ESMPIN Expanded Social Marketing Project in Nigeria
A Book of Abstracts Book of Abstracts ESMPIN 01
FOREWORD
The ESMPIN Project is a social marketing project implemented by Society for Family Health (SFH) along with the Association for Reproductive and Family Health (ARFH), BBC Media Action (BBCMA) and Population Services International (PSI). The goal of the project is to improve the health of women and children in Nigeria by increasing the use of modern family planning methods and child health. To achieve this, the team worked to increase access to family planning (FP), reproductive health (RH) and child health products; increase the use of health products and practice of health behaviors; generate support from all sectors for social marketing as an important part of a total market approach; and improve the viability of local manufacturing of key health products. As an integrated project, ESMPIN had quality and scale as its implementation focuses. The project therefore used several distinct channels to promote healthy practices among separate target groups in the areas of family planning, malaria, diarrhea and nutrition. The intervention strategies were implemented one at a time or together over a period of time with the aim of changing behavior. The project also used approaches proven over time to design and deliver these messages to the target groups. To achieve scale, ESMPIN designed and implemented several approaches, some with a nationwide spread, while others focused on 22 states in Nigeria (including the Federal Capital Territory). This document therefore provides a brief outline of specific approaches used by ESMPIN as well as some program outcomes recorded during and after field implementation.
SIR BRIGHT EKWEREMADU, Managing Director, Society for Family Health 02 ESMPIN Book of Abstracts SECTION Book of Abstracts ESMPIN
CONTENTS
List of Acronyms 04
Introduction 06
ABSTRACTS
Acknowledgment This document is a product of Expanded Social Marketing Project in Nigeria (ESMPIN) consortium partners led by Society for Family Health (SFH). Demand Creation 08 The Federal Ministry of Health (FMoH), along with the various State Ministries of Health (where ESMPIN was implemented), were resourceful in providing support and access to relevant stakeholders and sharing relevant information
and data that informed the strategy design. Their efforts are much appreciated. Expanded Social Local government departments of health were beneficial and physically Marketing Project Capacity Building 20 in Nigeria (ESMPIN). available to support actual field interventions. We are grateful for all their 2016. Expanded Social Marketing Project in guidance and active involvement during the project implementation. Nigeria (ESMPIN): A Book of Abstracts (2011 We acknowledge the effort and contribution of the staff ofSFH , BBC Media – 2016). Abuja: ESMPIN. BBCMA ARFH Action ( ), Association of Reproductive and Family Health ( ) and The content of this report Service Provision 24 Population Services International (PSI) for their relentless drive in achieving is the responsibility of ESMPIN. This material impactful results and for taking the time to document the processes involved. has been funded by United States Agency Finally, we acknowledge the technical support received from PSI as well for International Development (USAID). as content input from SFH, BBCMA and ARFH staff (both field and program). However, the views expressed do not Advocacy and Collaboration 40 necessarily reflect the US government’s DR. JENNIFER ANYANTI, Chief of Party, ESMPIN Project official policies.
04 ESMPIN Book of Abstracts ACRONYMS Book of Abstracts ESMPIN 05
Acronyms ACRONYM MEANING ACRONYM MEANING ACRONYM MEANING ACRONYM MEANING ACRONYM MEANING ACPN Association of Community CWC Child Welfare Clinic ICFP International Conference M&E Monitoring and Evaluation RDT Rapid Diagnostic Test Pharmacists of Nigeria on Family Planning CWO Catholic Women’s Organization NAFDAC National Agency for Food and RH Reproductive Health ACT Artemisinin Based IEC Information, Education Drug Administration and Control DALYS Disability Adjusted Life Years RNM Registered Nurse/Midwife Combination Therapy and Communication NANNM National Association of Nigeria DCR Demand Creation Representative SACA State Agency for the AGPMPN Association of General IPCA Interpersonal Nurses and Midwives Control of AIDS and Private Medical DHIS District Health Communication Agent NAPPMED National Association of Patent Practitioners of Nigeria Information System SDP Service Delivery Point IPC Interpersonal Communication and Proprietary Medicine Dealers ANC Antenatal Clinic DT Dispersible Tablet SFH Society for Family Health IPT Intermittent Preventive NCE No Cost Extension AOR Agreement Officer EBF Exclusive Breast Feeding Treatment SHOPS Strengthening Health O utcome NEMCM National Essential Medicines Representative of through the Private Sector EC Emergency Contraceptive IR Intermediate Result Coordination Mechanism APCON Advertising Practitioners SMOH State Ministry of Health ESMPIN Expanded Social Marketing IUCD Intrauterine Contraceptive Device NPHCB National Primary Council of Nigeria Project in Nigeria Health Care Board SMS Short Message Service ITD Inception till Date APLS Annual Population Lecture Series FC Female Condom NRHTWG National Reproductive Health SOP Standards of Practice IYCF Infant and Young Child Feeding ARFH Association for Reproductive Technical Working Group Meeting FCT Federal Capital Territory SPARCHS State Specific HIV/AIDS, and Family Health JAMB Joint Admissions and NSPAN National Strategic Plan Reproductive Health and FGD Focused Group Discussion Matriculation Board ASM Area Sales Manager of Action for Nutrition Child Health Survey FH+ Family Health Plus Project KII Key Informant Interview AUX Auxiliary NURHI Nigerian Urban Reproductive SR Sales Representative FMOH Federal Ministry of Health LARC Long-Acting Reversible Health Initiative BBCMA British Broadcasting SSV Supervisory Support Visit Contraceptives Corporation Media Action FOMWAN Federation of Muslim Women NTO Non-Traditional Outlet TBA Traditional Birth Attendant Association of Nigeria LGA Local Government Area BCC Behavior Change Communication ORS Oral Rehydration Solution THM Town Hall Meeting FP Family Planning LLIN Long-Lasting Insecticide- BCS Balanced Counselling Strategy OTC Over-the-Counter treated Net TM Territorial Manager FPAWG Family Planning Advocacy CAN Christian Association of Nigeria PBCC Provider Behavior Change Working Group LOP Life of Project TOR Terms of Reference Communication CBD Community-Based Distribution FSUP Family Succour and LTM Long Term Method TWG Technical Working Group PCN Pharmacists Council of Nigeria CBDA Community-Based Upliftment Programme MAP Measuring Access and UHC Universal Health Coverage Distribution Agent PBCC Provider Behavior Change FY Fiscal Year Performance Communication USAID United States Agency for CBO Community-Based Organization GF Global Fund MCH Maternal and Child Health International Development P&G Procter and Gamble CCMS Contraceptive Central GSM Global System for Mobile MCSP Maternal and Child WDC Ward Development Committee Medical Store PHC Primary Healthcare Centre Communication Survival Program WHO World Health Organization CHEW Community Health PMP Performance Monitoring Plan HCC Health Communication MNCH Maternal, Newborn Extension Worker WHP Women’s Health Project Coordinator and Child Health PoU Point-Of-Use CHO Community Health Officer WRA Women of Reproductive Age HCP Health Care Provider MDS Manufacturers Delivery Service PMS Patent Medicine Store CHTWG Child Health Technical Y/N Yes/No HF Health Facility MDK Media Dark Kit PPMV Patent Proprietary Working Group Medicine Vendor YTNA Ya Take’ Ne Arewa HIV Human Immunodeficiency Virus MEC Medical Eligibility Criteria CHX Chlorhexidine PSI Population Services International Zn Zinc HNQIS Health Network Quality MOS Month of Stock CMO Catholic Men’s Organization Improvement System Q Quarter MSIN Marie Stopes CS Contraceptive and Child Survival iCCM Integrated Community International Nigeria QA Quality Assurance CYP Couple Years of Protection Case Management 06 ESMPIN Book of Abstracts Book of Abstracts ESMPIN 07
INTRODUCTION
Expanded Social Marketing Project in Nigeria Family Planning Conference 2016 Nigeria (ESMPIN) is funded by the United States Agency for International 2015 American Society of Tropical Development (USAID) and implemented Medicine and Hygiene 64th Annual by Society for Family Health (SFH) Nigeria. Meeting, Philadelphia, Pennsylvania, USA The five-year (April 2011–March 2016) social marketing project was nationwide Nigeria Family Planning Conference 2014 and now focuses on 22 priority states in Nigeria (11 in the north and 11 in the south). 2013 International Conference on Family ESMPIN contributes to USAID’s Planning, Addis Ababa, Ethiopia development objective of improving the health of women and children in The abstracts provide information on Nigeria, primarily by increasing the use effective family planning and child survival, as of modern family planning methods well as support information and services for and by increasing the use of child health reaching the most women and children. The products in Nigeria. SFH implements work presented in the abstracts includes best ESMPIN in partnership with the Association practices, lessons learned, and recommen- for Reproductive and Family Health dations in improving and increasing access (ARFH), BBC Media Action (BBCMA) and to family planning methods and services; Population Services International (PSI). and improving knowledge, attitude, per- This publication compiles abstracts ception and practices of healthy behavior. developed by ESMPIN consortium partners Not all of the abstracts are based on and collaborators, as well as staff of various ESMPIN project data, but ESMPIN did The abstracts government ministries, departments provide technical, institutional and provide and agencies supported by the project. individual support to develop and present information on The abstracts were presented at several the abstracts at regional and international effective family regional and international family planning conferences and for publication in various planning and and child survival-related conferences family planning-related journals. child survival, as and were also published in various This book of abstracts recognizes the well as support national and international journals. important contributions of the project information and The conferences include: staff, partners, and collaborators who services reaching worked towards achieving the vision of the most women 2016 International Conference on healthy women and children in Nigeria. and children.” Family Planning, Nusa Dua, Indonesia 08 ESMPIN Book of Abstracts SECTION SECTION Book of Abstracts ESMPIN 09
DEMAND CREATION
Demand creation activities under the integrated health ESMPIN project were designed to focus on the provider and the consumer. While provider BCC (PBCC) and mass media activities were held nationwide, the community-level demand creation activities for consumers were implemented across 22 priority locations in Nigeria (11 in the north and 11 in the south). These include Abuja, Adamawa, Akwa Ibom, Bauchi, Cross Rivers, Delta, Ebonyi, Edo, Enugu, Imo, Jigawa, Kaduna, Kano, Katsina, Kebbi, Kogi, Ogun, Lagos, Oyo, Ogun, Rivers, Sokoto and Zamfara. The project conducted detailed activities, PPMV trainings, clinical presentations, use of below-the-line materials and leave-behind IEC materials for demand creation across providers. As for community-level demand creation activities for the consumer, the project planned and implemented the IPC and CBD program targeting men and women of reproductive age; developed and distributed IEC materials to the same target group; and used mass media. With regards to ESMPIN’s demand creation activities, abstracts were developed and presented at conferences to showcase our work. 10 ESMPIN Book of Abstracts DEMAND CREATION Book of Abstracts ESMPIN 11
ABSTRACT ABSTRACT
