psi/tanzania presentation private sector role in family planning by dr. nguke mwakatundu,rh director
TRANSCRIPT
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PSI/Tanzania Presentation
Private sector role in Family PlanningBy Dr. Nguke Mwakatundu,RH Director
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Some Abbreviations
• CPR: Contraceptive Prevalence Rate• CYP: Couple Years of Protection• FP: Family Planning• IPC: Interpersonal Communication• IUCD: Intrauterine Contraceptive Device• LTM: Long Term Method• MWRA: Married Women of Reproductive Age• OC: Oral Contraceptive• PA: Public Announcement
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National Reach
Zonal Offices
Regional Offices
National Coverage
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Background and Geographical Coverage-RH Program• Familia RH program was initiated in 2007,and started
services provision in January 2009• Sales of RH products cover the whole of Tanzania
with exception of IUCDs and Implants which cover 13 regions in Tanzania.
• PSI/Tanzania distributes six FP products and offers service delivery in 17 regions of mainland Tanzania (Network facilities in 13 regions and outreach activities in 12 regions).
• Distributes one safe motherhood product and will start limited distribution of another one in Q2 2013
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RH Program Objectives
• Family Planning To contribute towards increase of national CPR target
(target 60% use among MWRA by 2015) and reducing total fertility rate from 5.4 to 3.1 by 2015
To promote usage of FP methods especially long-term methods (Implants and IUCD’s).
• Maternal mortality To contribute towards reducing maternal mortality to
193/100,000 live births by 2015(Currently at 454/100,000) To reduce maternal deaths due to post partum
haemorrhage (PPH) and incomplete abortions using misoprostol.
To increase access to safer delivery -Clean delivery pack
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Program Components
• Product procurement, packing and distribution• Social marketing of 6 FP products,1 safe motherhood product,
and another safe motherhood product from Q2 2013 • Distribution at national and regional level in all authorized
outlets.
• Increased access to services (esp LTM)• Comprehensive partnership with private sector facilities• Service provision through outreach teams
• Behaviour Change Communication• Inter Personal Communication in communities• Medical detailing to health facilities and pharmacies• Community events• Public Announcements
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Program Components
• Supportive environment • Curriculum revision• TOT’s• Working with universities, professional associations (e.g.
AGOTA)• Working with the Ministry of Health at national and local level to
improve the environment for better access to FP and safe motherhood services
• Integration• FP / HIV : Counselling, referral for testing and free condom
distribution• Treatment of Incomplete abortion / FP• Postpartum FP
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Familia Products Range
• Family Planning Products: IUCD’s Implants Condoms(male and female) Injectables Oral Contraceptives Emergency contraceptives(supplier brand)
• Safe Motherhood Products Misoprostol (supplier brand) Clean Delivery Pack
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Pharmaceutical Regional
Distributor Urban retailer
District/Rural Centers
wholesaling outlets
Urban wholesaling
outlets
Rural retailer
Institutions, NGOs, CBOs
etc
Health facilities
PSI/Tanzania Current distribution modelTarget G
roups
Clinics, VCT, HBC, CHWs,
Peer educators
MDCs
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Behavioural Change Communication Activities• IPC activities: Household
Visits, Neighbourhood Meetings, Clinic meetings
• Women groups meetings : Markets places, Saloon s visits, kitchen parties
• IEC materials: posters, brochures
• Public Announcements (PA)• Mass media: radio spots,
newspapers
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Private Sector PartnershipService Delivery
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Approach
• Social franchising model• Selection of health facilities based on specific criteria• Signature of MOU• Comprehensive training in clinical skills for LTM• Equipment for LTM provision• Access to products, expendables and job aids• Monthly event days post-training for capacity building• On going coaching and mentoring for quality• Branding and local promotion of services through
posters, wall paintings, PAs• Referral system to facility using IPC agents
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Branding of Facilities
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Wall Paintings
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Public Sector Approach• 10 outreach teams supporting the public sector in 12
regions.• Each team is of 2 nurse midwives partnering with
public sector providers trained in LTM• Selection of location / health facilities driven by
district authorities• Demand creation prior to the event using posters;
public announcements; local leaders; facility providers
• Equipment, supplies and IP material brought by PSI team
• All FP clients are screened for HIV and referred for testing if they are at risk
• Free condoms offered to all clients in need
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Major Achievements in 2012• More than doubling in provision of LTM’s(102,778
insertions in 2012 Vs 48,518 in 2011)• Increased provision of LTM’s in private sector by 92%(58327
combined IUCD’s and Implants Vs 30446 in 2011)• Increased provision of LTM’s in the public sector by
145%(44451 combined IUCD‘s and Implants Vs 18072 in 2011)
• Over 317 providers in the private sector network as of Dec 2012 from 255 at end of 2011, 24% increase in number of providers in the private sector network.
• 250 IPC workers supporting the private sector network as of Dec 2012
• Over 300,000 women reached through IPC in 2012
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Major Achievements cont.
• Increase in number of outreach teams from 5 to10 teams supporting the public sector in 12 regions.
• Increase in number of women counselled for HIV during FP counselling by 55% (82,891 in 2012 from 53,593 in 2011)
• Increase in number of women referred for testing for HIV by 66%(16,849 in 2012 from 10,134 in 2011)
• Increase in number of free condoms distributed by 98%(486,315 in 2012 from 245,541 in 2011)
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LTM’s Insertions-Private Sector
2009 2010 2011 20120
5000
10000
15000
20000
25000
30000
35000
40000
45000
1470012578
21833
40741
3677 3650
8613
17586
IUCD insertions
Implant insertions
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LTM’s Insertions-Outreach
2010 2011 20120
5000
10000
15000
20000
25000
30000
994
12911
28459
239
5161
15992
IUCD insertions
Implant insertions
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IUCD’s and Implants Distribution
2009 2010 2011 20120
5000
10000
15000
20000
25000
30000
400
10235
15418
27155
0
2060
4400
21370
IUCD's distributed
Implants distributed
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OC’s distribution
2009 2010 2011 20120
200000
400000
600000
800000
1000000
1200000
1400000
1600000
525072
718092663552
1428336
OC's Sales
OC's Sales
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Injectables distribution
2010 2011 20120
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
4,100
18,090
170,650
Injectables sales
Injectables sales
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Familia condoms distribution
2009 2010 2011 20120
5,000,000
10,000,000
15,000,000
20,000,000
25,000,000
6,785,032
20,088,720
4,262,400
10,929,600
Familia condoms distribution
Familia condoms distribution
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Misoprostol distribution
2009 2010 2011 20120
50000
100000
150000
200000
250000
300000
350000
191710172080 177960
310408
Misoprostol distributed
Misoprostol distributed
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CYP’s growth
2009 2010 2011 20120
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
CYP's other FP methods
CYP's condoms
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MoHSW70%
PSI24%
T-MARC7%
National CYP Contribution, Jan-Dec 2011 by organisation
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2013 Priorities
• Integrating other services to be delivered in the Familia social franchise
• Increasing productivity of private network providers and IPC workers
• Increasing sales of FP products• Introducing Clean Delivery Pack
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THANK YOU