosp / HCIV N=62 (%) HCIII N=294 (%) All N=356 (%)
67.7
27.934.8
% facilities with IUDs in stock*
Staff trained
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Hosp / HCIV N=62 (%) HCIII N=294 (%) All N=356 (%)
83.9
60.9 64.9
% of facilities with at least one staff trained to insert IUDs*
%
Equipment
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Hosp / HCIV N=62 (%) HCIII N=294 (%) All N=356 (%)
35.5
6.511.5
% of facilities with all required equipment to insert IUDs (func-tional)*
%
Instrument tray and trolley; Examination couch; Tenaculum / Vulselum; Uetrine sound; Long scissors for cutting IUCD string; Sponge holding forceps; Kidney dish; Gallipots; Autoclave / sterilizer; Speculum sims cusco
Supplies
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Hosp / HCIV N=62 (%) HCIII N=294 (%) All N=356 (%)0
10
20
30
40
50
60
70
80
90
100
58.152.7 53.7
% of facilities with all required supplies to insert IUDs
Facility type
%
Jik / chlorine for decontamination; Surgical gloves; Disposable gloves; cotton; Gauze; Surgical blades; Plaster (adhesive elastoplasts); Color coded waste bins; Safety box for disposal of sharps
Overall service readiness
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Hosp / HCIV N=62 (%) HCIII N=294 (%) All N=356 (%)
16.1
0.7 3.4
% of public facilities reporting all 4 components of IUD pro-vision at time of survey
Trained Equipment Supplies IUDs
Conclusions• Opportunity exists – since two thirds of facilities have
trained providers
• Significant gaps are evident at HC III level hence a need to focus interventions to this level.
• Components that require improvement are: –Equipment, stocks and supplies
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Recommendations
• A total market approach harnessing public and private sectors resources will be key in covering unmet need for FP in Uganda
• Non government agencies will be required to support PHFs;
–to acquire complete sets of equipment; –to strengthen their forecasting and procurement systems so
as to ensure reduced cases of stock out of essential supplies for provision of IUDs
Acknowledgements
• Ministry of Health • District Health Officers in the study districts
• Health Facility – In – charges• Study respondents
• Makerere University, Kampala Department for Social Work and Social Administration (SWSA)
• MUREC & UNCST• Illustrations - http://www.carmma.org/
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