Facilitating Knowledge, Access, FP with community and religious leaders to Contraceptive Information chi central and Bauchi north. Bogoro, Ningi Product Availability and Service identify trusted community members. These and Access Among Youths: and Katagum local governments were selected Uptake Through Community- trusted community members are trained as Findings From Bauchi State respectively. A total of 50 males and 50 females Based Distribution community-based distribution agents who from each local government were selected for conduct one-on-one and group interpersonal AUTHOR: Gbue Denen Daniel interviews, making a total of 100 per local gov- AUTHORS: Ogechi Onuoha, Aliyu Guraguri, communication (IPC) sessions and distribute PRESENTER: Gbue Denen Daniel, Society for ernment. A total of 300 questionnaires were Mukhtar, Boladale Akin-Kolapo family planning and child survival products Family Health, No. 8 Port Harcourt Crescent, used for the study, 150 males and 150 females. PRESENTING AUTHOR: Ogechi Onuoha in the project communities. They are off Gimbiya St. Area 11 Garki, Abuja, Nigeria The interviews were carried out among youths EMAIL: [email protected]; eronini@ residents in the communities and are able to EMAIL: [email protected], dgbue@ between the ages of 15-24. These various sam- gmail.com PHONE: 08037922489 reach women in purdah. For FP, these agents sfhnigeria.org PHONE: 08066773092. Presented ple sizes were determined on the availability Presented at 2016 Nigeria Family Planning issue referral cards to willing contacts who at 2014 Nigeria Family Planning Conference, and acceptability of the target populations to Conference, Abuja, Nigeria, November 7-9, 2016 visit the closest health facility for family Abuja, Nigeria, November 26-28, 2014 participate in the study. Data collection was planning counseling and method uptake. The carried out over a four-month period from Background agents also carry non-ethical family planning Background February-May 2014, using a structured ques- Nigeria presents a challenge to programmers products, such as the pill, which is sold at little Youths, especially female, experience a high tionnaire administered by the research team. because of the country’s wide-ranging mark-up price to already initiated users. The risk of unplanned pregnancy because of their Descriptive statistics were estimated and mul- cultural, religious and political contexts. services of the CBD agents create awareness limited knowledge about contraceptives. tivariable logistic regression analysis was used Disparities are apparent between the north and generate demand for FP services, and Knowledge of contraceptives and contracep- to access contraceptive information and access and the south. Research has shown that many make the products accessible and available tive use are important indicators of sexual among youths. SPSS was used for data analysis. rural areas, especially in the north of Nigeria, to women who ordinarily would have been health among youth. Youth have the right to do not have access to medical retailers. In discouraged by product unavailability. lead healthy lives. They should have access to Results/key findings the north, communities and households are the tools they need to protect their health— Findings from the study indicated that widely spread geographically and less densely Results including access to condoms, contraception, 89% of youths knew at least one method populated than in the south and women are The project has reached 6,582,840 contacts and the full array of reproductive health care of family planning, while only 11% knew less likely to seek care outside their homes. through IPC as of June 2016. Of these services. The study used the United Nations’ more than two methods. 72% did not The community-based distribution approach numbers, males are 3,081,556 and females definition of youth “as those persons be- know that condoms were a method for provides key distribution channels for FP are 3,501,284. The strategy has improved tween the ages of 15 and 24 years, without family planning and so did not know that The services and MNCH products and health information knowledge and understanding of the benefits prejudice to other definitions by Member condoms are used for dual protection. of the CBD for families living in these locations. of child spacing in the communities and uptake States.” The study uses the age range of 15 and 20% had ever used contraceptives while agents create of services by women in the communities. 24 years to test the hypothesis of the study. 80% had never used contraceptives. Out of awareness and Objectives the 20%, less than 10% acquired it from generate demand Bridge accessibility, availability and Conclusion Main research question/ a provider in the hospital, 56% received for FP services, affordability gap and increase FP products The ESMPIN experience shows that hypothesis and program area it from PPMVs, and 35% said they got it and make uptake in hard-to-reach communities. CBD is a proven means for bridging the The purpose of this study was to test the from friends and peer groups. The study the products accessibility, availability and affordability hypothesis that “youths lack knowledge of con- also indicated that 83% of youth wanted accessible and Methodology gap in increasing FP products uptake. traceptives and access to contraceptives.” The knowledge of contraceptives and their use, available to Since 2011, the Expanded Social Marketing The networks represent a viable study used questionnaires to test the hypothesis. but 74% said they felt more comfortable women who Project in Nigeria has worked in four medium of sustaining the strategy. discussing contraception with friends than ordinarily would northern states: Katsina, Jigawa, Kebi Methodology providers because providers sent them have been and Zamfara, where it implements the The study used simple random sampling to away, saying that FP was not for youths. discouraged community-based distribution strategy select three local governments in Bauchi State. Findings from the study revealed that there by product in 64 local government areas, covering at One local government was selected from each were no youth-friendly centers that offer unavailability.” least 10 wards per LGA. The project worked senatorial district, namely, Bauchi south, Bau- FP counseling and services to youths. 12 ESMPIN Book of Abstracts DEMAND CREATION Book of Abstracts ESMPIN 13
Contribution to knowledge Main Research Question ABSTRACT Policymakers and program managers can Is the experience of side effects among develop programs that more effectively women in Ogun state real or rumored? This Interpersonal Communication: states and the federal capital territory in Nige- respond to contraceptive knowledge and was determined by the number of women Increasing FP uptake in 3 ria, namely: Kano, Kaduna, Sokoto, Adamawa, needs of youths. who have either experienced a side effect Northern Nigerian States Bauchi, Lagos, Ogun, Oyo, Port Harcourt, Cross from using a contraceptive or have seen River, Edo, Enugu, Imo, Delta, Akwa Ibom Conclusion someone who has experienced a side effect. AUTHOR: Gbue Denen Daniel and Abuja. IPCAs were used as a mechanism In conclusion, the study is a clear indication PRESENTER: Gbue Denen Daniel, Society for to drive demand for FP services and uptake. that youths who are supposed to be the Methodology Family Health, No.8 Port Harcourt Crescent, leaders of tomorrow lack knowledge and This descriptive cross-sectional study carried off Gimbiya St. Area 11 Garki, Abuja, Nigeria Methodology access to contraceptives which would help out in Ogun state, Nigeria was conducted EMAIL: [email protected], dgbue@ The study was the assessment of three north- guide and protect their future. There is a between June and October 2013. A multi- sfhnigeria.org PHONE: 08066773092. ern Nigerian states: Bauchi, Kano and Sokoto need for involving the youths in policies and stage sampling technique was used to select Presented at 2014 Nigeria Family Planning using referral health facilities within IPC programming of family planning in Nigeria. the respondents from one local government, Conference, Abuja, Nigeria, November 26-28, 2014 intervention communities as a case study. It each from the three senatorial districts in the covers the period of IPCA intervention from state. A total of 515 pre-tested semi-structured Background July-December 2013. The IPCAs conducted ABSTRACT questionnaires were administered, sorted out The study assesses the role of IPCAs (Interper- one-on-one and group sessions with com- and analyzed using SPSS statistical package. sonal Communication Agents) in increasing munity members after which referral forms Fear of Side Effect as a Barrier The study population were women attending family planning uptake in three northern were issued to visit health facilities for FP to Long Term Contraceptive the antenatal and immunization clinics in Nigerian states, where the CPR (Contraceptive counseling and uptake. The data source of the Use in Ogun State, Nigeria primary health facilities in the communities. Prevalence Rate) is very low, ranging from 0-4%, study is from the health facilities’ FP register. compared to the south which ranges from The study assesses the number of FP uptakes AUTHOR: Awolaran O, Ogbondeminu F. O, Results/key 20-50%. It is believed that most community before the intervention (baseline) and six Adebayo E.S PRESENTER: Awolaran O, Society 94% of the respondents had heard of child members want FP but lack correct knowledge months after the intervention (end line) to for Family Health, 2B, Oyetola Street, Off spacing and their major source of information and have a lot of myths and misconceptions see if there was any significant increase in Ajanaku Street, Off Salvation Road, Lagos State, was from health workers (58.5%). 62% of about FP. The study assesses the use of interper- FP uptake as a result of the IPCAs activities. Nigeria EMAIL: [email protected] the respondents had used one form of child sonal communication agents to increase FP up- PHONE: 234-806-000-2005. Presented at spacing method or the other before, while take by bridging the gaps between knowledge Results/key findings 2014 Nigeria Family Planning Conference, more than half of the women (54.1%) had and practice of family planning in northern Findings from the study indicated an increase of Abuja, Nigeria, November 26-28, 2014 heard of side effects of child spacing methods Nigeria using interpersonal communication. over 100 percent in FP uptake at referral health but only about 21% had experienced one facilities. This is a clear indication of the IPCAs Background form of side effect or another. Another 45% Main research question/ direct impact within the communities of inter- Many studies have used large scale survey of the respondents claimed to have seen hypothesis and program area vention. The study results from referral facilities data to determine the socio-economic and someone with a side effect of child spacing. The assessment was based on the USAID shows; Bauchi (Baseline uptake = 111, end line cultural characteristics which may act as About 58% said they are scared by the side It is believed Expanded Social Marketing Project in Nigeria uptake = 885 making and increase uptake of determinants of individuals’ contraceptive effect information. There is no statistically that most (ESMPIN) community intervention strategy 797%), Kano (Baseline uptake = 107, end line behavior. In doing so, they have identified significant association between the level of community of IPCA’s activities to disseminate information uptake = 613 making and increase uptake of several barriers to contraceptive use. One education of the respondent and if they have members on malaria, diarrhea, nutrition and family 909%) while Sokoto (Baseline uptake = 481, end issue consistently raised in such studies ever used a child spacing method in the past. want FP but planning, thereby improving knowledge, line uptake = 613 making and increase uptake in Sub-Saharan Africa is the non-use of lack correct attitude, perception and practice of healthy of 127%). This traced back to the FP registers contraceptive methods due to fear of side Contribution to Knowledge knowledge behaviors. IPCAs are recruited and trained as a result of those who received referral forms effects or detrimental health effects. This It can be said that the way people ‘perceive’ and have a lot to work for a period of six months within and went to the facilities for FP uptake. The in- study explored the fear of side effects as a potential side effects is based on the of myths and their communities, conducting interperson- crease in FP uptake indicated that interpersonal barrier to the uptake of modern long term second-hand relating of experience rather misconceptions al communication of FP. The ESMPIN IPC communication provided better knowledge and contraceptives among women in Ogun state. than past negative personal experience. about [it].” community intervention is carried out in 15 information about FP, thus leading to uptake. 14 ESMPIN Book of Abstracts SECTION SECTION Book of Abstracts ESMPIN 15 16 ESMPIN Book of Abstracts DEMAND CREATION Book of Abstracts ESMPIN 17
