Interventions and Approaches
Help women and their partners develop a plan for contraceptive use after delivery
Counsel and provide immediate post-partum family planning options
Provide FP information, counselling and services during clinic visit
Women of reproductive age visit healthcare facilities for Maternal New-born and Child Health (MCH) services and other reasons. Most of these women however, do not want to get pregnant, but lack access to the information and services required. The project eliminate these missed opportunities by promoting the integration of family planning services across the MNCH continuum of care, so that counselling and referrals are provided at the various health service delivery units. Every facility visit is therefore an opportunity to provide comprehensive family planning information and services.
The service delivery approach is focused on improving the quality of family planning services by holistically addressing three key areas:
Commences with a performance improvement assessment to access the FP needs of each facility
Modified 72-hour Clinic Makeover
To create an enabling environment for the provision of quality family planning services within the private sector, the project adapted the proven-to- work 72-hour clinic makeover approach of the Nigerian Urban Reproductive Health Initiative (NURHI) 2 project . The approach is geared towards upgrading the physical environment of the health facility to improve the provider-client interaction, client experience and satisfaction. The concept of the makeover was modified to suit the peculiarities of the private sector.
The cadres of health providers and clinic staff in the supported facilities require different training and supervision packages. As part of the project’s entry into the private sector, the private facilities were engaged in a needs assessment process with interventions tailored to meet their needs as follows:
Expanding private sector access to affordable commodities.
One of the barriers to provision of family planning services in the private sector is the high cost of the commodities. Private providers do not have access to the source of low-cost commodities as they are unable to buy in bulk given the low family planning client volume. The project addressed this by connecting the facilities with two social marketing organization to service the contraceptive commodity needs of the facilities. With access to reasonably priced commodities, the private health sector can can transform family planning services into a sustainable business model.
In addition, the project linked supported facilities to the State Government for the collection of free commodities, and developed a how-to guide that detailed a step by step instruction for obtaining the commodities and providing it at an affordable cost. The guideline are also being used for step down trainings and onboarding training for new employees. These interventions has contributed to addressing commodity stock-outs across the supported facilities.
Family Planning Provider Network
Considering the huge participation of the private sector in health service delivery in Lagos state, the family planning providers network (FPPN) was set up to foster effective communication and collaboration amongst the various private healthcare professional associations; Association of General and Private Medical Practitioners of Nigeria (AGPMPN), Association of General Private Nursing Practitioners (AGPNP), National Association of Patent and Proprietary Medicines (NAPPMED), Lagos State Medicine Dealer Association (LSMDA), and Association of Community Pharmacists of Nigeria (ACPN) to ensure the delivery of quality and safe client care.
The Sustainable Family Planning Providers Association (SFPPA) also known as the Family Planning Providers Network (FPPN), is an innovation of the NURHI2 Project, which was successfully established during NURHI 1 in supported states. It is a model of a public-private partnership comprising family planning providers from both sectors. The clinical providers were drawn from the projects’ supported facilities as well as non-clinical providers working within the environment near the facilities. The network currently has over 300 members.
Elected FPPN Executives and other project Stakeholders
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Pacific hospital’s family planning room
Ancel hospital’s family planning room
Before the makeover
After the makeover
Ladilak hospital’s family planning room
Before the makeover
After the makeover
A compendium of basic equipment and infrastructure were provided in line with the performance standards for family planning service provision in Nigerian hospitals. The process included initial assessment, prioritization, quantification, minor renovations of the FP space and provision of basic equipment , all within 3 days. To foster ownership, cost-effectiveness and prompt completion of the renovations, the activities were carried out by local artisans within the health facilities’ locality and the timing of renovation for each facility was based on their preference. Each private facility has unique needs, hence the modified makeover approach was tailored to suit the nuances of the individual facilities.
Based on identified gaps, trainings were conducted for health providers on modern family planning methods such as injectables, Intrauterine devices (IUDs) and Implants. These trainings include sessions on data reporting and commodity logistics management. The participants include medical doctors and nurses. Till date, the project has trained 1,212 medical doctors and nurses on Long-Acting Reversible Contraceptive Methods (LARC).188 Community Health extension workers have also been trained on injectables, interpersonal communication and counselling (IPCC) skills and referrals in line with the Lagos state task shifting and task sharing policy.
Others Trainings, Tools and Materials.
299 lower cadre health workers were also trained on interpersonal communication and counselling skills. The project provided the Distance Learning Application tool which has a library of educational platforms, service protocols, and other essential job aids geared towards addressing providers’ bias and values. A PPFP specific module on family planning health talk provision designed to suit the private on PPFP tailored on the private sector and PPFP specific content were incorporated into the Application. The facilities were provided with hard and electronic copies of service protocols, service delivery job aids and social and behavioural Change Communication (SBCC) materials.
Facility step-down training
The project supports timely step-down training of providers to address the high staff attrition prevalent in the private sector. These are conducted immediately after trainings, when a new staff is employed and as a refresher training. The trained providers utilize the developed guideline for conducting step-down training, job aids, training models and tools. In addition to ensuring capacity retention, these trainings also increase family planning intra-facility referrals from all service delivery points within the facilities.
PPFP trained provider conducting cascade training in De-Yula
PPFP trained provider conducting cascade training in Uwemedimo Hospital
Supportive supervision/on-the-job training promotes mentorship, joint problem-solving and communication between supervisors and supervisees. Supportive supervision is conducted for newly trained providers 6 weeks post- training, and quarterly to establish the correct application use of impacted knowledge and skills. The supervisory visits include sessions on adequate filling of family planning registers.
Whole site Orientation.
The whole site orientation (WSO) creates an avenue to provide an overview of family planning, discuss the benefits with all facility staff (clinical and non-clinical) and address myths and misconceptions. WSO is crucial in ensuring that the facility workers are knowledgeable and can act FP advocates within the community. For sustainability, WSO has been incorporated into the facility’s monthly meeting.