Contribution to knowledge Program area ABSTRACT The use of IPCAs as interpersonal commu- Increasing the acceptance of family planning nicators on FP within communities will through Behavioral Change Communication Assessment of Interpersonal learning and action (PLA) techniques of pair- help address the issue of low CPR, especial- Communication (IPC) As a High wise ranking and flow diagrams) was used ly in northern Nigeria. The use of IPCAs Methodology Impact Model to Promote Family for data collection. Twenty-six PLA sessions provides privacy for clients to discuss FP The intervention site was Agege local govern- Planning Uptake in Nigeria were conducted, 11 with men and 15 with because IPCAs meet them in the comfort ment area, Lagos state. Thirty interpersonal women. Six KIIs each were conducted with of their homes or businesses. Clients ask communication agents were trained and AUTHORS: Temple Jagha, Etim Nnanke, health communication coordinators, facility questions freely about various methods, deployed into the community to work for a Nkiru Awogu, Isa Babale PRESENTER: Temple providers and community leaders. Following myths/misconceptions and their side period of six months educating people on Jagha. Presented at 2013 International FGDs, participants paired and ranked various effects before visiting the health facilities. family planning in order to dispel the fear of Conference on Family Planning, Addis issues based on criteria they set to identify side effects, return to fertility and the bene- Ababa, Ethiopia, November 12-15, 2013 the issue of most prominence. The most Conclusion fits of family planning. Referral cards were prominent issues were then used to construct The use of IPCAs is a best practice to issued to the target audience to accept family Significance/background a flow diagram of causes, consequences and address FP knowledge and usage in planning methods. The target audience IPC is largely recognized as a community- solutions. A multi-stage sampling technique northern Nigeria and in any other were men and women of reproductive age. level model to influence behavior change, based on the six geopolitical zones (clusters country where FP faces challenges together with other strategies such as of six states grouped as north west, north ranging from tradition and culture, to Results subsidized sale of products, clinical practice east, north central, south west, south east religion and illiteracy. Interpersonal The interpersonal communication agents and use of mass media. IPC interventions and south south zones) in Nigeria was communication allows for direct feedback. on the intervention reached 119,200 focused on the advantages of face-to-face used to identify study locations. One state men and women of reproductive age contact, the ability to tailor information to each, from the six geo-political zones, was ABSTRACT with family planning messages and the a client’s needs and the power of persuasion selected for this study and three IPC inter- benefits of planning their families using and social influence. Society for Family vention localities in each state were visited. Interpersonal Communication modern contraceptive methods. 23% of Health Nigeria employs IPC as a high-impact (IPC); A Strategy to Increase the the individuals reached with FP messages strategy to move individuals from simply Results/key findings Acceptance of Family Planning accepted referrals to FP facilities within being knowledgeable about a concept like Findings showed that IPC helped to effec- the vicinity and about 15% of those family planning (FP) to uptake of a method tively deliver FP information to community AUTHOR: Dave-Agboola I.O; Okafor Uchenna; referred adopted a family planning and continued practice of the new behavior. members, and these appeared more accessi- Society for Family Health method as a result of the intervention. ble within communities. Community leader PRESENTER: Dave- Agboola I.O Main question/hypothesis and male partner involvement increased the EMAIL: [email protected] Contribution to knowledge This evaluation sought to establish the ap- target group’s understanding of the benefits PHONE: 08032449243, 08129940476 The use of modern contraceptive methods propriateness and success of the IPC strategy and need for FP. Findings showed also that Presented at 2014 Nigeria Family Planning can be significantly increased by the use in the areas of design, implementation and referral linkages were strengthened by IPC The use of Conference, Abuja, Nigeria, November 26-28, 2014 of interpersonal communication (IPC) as a results. In other words, how has the IPC agents. This is elucidated by the target group’s modern behavior change strategy. Specific individual intervention influenced changes in behavior ability to identify community-based referral contraceptive Background barriers to family planning uptake can be towards increased uptake of contraceptive facilities, thereby reducing complaints about methods can The awareness on family planning has in- addressed directly using this method and scale methods in specific locations in Nigeria? distance/transportation costs. Use of flip be significantly creased over the years, but in spite of this up is recommended, especially with youths. charts, messages accompanied by pictures, increased acceptance has remained low due to fear of Methodology was overall reported as facilitating better by the use of side effects and return to fertility. This poor Conclusion This study was conducted between August communication of FP information in com- interpersonal acceptance has had many drastic consequenc- Interventions to increase uptake of modern and September 2012. A desk review of munities. IPCAs activities led to increased communication es ranging from maternal mortality to poor contraceptive methods should incorporate activity results, facility service statistics, and demand to stock contraceptive methods that (IPC) as a socio-economic conditions. This intervention the IPC strategy to improve the acceptance of mixed method qualitative approach (in- are legally allowed to be sold off-the-shelf by behavior change aimed to improve the knowledge of men and family planning among target populations. cluding focus group discussions (FGDs), key patent medicine vendors. Thus, there is an strategy.” women of reproductive age on family planning. informant interviews (KIIs), participatory increase in update of FP methods as observed 18 ESMPIN Book of Abstracts DEMAND CREATION Book of Abstracts ESMPIN 19
in facility records based on community access. Significance/background narratives with the study population. This interviewees reported dissatisfaction with Three hundred IPCAs in 37 local Nigeria’s maternal mortality rate is high at 546 study was conducted between June-July 2013. condoms as a FP method because they reduce government areas (LGAs) and 92 per 100,000 live births (NDHS 2008). Studies A sample stratified by FP use (current FP the pleasure of skin-to-skin contact during sex. communities reached 989,955 people show that countries with low contraceptive users, FP method switchers, ever users, and Finally, interviewees state that providers’ bad through one-on-one and group sessions in prevalence rates (CPR) are countries with high never users, all female) and age (aged 20-25 attitudes, for instance, nastiness, impatience, the gender ratio of 1:3. IPCAs successfully maternal mortality ratios. This is true in Nige- and 30-40 years old) was targeted. Based on stigmatizing FP users as promiscuous and referred 65,802 women for FP services and ria where knowledge of modern contraceptives existing studies such as the NDHS 2008, and the concomitant poor quality of FP services 26,822 redeemed the referrals. Notably, 1127 is high (72% all women, 90% all men) but the basic social influences (marriage, religion, provided are considerable barriers. women (4.2%) who visited health facilities national CPR among all women is low (15% etc) on women’s contraceptive method use, based on these referrals obtained a FP method. all methods; 10% modern methods), and the a sample of male spouses of FP users/non- Knowledge contribution This is an important success, considering that total fertility rate is 5.7 children per woman users was also selected to get an insight into FoQUS collects data describing the target there has only been an increase of around (NDHS, 2008). This high CPR is attributed social factors from a male’s perspective. population in a way that gives essence to 1% in the national CPR, which has been to women’s inability to access birth spacing Multi-stage sampling, based on existing the data, therefore, bringing the target stagnant around 10% in the last decade. contraceptives. Contraceptives are sometimes clusters of six geo-political zones (GPZ), population to life. FoQUS highlights the too expensive, unavailable and not easily containing six states each, was used to sample contextual factors influencing women’s use or Knowledge contribution accessible to many segments of the population. study locations and sample population. One non-use of contraceptive methods. Men and IPC strategies need to be tested and re-tested There is a lack of information on the benefits state from each of the six GPZs and one out women continue to harbor misconceptions for effectiveness. This study provided evidence of family planning (FP), as social and cultural of three senatorial districts in each state regarding the use and effects of contraceptive for re-design of the subsequent IPC cycle and misconceptions are pervasive in many areas. was selected. Within the selected senatorial methods, where these methods are available. strategy. Data from the study highlighted the Society for Family Health/Nigeria districts, one urban and one rural locality Most men do not support their spouses need to expand the scope and scale of inter- implements FP/MNCH programs using were selected to implement the study. use of contraceptive methods because vention, for instance, increasing the length strategies that develop commercial markets it appears they think the disadvantages of time spent by IPCAs in a community per for the benefit of the poor and ensure that Results/key findings outweigh the benefits. Peer group influence cycle to stimulate more project outcomes. The products are available to meet demand in the According to respondents, the driving force still happens; women reported that more IPC cycle was increased from four months of lowest wealth quintiles. This study highlights behind contraceptive method use is difficult of their peers would use contraceptive activities in a community to six months. The socio-cultural influences on contraceptive economic conditions, which lead families to methods if the husband agrees to let them number of IPCAs was slightly increased and methods use, and the economic impact of plan their desired number of children. Child use. The study, therefore, shows that it is use of information, education and commu- access. Findings from the study aided in spacing is seen as a means of enhancing good important to target male spouses as a target nication (IEC) materials increased. In other developing marketing and behavior change health and well-being of family members. population in order to increase FP use. words, IPCAs used more of counseling flip communication plans to increase access to In addition, the need for dual protection With ubiquitous misconceptions regarding charts, information brochures, and educa- and use of contraceptive methods in Nigeria. (simultaneous prevention of pregnancy and FP methods and use, more appears to tion posters to communicate messages. sexually transmitted infections) also drives be required in the area of information, Main Question/hypothesis the use of condoms. Many interviewees education and communication (IEC). People The purpose of this study is to use the report that contraceptive methods are easily do not seem to be appropriately informed ABSTRACT framework for qualitative studies in social accessible, cost effective and easy to use for about methods and benefits or contra- marketing (FoQUS) to determine what ... women the prevention of unplanned pregnancy. indications of different methods. These Drivers and Barriers of Modern motivates and obstructs women from using reported Across study sites, a major barrier to they misconstrue as negative effects. Family Planning (FP) Contraceptives contraceptive methods. FoQUS provides that more of contraceptive use is men’s reluctance to accept Method Use in Nigeria a unique opportunity to build familiarity their peers and support use of contraceptives by their with the target audience and the specific would use spouses. This reluctance is primarily due to AUTHOR: Temple Jagha, Joseph Inungu, contexts where behavior change takes place. contraceptive inadequate information or misconceptions Isa Babale PRESENTER: Temple Jagha methods if related to effects of contraceptive use; for Presented at 2013 International Methodology the husband instance, perceived side effects such as Conference on Family Planning, Addis FoQUS is a qualitative study employing agrees to let infertility, the belief that FP causes cancer, Ababa, Ethiopia, November 12-15, 2013 in-depth, one-on-one interviews and photo them use it.” weight gain and menstrual disruptions. Many 20 ESMPIN Book of Abstracts DEMAND CREATION Book of Abstracts ESMPIN 21
CAPACITY BUILDING
A brief introduction on capacity building and the nature of abstracts published under it: this is one of ESMPIN’s core strategies in achieving its overall objectives by strengthening the capacity of both field agents and healthcare providers. ESMPIN’s capacity building activities included trainings and meetings which served as suitable platforms to update or correct gaps observed during interventions. With regards to ESMPIN’s capacity building activities, abstracts were also developed and presented at conferences. 22 ESMPIN Book of Abstracts CAPACITY BUILDING Book of Abstracts ESMPIN 23
ABSTRACT
Improved Uptake of Modern provider-balanced counseling meeting was Child Birth Spacing Methods held with these health care providers in Through Provider-Balanced the third month of the cycle. The meeting Counseling Meeting in Ajeromi- helped build the capacity for proper FP Ifelodun LGA, Lagos State counseling using standard guidelines.
AUTHOR: Onyedikachi Ewe Result/key findings PRESENTER: Onyedikachi Ewe In the first and second month of EMAIL: [email protected]; intervention, uptake was lowest (54 and PHONE: 08030523557 125 for January and February, respectively) Presented at 2016 Nigeria Family Planning but steadily increased after the third Conference, Abuja, Nigeria, November 7-9, 2016 month once providers were coached on balanced counseling strategy (BCS). Background The trend in method uptake showed a The contraceptive prevalence rate in substantial and steady increase in the Nigeria still ranks among the lowest in the number of clients taking up a method world at 10%. This is attributed to poor after the BCS update with figures of accessibility of family planning services, 458, 469, 480 623 from March to June. social support and provider skills. To The providers meeting also addressed address these challenges, the United States other FP challenges such as the cost Agency for International Development of FP services, provider absenteeism, (USAID) designed the Expanded Social stock out issues and others. Marketing Project in Nigeria (ESMPIN). ESMPIN has been working in the family Conclusion planning and reproductive health sector Balanced counseling is key to family in Nigeria since 2011 to create demand planning method uptake. This can only be for modern child spacing methods and achieved by continuous training of health child survival products. The project uses care providers. Provision of consumables Interpersonal communication (IPC), should also be made to health care providers specialized sessions and male involvement alongside the free commodities in the meetings among other strategies. public sector as a means of driving down Balanced cost of FP services. This will encourage counseling is Description of Activity method uptake among clients who are key to family ESMPIN IPC program was implemented in willing to take up a method but cannot planning Ajeromi Ifelodun LGA within a six-month afford to pay for these consumables. method uptake. intervention cycle (January to June 2016). This can only Five referral health facilities for family be achieved planning services were selected within the by continuous intervention communities. Referral forms training of issued to willing IPC contacts were retrieved health care on a weekly basis, analyzed and documented. providers.” However, to improve provider skills, a 24 ESMPIN Book of Abstracts SECTION SECTION Book of Abstracts ESMPIN 25
SERVICE PROVISION
With regards to ESMPIN’s service provision activities, abstracts were also developed and presented at conferences. The SFH strategy for improving the access to child spacing and child survival commodities involved a robust commodity logistic plan. The ESMPIN project leveraged the SFH supply chain platform built over a relatively long period of time and with a track record of widespread distribution, to the admiration of many donors. The ESMPIN project approach to improve access to commodities at the consumer level are the product sales/distribution to service delivery points and direct service provision through community health extension workers (CHEWs) and community-based delivery agents (CBDA)—the latter led by the ARFH team. CHEWs who were not employed were identified within intervention communities and trained to conduct ESMPIN IPC. They were further trained on FP service provision with curriculum designed from the FMoH CHEW Training Manual. Trained CHEWs offered family planning commodities that included condoms, oral pills, emergency contraceptives, CycleBeads and injections. The CHEWs went through the intervention communities conducting IPC sessions and providing counseling and on-the-spot service for IPC contacts willing to take up a short or medium term FP method, thereby saving the contacts transport cost (time and money) incurred when referred to the health facility. The CHEWs also work closely with referral HFs to refer contacts who desire long term (insertion) methods as well as to dispose of wastes. Regarding ESMPIN’s activities on service provision, several abstracts were developed and presented at conferences. 26 ESMPIN Book of Abstracts SERVICE PROVISION Book of Abstracts ESMPIN 27
baseline and the evaluation was higher well as access to and utilization of quality ABSTRACT in rural areas (12.3%) when compared family planning and reproductive health with urban areas (9.9%). No significant services (NDHS 2013). However, these Changing Patterns of Barriers to Method difference was noticed as regards figures are much worse in northwestern Family Planning Method Uptake Secondary analysis was conducted using to “opposition to FP” in both rural and Nigeria (3.6%), where negative traditional in Intervention Communities responses from women aged 15-49 years, urban areas. Age of respondents was also perspective, religious and socio-cultural of Selected States of Nigeria who were either married or in a union recorded to affect the change in barrier beliefs and myths about contraceptive from two cross-sectional surveys that were pattern of FP; with persons aged 30-39 use are deeply entrenched. This is further AUTHORS: 1Ohemu Benson, 2Ijaiya Mukhtar, held in 2011 (2002 respondents) which years more influenced by IPC work. compounded by inadequate healthcare 1Daini Babajide, 1Fajemisin Oluwole, 1Boladale acted as baseline to the intervention, and services in hard-to-reach rural communities. Akin-Kolapo, 1Society for Family Health, 2016 (1451 respondents) to evaluate the Conclusion Community-based distribution (CBD) 2Association for Reproductive and Family Health interpersonal communication strategy. The findings from this study showed that programs have been used to bridge the gap PRESENTING AUTHOR: Ohemu, Benson Responses to questions on current use of as people move from self/social opposition in hard-to-reach rural areas where there is EMAIL: [email protected] family planning and reasons for not using to FP with effective IPC strategies, they inadequate access to both public and private PHONE: 08073896619 were analyzed and compared between these are possibly moved towards seeking healthcare services. Thirty trusted members Presented at 2016 Nigeria Family Planning two survey respondents. The surveys employed methods and thus method related barriers of local communities from each of the Conference, Abuja, Nigeria, November 7-9, 2016 multistage sampling to select respondents increased. There is a need to address selected Expanded Social Marketing Project across project sites. Data in both surveys was method-related concerns (access, cost, in Nigeria-CBD local government areas captured with a semi-structured interviewer- health concerns) especially in rural areas (LGA) in four North Western states of Jigawa, Background administered questionnaire using a personal and among those between 30-39 years. Katsina, Kebbi and Zamfara were trained as Over the years, stakeholders in Nigeria digital assistant and analyzed with STATA 14. CBD agents (CBDAs). They were trained to have used several approaches to increase conduct one-on-one and group interpersonal the modern contraceptive prevalence rate, Results ABSTRACT communication (IPC) sessions, distribute presently estimated at 11% (NDHS 2013), Results show that the major contributor short-term family planning (FP) methods and with little success. A major reason for the to non-use of FP in the selected states was A Study Evaluating the Effectiveness refer individuals for long term FP methods. low uptake of family planning methods as “wanting to have children.” The percentage of the Community-Based Four years into the project, an evaluation of seen in the 2013 NDHS have been barriers who wanted to have children was about Distribution Strategy in Increasing the effects of the intervention was conducted. offered as reasons for not using a family 40% (baseline: 38.04%, end-line: 43.93%); Contraceptive Prevalence Rate in planning method. The most common some reported not being in need for FP Rural North-Western Nigeria Objective barriers have been desire for pregnancy, (baseline: 23%, end-line: 18.61%); and This study evaluates the effectiveness opposition to family planning and health others mentioned other barriers related to AUTHORS: Ijaiya Mukhtar1, Daini of the CBD intervention designed to concerns about family planning methods. several opposition to FP and method-related Community- Babajide2, Iheoma Chukwunonso2, increase modern contraceptive method The USAID-funded Expanded Social barriers (baseline: 26.11%, end-line: 32.9%). based Anibi Adedotun2, Fajemisin Wole2 utilization amongst hard-to-reach rural Marketing Project in Nigeria (ESMPIN) Among those who had reported barriers distribution 1Association for Reproductive and Family populations of four northwestern states. worked to reduce identified barriers to of opposition and method-related barriers, (CBD) programs Health, 2Society for Family Health family planning through information, it was observed that individuals within have been used PRESENTING AUTHOR: Ijaiya Mukhtar Methodology education and communication using its intervention communities had a reduced to bridge the EMAIL: [email protected] A population-based, cross-sectional survey interpersonal communication strategy. opposition to FP; approximately about gap in hard-to- PHONE: 08058608298 was conducted in two randomly selected CBD 5%-point difference (baseline: 17.55%, reach rural areas Presented at 2016 Nigeria Family Planning intervention communities and two corre- Objective end-line: 12.13%) and percentage of where there Conference, Abuja, Nigeria, November 7-9, 2016 sponding contiguous control communities This study was carried out in order to persons who mentioned health concerns/ is inadequate with similar characteristics from the same determine what changes had occurred method related concerns reason rose access to both Background LGAs in the four states. Consequently, a total after the implementation of the strategy in (baseline 8.56%, end-line 20.73%). public and private The country’s low contraceptive prevalence of eight intervention communities and eight selected states of Nigeria (Akwa-Ibom, Bauchi, The difference in proportion of women healthcare rate of 11.1% for modern methods is control communities in eight LGAs (two Edo, Kaduna, Lagos, Oyo and Sokoto states). stating method-related reasons between services.” largely due to inadequate information, as LGAs per state) were selected. Based on an 28 ESMPIN Book of Abstracts SERVICE PROVISION Book of Abstracts ESMPIN 29
CBD: 32.1%; P<0.001), with 26.6% of on maternal and child health. ESMPIN uses tors (HCCs) who assess the quality of mes- them mentioning CBDAs as their source behavior change communication (BCC) sages delivered. Being an integrated project, of information as opposed to 4.7% in strategy, which actively seeks to change topics discussed are centered on FP/Malaria the control communities. There was behaviors by altering the social context for the first three months of a cycle and on a significantly higher level of ever-use in which behavior occurs. This strategy FP/diarrhea for the remaining three months. (CBD: 15.7%; Control: 3.5%; P<0.001) and emphasizes the need to deliver messages The IPCAs are monitored by HCCs two or current-use (CBD: 9.1%; non-CBD: 2.0%; in a phased manner in order to take three times a month where HCCs directly P<0.001) of modern contraceptive methods audiences from “lack of knowledge,” which observe IPC sessions and score IPCAs on in the intervention communities. Of those requires basic awareness raising activities, different areas including persuasion of target currently using family planning methods to “sustained behavior change” which audience (M/WRA), recall of key messages by in the intervention communities, 15% requires specific information on services target audience, and supervision. The su- mentioned CBDAs as their source of access and reinforcement of the individual and pervision component comprises of building and the key informant who suggested its use. social benefits of behavior change. ESMPIN rapport with target audience, relevance of uses Interpersonal Communication (IPC) to message to target audience, message delivery Conclusion reach men and women of reproductive age and functional performance. At the end of The CBD approach increased the knowledge (M/WRA) in order to generate demand for the sessions, referral cards for FP services and practice of modern family planning modern family planning (FP) method uptake, are provided to the M/WRA upon expressing methods in hard-to-reach rural areas of among other project areas. Occasionally interest. Successfully completed referrals northwestern Nigeria. An institutionalization during IPC sessions, quality of messages were afterwards redeemed (or retrieved) from and integration of CBD programs into is reduced, hence, the need for supportive referral facilities within the intervention existing healthcare framework represents supervision to ensure M/WRA receive communities. The data presented was collect- an opportunity to sustain these gains qualitative FP messaging and services. ed from January-June 2016 in Ogun state. during post-project implementation. Methodology Results ESMPIN’s community IPC implementation The monthly figures from Cycle 9 were assumption of 50% expected frequency and ABSTRACT activities run in cycles of six months. During analyzed to see performance trends of IPCAs. 95% confidence level, a minimum sample this period, IPC is conducted by trained IPC From the observation, IPCA performance of 400 men and women of reproductive age The Influence of IPC Supervision Agents (IPCAs). These IPCAs are supervised by seems to be improving on a monthly basis. (15-49 years) were systematically sampled in in Improving Access to Health ESMPIN Health Communication Coordina- The supervision score average showed a each group. The survey was conducted in May Facilities for Modern Family steady increase from 2.2 in January to 2.7 in 2015, with the data captured via a semi-struc- Planning Services in Ogun State June. A similar trend was seen for persuasion tured interviewer-administered questionnaire score average and recall score average. AUTHOR: Ofoegbu C., Egbeleke O., Ohemu B., using a personal digital assistant. Analysis INDICATOR JAN FEB MAR APR MAY JUN The number of referral cards redeemed was conducted using bivariate analysis Akin-Kolapo B. PRESENTER: Ofoegbu C. Society against set target also showed an increase with significance testing using Stata 13. for Family Health, 8 Port-Harcourt Crescent, Supervision Score Average 2.2 2.4 2.6 2.7 2.7 2.7 from 17% to 113% between January and June. Area 11, Garki, Abuja EMAIL: cofoegbu@ Results/Key Findings sfhnigeria.org PHONE: 07030968489 Persuasion Score Average 2.3 2.3 2.4 2.5 2.6 2.7 Conclusion Intervention and control groups were Presented at 2016 Nigeria Family Planning The findings from the study showed that with comparable for most background Conference, Abuja, Nigeria, November 7-9, 2016 Recall Score Average 1.4 1.6 1.7 2.0 2.0 2.0 supportive supervision, IPCAs’ performance characteristics: age, sex, marital status improved over time, contributing to more and occupation; and different for level of Background people going to referral facilities to take up education and mobile phone possession. Expanded Social Marketing Project in Nigeria INDICATOR JAN FEB MAR APR MAY JUN modern FP methods. There is therefore a Residents of the intervention communities (ESMPIN) implemented by Society for Family Referral Cards Redeemed need to encourage supportive supervision were more likely to be aware of family Health works in 22 states of Nigeria where Against Target 17% 23% 55% 87% 117% 113% during IPC sessions to ensure M/WRA planning methods (CBD: 55.5%; non- it conducts demand generation activities receive qualitative FP messaging and services. 30 ESMPIN Book of Abstracts SERVICE PROVISION Book of Abstracts ESMPIN 31
ABSTRACT ABSTRACT
Expanding Availability, Access and the Nigerian society. The social marketing Greater Impact at a Lower Cost: Methodology Partnership in the Private Sector component has been implemented in 36 Prioritizing Support to Patent and The project uses two data sources through Social Marketing states and FCT since 2011. The project Proprietary Medicine Vendors to classify providers: engages with patent and proprietary for Increased Quality Fever Case AUTHORS: Ogechi Onuoha, Boladale Akin-Kolapo, medicine vendors, pharmacies, private Management in Ebonyi State, Nigeria 1. Case management performance obser- Jennifer Anyanti, Nkiru Anonyuo, Joy Ede health facilities and medical professional vations to classify providers into three PRESENTING AUTHOR: Ogechi Onuoha associations. It conducts advocacy, FP/ AUTHORS: 1Victor Lara, 2Ogechi C. different groups (good, average and poor). EMAIL: [email protected]; Ogechi. RH training, product detailing, clinical Onuoha, 1Martin Dale, 2Akin-Kolapo B. [email protected] PHONE: 08037922489 presentations, opening of new service Nurat, 1Martin Bell 1Population Services 2. Commodity stock tracking as a proxy Presented at 2016 Nigeria Family Planning delivery points and FP product enlistment International, 2Society for Family Health of caseload, to separate PPMVs into two Conference, Abuja, Nigeria, November 7-9, 2016 in national drug formulary. This is done AUTHORS: 1Victor Lara. Presented at American groups according to productivity (high to increase provider knowledge, address Society of Tropical Medicine and Hygiene = PPMVs accruing 80% of the overall provider bias, influence adoption of positive 64th Annual Meeting 2015, Philadelphia, caseload and low = the remaining 20%). Background FP service delivery behavior for providers Pennsylvania, USA, October 25-29, 2015 Nigeria has a contraceptive prevalence and increase FP product outlets, especially The analysis yields a performance vs. rate of 15% and a national plan to increase in rural and hard-to-reach locations. Data Background productivity matrix that helps prioritize CPR to 36% by 2018. An assessment of on these activities are captured on DHIS and In Ebonyi state, Southeast Nigeria SFH, PSI providers for support, focusing first sources of FP commodities reveals that the activities are regularly evaluated through and MalariaCare are working to improve on those with a higher caseload and private medical sector is the most common surveys to access performance and outcome. quality integrated community case lower performance. This classification source for users of modern contraceptive management of childhood illness (iCCM) enables a more focused and tailored methods, serving 60% of users of FP. This Results in two local government areas (LGAs) by monitoring effort towards those 60% is largely through social marketing. More than 14 million CYPs were generated strengthening the capacity of 325 private providers who will benefit the most. Social marketing uses marketing techniques through socially marketed contraceptive patent medicine vendors (PPMVs). The project has launched an innovative to influence the voluntary behavior of commodities. More than 5,000 new PPMVs are often the first place people go approach called Health Network Quality the target audience for health benefits. FP service delivery points have been when they seek care for basic health needs. This Improvement System (HNQIS). This system Expanding Expanding partnership and capacity of the established, and more than 50,000 PPMVs includes drugs to treat common childhood will be used to collect data to monitor, track partnership private medical sector has the potential to were trained on FP and reproductive health. illnesses such as malaria, diarrhea and pneumo- and improve quality of iCCM at PPMV level. and capacity increase availability of commodities, access Maintenance of a strong private sector FP nia, which are common causes of death among The system is based on the development of the private and uptake of quality FP services in Nigeria logistic supply system was also developed. In children under five years. The PPMVs have wide of a District Health Information System medical leading to higher met needs and better CPR. addition, all relevant professional medical coverage and reach to rural localities where (DHIS2)-enabled tablet-based solution sector has associations are engaged on FP, including health facilities or licensed pharmacies do that operates off an Android application the potential Objectives the Nigerian Medical Association, the not exist. Increasingly, evidence from national and it is fully functional without internet to increase Building private medical sector partnerships National Association of Nigerian Nurses surveys such as ACT Watch and the National connectivity. This technologically-driven availability of and capacity for better FP services. and Midwives and the Pharmaceutical Demographic and Health Survey show the sig- system is principally focused on enabling commodities, Society of Nigeria, among others. nificant roles of this cadre of private health pro- supervisors and project managers to: access and Methodology viders in the health and well-being of the gener- uptake of The ESMPIN project implemented by Conclusion al population. This growing recognition comes Effectively plan their support visits quality FP Society for Family Health (SFH) employs The social marketing approach of the with concerns over their capacity for correctly to PPMV outlets prioritizing where services in a social marketing model to influence project is strengthening the FP private diagnosising, and correctly using drugs, as support is required, and where Nigeria leading voluntary adoption of positive FP behavior sector landscape in Nigeria, building well as the overall quality of care offered by it will have the most impact to higher met change among Nigerians, especially in partnerships, strengthening capacity PPMVs. Large-scale support systems available needs and rural and hard-to-reach communities, in and increasing product reach and for PPMVs are currently incomplete, and often Undertake assessments with comparable better CPR.” order to improve their health and that of access for FP across the nation. do not emphasize quality of care aspects. scoring and benchmarking mechanism 32 ESMPIN Book of Abstracts SERVICE PROVISION Book of Abstracts ESMPIN 33
Consistently and effectively provide feedback Result and key findings methods. In addition, the state government brainstorming sessions, illustrative lectures, and coaching following quality assessments The project implementation is at the reduced its annual budget for FP consumable individual and group exercises, role play/ commencement stage and has not generated to a paltry hundred thousand Naira case studies, simulated practice/ guided Monitor performance of providers results and key findings. However, the project (N100,000.00). The few trained LARC clinical activities, demonstrations and over time in order to understand the has received the collaborative support of health HCPs were discouraged to practice return demonstrations. After, they received return on their support efforts Nigeria’s federal ministry of health and the as community members advocate for three supportive supervision visits (SSV) support of Ebonyi state ministry of health. lower price or free FP services. Religious by master trainers in their facilities. HSDF The system consists of four modules The commitment of 325 PPMV shop owners beliefs which discriminate against modern collected data from all health facilities designed to support the focus areas to participate in the pilot study has been contraceptives have contributed to the and keyed it into the DHIS for the state. mentioned above: Plan, Assess, Improve and received. The project has trained 32 state lower LARC adoption rate. This is reflected Monitor, respectively. Supervisors will be using level trainers and supervisors. The training in the CPR of Imo state for any method at Results/key findings the modules to assess and improve during on- of 325 enlisted PPMVs on iCCM will be 40.6 % and modern method at 10.6%. In The collaboration between the two site supervision visits, using these observations held October 2015. Case management by 2015, only 330 IUCDs and 49 implants organizations has improved the acceptance to assess providers’ performance in iCCM and the PPMVs will commence following the were inserted across Imo state (DHIS). of LARC in Imo state. Imo 2015 LARC improve PPMVs’ case management through training. The assessment of the PPMVs data from DHIS shows 330 IUCD and 49 the provision of a standardized feedback. using the HNQIS system to monitor, track Methodology implants. However, between January-June The plan module automatically calculates and improve the capacity of the PPMVs SFH USAID-funded ESMPIN project 2016, LARC uptake stands at 799 IUCD and the date of the next supervision visit taking will commence following the training. targets hard to reach men and women 4813 implants. This shows an astronomical into account two factors: quality (the score of reproductive age (WRA) in rural percentage increase of 142% for IUCD and obtained from the on-site supervision visit) and communities with FP Behavior Change 9729% for implants in just six months. productivity (the client load reported by each ABSTRACT Communication (BCC) messages in order PPMV) and offers a way to prioritize PPMVs to create a burst of demand for FP products, Conclusion/next steps with poor quality and high client load versus Strategic Partnership Linking which are made available through SFH. Marie With the knowledge and skills upgrade of PPMVs with good quality and low client load. Behavior Change Communication Stopes Nigeria (MSN) has USAID funding the HCPs in LARC, coupled with sustained The data is seamlessly integrated with Skilled Service Provision in to implement the Family Health Plus (FH+) BCC messaging, acceptance of LARC in Imo into the monitor module that offers an LARCs: The Story of SFH-USAID FH USAID- project with a focus on training public health state increased considerably, showing that overview of key performance indicators to ESMPIN and MSN-USAID FH+ in funded ESMPIN providers to provide LARCs. FH+ project availability of knowledge and skills impart drive strategic decision-making based on Obowo LGA of Imo State, Nigeria project targets commenced in Imo state in February 2016. positively on unmet needs for LARCs and evidence at project management level. hard to reach Twenty-two interpersonal communication otherwise. Accurate record-keeping by a AUTHORS: 1Ibekwe Samuel O., 1Kelly Ikechi men and women agents (IPCAs) were selected and trained by dedicated manager also results in quality Hypothesis Mbakwem, 1Affiah Nsikan, 2Dr. Chideraa of reproductive SFH on BCC using the dialogue framework data and better decision-making. This model The pilot seeks to determine if providing Chukwu, 3Ikechukwu Okoro 1Society age (MWRA) on a colorfully-illustrated flip chat. This should be replicated in all communities training, mentoring and coaching to improve for Family Health, 2Marie Stopes Nigeria, in rural provided sustained mobilization from where LARC unmet need is on the rise. the capacity of PPMVs to manage childhood 3Health Strategy and Delivery Foundation communities house to house, one on one and group fevers (non-complicated cases of malaria with PRESENTING AUTHOR: Ibekwe Samuel O. with FP Behavior meetings with supervision from a SFH health ACTs, diarrhea with ORS and Zinc and pneu- EMAIL: [email protected] Change communication coordinator. Referrals to monia with antibiotics). Strict supervision PHONE: 0803 3460422 Presented at Communication HFs were issued by the IPCAs to potential will ensure compliance to case management 2016 Nigeria Family Planning Conference, (BCC) messages clients. FP registers at the HFs were used standards, thereby reducing the morbidity Abuja, Nigeria, November 7-9, 2016 in order to to capture uptake data while SFH retrieved and mortality among children under five create a burst dropped referral cards and cross-checked years caused by PPMVs’ poor competence and of demand for them with the HF register. MSN’s FH+ project lack of adequate supervision in management Background FP products, trained 120 providers from 118 facilities of childhood fevers. The pilot will equally Imo state lacks trained health care which are in 27 LGAs of Imo state for six days (four- facilitate regular commodity supply for providers (HCP) on long-acting reversible made available day classroom session and two days field childhood fever management to the PPMVs. contraceptive (LARC) family planning (FP) through SFH.” practicum). Training used discussions/ 34 ESMPIN Book of Abstracts SERVICE PROVISION Book of Abstracts ESMPIN 35
ABSTRACT
Comparative Analysis of Facility reinvigorate the discourse on accelerating Type and Product Preferences for family planning uptake in Nigeria. Family Planning Services in Two Rural Communities in Nigeria Methodology The study was conducted in two rural AUTHOR: Chukwunonso Gerald Iheoma, communities in Imo state – Uratta (Owerri Kelly Augustina Mbakwem North LGA) and Mgbidi (Oru West LGA). PRESENTER: Chukwunonso Gerald Iheoma, Data was sourced from three private and Society for Family Health, Plot LM Garden eight public facilities that offer family Estate, MCC/Uratta Rd. Owerri Imo State planning services in Uratta and from six EMAIL: [email protected] private and 10 public facilities in Mgbidi. [email protected] The study covered a period of eight months, PHONE: 08066131735. Presented at from February to September 2014. A total 2014 Nigeria Family Planning Conference, of 780 WRA were sampled from Uratta, Abuja, Nigeria, November 26-28, 2014 while 277 WRA were sampled from Mgbidi. Comparative analysis approach was Background employed to analyze clients’ facility and The types of health facilities and family product preferences in both communities. planning methods available to clients have been shown to be the determinants for Results acceptance of family planning services. Results showed that both communities shared Empirical evidence shows that family similar preferences for facility type and planning service uptake could be accelerated if method, though in varying degrees. In Uratta, facilities and methods available match clients’ 72% of all service uptake occurred in public preferences. To increase family planning facilities, while 98% of services was accessed service uptake in Nigeria, it is important to from public facilities in Mgbidi. Similarly, understand clients’ preferences in terms of both communities showed strong preference methods and facilities that provide those for pills—Combination 3 accounted for 50% methods in different geographical scenarios. and 35% of all products uptake in Uratta and We compare the facility and product Mgbidi respectively. Standard day methods preferences of women of reproductive age (Cycle Beads) and injectables (Depo Provera) (WRA) in two communities in Imo state. respectively accounted for 20% and 16% of product uptake in Uratta; and 30% and 21% Main research questions in Mgbidi respectively, indicating a strong We pose the following research questions: preference for these products to others. what are clients’ facility preferences between public and private facilities and Contribution to knowledge what are clients’ preferences with respect This study highlights the similarities in facility to available long and short term family and product preferences of clients in different planning methods? Are there differences in geographical settings. Family planning pro- facility and method preferences as a result grammers will now understand the impor- of geographical disparities? This study will tance of prioritizing public health facilities provide evidence-based results that will in facility selection. Concentration of clients’ 36 ESMPIN Book of Abstracts SERVICE PROVISION Book of Abstracts ESMPIN 37
product selection on a few products can be specific fertility rates are as high as 121 and 2011, 30.6% among those with higher- ABSTRACT minimized by ensuring adequate sensitization 225 per 1,000 for age 15–19 and 20–24 education and 1.6% among those with of clients on product availability, benefits respectively. One of the factors underlying Qur’anic education. Use increases with Using Integrated Family Planning and challenges associated with their use. high maternal mortality rates is the low use age but peaks at age 30-39. Rural and and HIV Care, Support and of modern contraceptives. Only 9.7 percent urban use of modern FP is 7.1% and 14.2% Referral Services to Reach More Conclusion of currently married women in Nigeria respectively. Use is higher among the Males in Northern Nigeria Expanding and sustaining family planning use modern methods of family planning. never-married (15.0%) and lowest among programs in Nigeria would require This figure, however, does not reveal those who were formally-married (5.4%). AUTHORS: Omokhudu Idogho; Selema understanding the choices of potential important age, geographic and educational Years (p <.001), educational-attainment Margaret Akuiyibo PRESENTER: Omokhudo clients regarding facilities and products. differences in Nigeria. Several efforts have (p <.001), age (p <.001), locality (p <.001), Idogho, Society for Family Health, Abuja Findings from this study confirm the been made to increase use of modern FP marital status (p <.001), and geographical- EMAIL: [email protected] existence of similar facility and product methods in Nigeria. Have these improved zones (p <.001) are significant variables Presented at 2014 Nigeria Family Planning preferences across different geographical the use of modern FP methods over time? that affects the use. Positive-correlation Conference, Abuja, Nigeria, Nov. 26-28, 2014 settings. Programmatic implications would exists between use and years, education and require extensive collaboration with public Main questions locality. Women with at least a secondary- Background/Objective health facilities for improved service delivery. school education are almost three times This paper seeks to showcase the successful Equally, ensuring redistribution of product Has use of modern FP methods improved? more likely to use a modern FP method; outcomes of integrating family planning preferences from a few products to a wide daily pills or long lasting method compared (FP) referral services into HIV programming range of them would require the capacity Are there geopolitical differences in to those without. Women in south-south amongst the male population of northern building of service providers on proper client the use of modern FP methods? Nigeria are more than three times and five Nigeria. Northern Nigeria is characterized sensitization on product availability and use. times as likely to use a modern method by early marriage, polygamy, patrilineality, What demographic variables are significant and a condom, respectively, as compared and high fertility rates—as high as seven in the use of modern FP methods? with those in northwestern Nigeria. children per mother with a concomitant ABSTRACT contraceptive prevalence rate of 3%. On Methodology Knowledge/ contribution results account of these peculiarities, family Patterns and Trend in Data for this study was obtained from The use of modern contraceptives has planning is most crucial in this region Contraceptive Use in South- four waves: the National and State Specific increased in both south-south and which has a significant level of illiteracy, South and North-Western Zones HIV&AIDS, Reproductive and Child Health northwestern Nigeria. However, there are still poverty, as well as few men who make the of Nigeria: 2003 – 2011 survey (2003, 2005, 2007 and 2011). The differences across age, educational attainment, most critical decisions regarding the family. survey is a population-based study among fe- locality, geographical zones and marital status. AUTHOR: Onoriode Ezire1; Samuel Ikani2; males (15-49 years) and males (15-64 years) Despite the religious and cultural Method Ajibade Theophilus3 1, 2. Society for Family living in households in rural and urban barriers associated with condoms, it is Enhancing Nigeria’s response to HIV & AIDS Health, Nigeria; 3 Population Council, Nigeria areas in Nigeria. Multi-stage cluster sam- still the most preferred source of family (ENR) program data was used to analyze the PRESENTER: Onoriode Ezire, Society for pling technique was used in the selection of planning (5.2%). Considering that condoms significant improvements in FP services within Family Health, No.8 Port Harcourt Crescent, respondents drawn from the updated mas- offer dual protection, scaling up the use of its HIV program in Benue and Nasarawa states. off Gimbiya St. Area 11 Garki, Abuja, ter sample frame of rural and urban local- condoms as an FP option, especially among Nigeria used interpersonal communication Nigeria; EMAIL: [email protected] ities and developed and maintained by the Despite the the never-married, is recommended. conductors (IPCCs) from the program within Presented at 2014 Nigeria Family Nigerian National Population Commission. religious and Education attainment appears to have three years (2010-2012) of program activity. Planning Conference, Abuja, Nigeria, cultural barriers a positive correlation with the use of November 26-28, 2014 Results associated modern FP methods. It is important that Results Almost one-quarter are age 30-39; one third with condoms, female child education is promoted. Early Statistics showed that in 2011, 226 men were Background lives together; 73.8% live in rural locations it is still the marriage may also need to be addressed, as it referred to health centers for FP services Nigeria is ranked 13th among countries with while 43.3% attained secondary-school most preferred reduces the chances of getting the required in Benue state compared to zero male the highest fertility rates in the world—5.7 education. Use of modern-contraceptives source of family education useful to making informed referral for FP services in 2010. There was births per woman on the average. Age- increased from 7.6% in 2003 to 10.2% in planning (5.2%).” decisions about the use of FP services. a corresponding 32% increase in referral 38 ESMPIN Book of Abstracts SERVICE PROVISION Book of Abstracts ESMPIN 39
services the following year, 2012. Nasarawa Conclusion product distribution and logistic challenges. Results state also showed significant increase from Integrated family planning and HIV Private patent medicine vendors (PPMV) are From Jan 2013 to December 2013, 15 PPMV 0 referrals in 2010 to 771 referrals in 2012. programming are essential to meet not faring better, as most lack knowledge trainings have been conducted, reaching The number of condoms distributed in Benue international development goals and targets, of the products, while those who do have 587 PPMVs. Three sessions of “Storming the state between 2010 and 2011 increased by including the MDGs, since clients seeking knowledge lack access to products since they Nightingale” have been done, reaching 163 128% from 45,242 condoms, and by 50% reproductive health and HIV services share do not know where to buy them. nurses. 1,095 direct medical detailing visits in 2012 to 154,255 condoms. In Nasarawa common needs and concerns. Integrating In view of this, the USAID SFH ESMPIN have been done reaching 1,095 doctors. state, condom distribution increased by 21% these services enables providers to efficiently project implementing FP interventions in These resulted in the following number of between 2010 and 2012. In addition, there and comprehensively address these needs. communities with high unmet FP needs product placements directly and indirectly: was a 319% increase in the number of IEC Moreover, because of socio-cultural interplays designed a program-with-product interven- 34,139,520 pieces of Gold Circle Condoms; materials distributed between 2010 and 2012 in northern Nigeria, family planning services tion to forestall out-of-stock and lack of stock 60,304 pieces of Lifestyle Condoms; 18,288 in Benue state and a simultaneous increase need to focus strategically and systematically situations after demand has been created. pieces of Elegance Female Condoms; 17,010 in Nasarawa state from zero IEC materials on both males and females, taking into bottles of Lubrica; 3,300 units of IUCD; in 2010 to 25,952 IEC materials in 2012. account gender roles in their society. Methodology 472,050 vials of Duofem injection; 121,300 PPMV sites were mapped and selected. vials of Depo Provera injections; 121,000 The PPMVs were identified and selected vials of Noristerat injections; 2,000 pills ABSTRACT alongside other non-traditional outlets of Norigynon tablets; 164,100 pills of (NTO). Programmatic intervention Postinor 2 tablets; 12,600 pills of Pregnon Strategic Product Placement, A included product awareness and knowledge. tablets and 1,600 strings of Cycle Beads. Core Link Between FP Intervention Product placement and distribution were and Service Delivery simultaneously carried out alongside Lessons learned intervention. Providers reported that they did not AUTHORS: Ibekwe Samuel O., Charles Ezebuike, The PPMVs were also trained on have stock-outs, while clients reported Society for Family Health, Imo State, Nigeria stocking of FP and other RH products that they never visited a facility without EMAIL: [email protected] which targeted all the PPMVs within a getting a method of choice. This Presented at 2014 Nigeria Family Planning selected geographic location at the time. way, demand creation and product Conference, Abuja, Nigeria, Nov 26-28, 2014 They were mobilized under the aegis of placement ensured method adoption. their professional association. During the Aims/objectives training, all FP products were sampled and Conclusion To establish the link between product explained. While the PPMVs appreciated From the facts above, it is evident that placement and family planning the over-the-counter (OTCs) drugs, they programmatic interventions without acceptance using a strategically tailored were also warned of the legal implications accompanying products is an exercise product detailing approach targeting of stocking and dispensing the ethical ones. in futility, while product and program FP product sellers and providers. The second approach targeted the service leads to method acceptance. providers who were mobilized through Background Providers their professional associations on zone or “No product, no program” is a popular apho- reported that unit basis. This was tagged “Storming the rism in social development work, especially they did not have Nightingales.” All FP products were sampled in the health sector. This saying is more apt stock-outs, while and explained. A simulated demonstration in family planning interventions particularly clients reported of IUCD and implant insertion was because demand creation hits brick walls in a that they never done using arm and abdo-pelvic models. state of out-of-stock or lack of stock. visited a facility The nurses took turns with simulated Baseline studies in Imo state southeast without getting demonstrations. The last approach was Nigeria show that most PHCs lack products a method of direct detailing visits to medical doctors due to political logjams with government choice.” with product samples and explanations. 40 ESMPIN Book of Abstracts SECTION SECTION Book of Abstracts ESMPIN 41
ADVOCACY & COLLABORATION
One core focus of the ESMPIN program at the national, state and community implementation level was partnership and collaboration. Apart from meetings with government and other relevant implementing partners, achieving community and spousal support was objectively sought through routine advocacy meetings with community level stakeholders. Discussions were held to find unique ways to gain the commitment of men and community leaders to promote the overall health status of families, especially in the areas of family planning, exclusive breastfeeding, malaria and diarrhea. Given that the ESMPIN project worked hard in the area of advocacy and collaboration, various abstracts were developed to showcase activities. These were then presented at conferences. 42 ESMPIN Book of Abstracts ADVOCACY & COLLABORATION Book of Abstracts ESMPIN 43
ABSTRACT ABSTRACT Mobilizing Spousal Support for FP generation activities on maternal and child tion (IPC) agents. Their job was to raise family Uptake: Facilitators and Barriers to health. The community demand generation The Role of Community Stakeholders planning awareness and refer community Family Planning Uptake in Nigeria activities run in cycles of six months. One in Facilitating Family Planning members to health facilities within their lo- approach used is the male involvement ses- Uptake: A Case Study of ESMPIN cality. Capacity-building forums such as town AUTHORS: Ogechi Onuoha, Benson Ohemu, sions conducted by trained health communi- Intervention in Cross River State hall meetings (THM) and male involvement Boladale Akin-Kolapo, Joshua David, cation coordinators (HCCs). The HCCs work sessions were carried out while implementa- Pascaline Nnorom, Kelechi Mbakwem through the community leaders to form AUTHORS: Nnorom Ngozi Pascaline, Comfort tion was monitored through demand creation PRESENTING AUTHOR: Ogechi Onuoha male groups that did not previously exist and Runyi Oyom PRESENTER: Nnorom Ngozi and service provision. Male involvement EMAIL: [email protected]; Ogechi. this intervention targets two different male Pascaline EMAIL: [email protected] sessions were also conducted to sensitize men [email protected] PHONE: 08037922489 groups in each community. The data present- PHONE: 07030669790 Presented at on their roles in family planning and to make Presented at 2016 Nigeria Family Planning ed was collected from January-June 2016. 2016 Nigeria Family Planning Conference, them more supportive towards their spouses Conference, Abuja, Nigeria, November 7-9, 2016 The male sessions were organized to Abuja, Nigeria, November 7-9, 2016 in taking up FP. Baseline and end line data change social norms around male involve- for FP uptake were sourced from the family Background ment in women’s health. Topics discussed Background planning registers of the 27 referral facilities Nigeria is Africa’s most populous nation with at meetings included role of men during This study assesses the role of community in the two LGAs for the period of intervention. a population of 173 615,0004, a total fertility pregnancy, labor and child spacing. stakeholders in facilitating family planning rate of 6.0 and 7,173,0005 annual births. The Referral cards for family planning services (FP) uptake among men and women of Results country also has a contraceptive prevalence were provided to the men upon expressing reproductive age in two local government The project witnessed an increase in number rate of 15%, maternal mortality at 58,000 interest. These male groups held planned areas (Boki and Akamkpa) of Cross River state. of women of reproductive age who accessed and lifetime risk of maternal death is one in interactions designed to increase social FP services from a base line of 59 in Boki (June 227. A comparison of Nigeria’s family plan- support. They endorsed and carried messages Program Area 2015) to an end line of 3,765 by December ning (FP) indices shows that the country is of greater male involvement in their commu- The Expanded Social Marketing Project in 2015. In Akamkpa, an increase in FP uptake below sub-Saharan Africa averages. In Nigeria, nity. Nigeria (ESMPIN) is a USAID-funded project rose from 61 in December 2015 to an end female use of FP methods is influenced by focusing on improving the health of women line of 3,973 by June 2016. This was recorded husbands/male partners. In communities, Results and children in Nigeria. ESMPIN intervention from both private and public health facilities. men are known as bread winners and hold In the 22 locations, 302 male sessions were strategy involves stakeholders at the com- Despite the increase in demand for condoms decision-making powers, while women are held with an average of 20 participants per munity level to advocate for family planning by males, there was also a marked increase perceived as implementers of these decisions, session. The strategy improved men’s FP practices through its cycle town hall meeting in demand for other long-lasting methods of often without questioning them. Often, these knowledge and understanding of their role (THM) and male involvement sessions to family planning from 59 in June 2015 to 3,353 men are excluded from FP programs and in women and children’s health, addressing address possible barriers that can affect the in December 2015 in Boki and 61 in December interventions where the majority of activities myths and misconceptions. Men take up FP overall goal of the project. These issues are: 2015 to 3,789 in June 2016 in Akamkpa LGA, focus on women. Lack of spousal support is a referral cards for their wives/partners and lack of trained providers, perceived high which excludes barrier methods. An enabling barrier to acceptance and uptake of FP coun- have become champions in their communities cost for FP services and decline by spouse as environment was created throughout the selling and services. Male involvement will fa- due to the information and understanding An enabling a result of traditional and religious norms. intervention as a result of involving of cilitate improved acceptance and uptake of FP. gained at the sessions. In the period, the proj- environment community structures from the inception. ect recorded 106,478 redeemed FP referrals was created Methodology This saw a total of 16 community outreaches Objectives and 69,950 method uptake; support from the throughout the The intervention was carried out in Boki and carried out in the period of intervention Increase support among men for FP and male sessions contributed to this achievement. intervention Akamkpa LGAs of Cross River state for six- in Boki LGA and an insertion of a total greater participation in women’s health. as a result of month cycles, respectively, between July 2015 number of 1,884 LARC despite the shortage Conclusion involvement and June 2016. Community structures like the of trained service providers in the LGA. Methodology Male involvement sessions are strength- of community WDC and faith-based leadership were carried The ESMPIN project implemented by SFH ening spousal support for women structures from along in the selection as well as recruitment works in 22 states where it conducts demand to access FP counselling services in the inception...” and training of Interpersonal Communica- the intervention communities. 44 ESMPIN Book of Abstracts ADVOCACY & COLLABORATION Book of Abstracts ESMPIN 45
groups addressed some of the misconceptions Conclusion preventing spousal support to family planning. Male involvement sessions and town hall The ESMPIN Project is designed to reach six dif- meetings help address possible barriers to FP ferent male groups within a cycle (six months). uptake by women of reproductive age. Pro- Each male group is reached for three months gram implementers should adopt innovative with messages on male support during pregnan- ways to engage community stakeholders cy, labor and delivery ,as well as family planning. for improved FP uptake in the country. Objectives ABSTRACT To assess the impact of male involvement on family planning method uptake. Male Involvement: A Key Factor in Promoting the Use of Family Method Planning Uptake Among Women Trained IPCAs on behavior change communi- cation reached males within the community AUTHORS: Kelly Mbakwem, Samuel along with women of reproductive age. Addi- Ibekwe, Dr Eze Nwokoma, Affiah Nsikan tionally, the male groups from the communi- PRESENTING AUTHOR: Kelly Mbakwem ties were identified and visited during their EMAIL: [email protected] monthly meeting. The team discussed male PHONE: 08037779279 Presented at 2016 support for women during pregnancy, labor Nigeria Family Planning Conference, and child spacing for three months. Six male Abuja, Nigeria, November 7-9, 2016 groups with a minimum of 20 people each were reached with targeted messages to identify and Introduction address challenges affecting spousal support. The 2013 Nigeria Demographic and Health Survey (NDHS) shows that in Imo state, the Results contraceptive prevalence rate for any family The monthly figures from Cycle 5 to Cycle 8 were planning method is 34.1% and for any modern summed to evaluate the performance trend after family planning method was 10.7%. This indi- or within the third month of male involvement cates that the adoption of modern methods sessions for child spacing. It was discovered is low. In a bid to address this GAP, USAID de- that when the IPCAs conducted sessions in the signed the ESMPIN project, a social marketing first three months, the uptake level, which was project that contributes to USAID’s develop- 135 on the first month, increased to 995 on the ment objective of improving the health of third month when it came to male involvement women and children in Nigeria, primarily by in child spacing. This upward trend increased Before the increasing the use of modern family planning until the end of the project which showed 2,061. intervention methods and secondarily by increasing use of the ESMPIN of child health products in Nigeria. One of Conclusion project, the the project components is to ensure male ESMPIN intervention reaching male groups major challenge participation through a series of activities like has demonstrated an increase in family affecting the male involvement sessions and IPC sessions planning uptake. This is reflected by the adoption of reaching males. Before the intervention of the increased method uptake shown in four family planning ESMPIN project, the major challenge affecting consecutive cycles from five to eight. The was on lack of the adoption of family planning was a lack male involvement promoted spousal support spousal support. of spousal support. The sessions with male and complements other key factors affecting 46 ESMPIN Book of Abstracts ADVOCACY & COLLABORATION Book of Abstracts ESMPIN 47
family planning uptake in Imo state. into program development and delivery. uptake of modern family planning methods. ABSTRACT Conclusion Method in Imo state. Panel data analysis method The acceptance, success and sustainability A strategic partnership was formed between Building Alliances for Improved was adopted and secondary data for a of family planning programs would the SFH-led ESMPIN project and a mobile Family Planning Uptake in Nigeria: period of eight months, between February depend on full involvement of MRA as FP outreach team from Marie Stopes Inter- Enhancing Male Involvement and September 2014. Data was extracted findings reveal that their involvement has national Organization Nigeria (MSION). from the family planning records of the 27 a positive and significant correlation with ESMPIN focused on creating demand AUTHOR: Chukwunonso Gerald Iheoma (nine private and 18 public) health facilities service uptake. Successful interventions through its interpersonal communication PRESENTER: Chukwunonso Gerald Iheoma, that provide family planning services in on family planning would require the (IPC) strategy, which is based on behavior- Society for Family Health, Plot LM Garden those communities. Twenty samples of maximization of male contacts and referrals. al change communication theory. On the Estate, MCC/Uratta Rd. Owerri Imo State EMAIL: male contacts, male referrals and service other hand, the mobile FP outreach team of [email protected]; ciheoma@sfhnigeria. uptakes were collected each month, totaling ABSTRACT MSION focused on service provision of Long org– PHONE: 08066131735. Presented at 160 samples. We developed a multiple Acting Reversible Contraceptives (LARC). FP 2014 Nigeria Family Planning Conference, regression model expressing service Increased Uptake of Modern Family outreaches were organized monthly in three Abuja, Nigeria, November 26-28, 2014 uptake as a function of male contacts, and Planning (FP) Methods – Lessons from mapped communities in Sagamu LGA. IPC referrals issued to men. We then used the Collaboration Between Implementing agents under the ESMPIN project engaged Background ordinary least square analysis technique Partners (IPs) in Sagamu Local contacts through IPC and referred willing Most family planning interventions tend to estimate the parameters of the model. Government Area (LGA), Ogun State clients to health facilities, where MSION to place low recognition on the role of provided FP service at no cost to the clients. Empirical men in family planning decisions during Results AUTHOR: Egbeleke O. PRESENTER: Egbeleke O. evidence has program development and delivery. This Results showed a positive correlation between EMAIL: [email protected] Outcome shown that latent disregard for the decisive role of men male contacts, referrals issued to men and PHONE: 08060438176 Presented at As obtained from the FP registers of the family planning in determining family size is based on the total service uptake. At 5% level of significance, 2016 Nigeria Family Planning Conference, health facilities where the outreaches programs tend assumption that family planning decisions an increase in male contacts by 1% caused Abuja, Nigeria, November 7-9, 2016 took place, FP uptake more than doubled to succeed with are exclusively the prerogative of women. total service uptake to increase by 0.43% (prob. across communities within Sagamu full integration Empirical evidence has shown that family = 0.048). Similarly, a 1% increase in referrals NOTES Background LGA in the months when FP outreaches of men, mainly planning programs tend to succeed with full issued to men led to a 0.2% (prob. = 0.033) In Ogun state, though 99% have heard of a were conducted, compared to previous 1 Nigeria, (2013) National at the program integration of men, mainly at the program increase in total service uptake. If both male Demographic Health modern FP method, modern contraceptive months when no outreaches were held. implementation implementation level. This study evaluates contacts and male referrals were increased Survey, NPC, Abuja prevalence rate (CPR) for women in the state level.” the effect of male involvement on acceptance simultaneously by 1%, for example, their joint 2 Ibid was at 21.5% (2013 NDHS).Many factors have Conclusion
of family planning services in Imo state. effect was a 0.63% increase in service uptake. 3 National Cancer Institute, been associated with this low uptake, some of This experience has shown that though other (2005) Theory at a Glance: A When compared with male referrals, male Guide for Health Promotion which include inadequate demand creation barriers to FP uptake exist, the number of Main research questions contacts had a greater effect on service uptake. Practice, available at https:// in communities and relatively low access women who took up a modern method of www.free-ebooks.net/ebook/ The study evaluates the following questions: Theory-at-a-Glance-A- to services. Recently, the Expanded Social FP increased during collaboration with a what is the nature of the relationship Guide-for-Health-Promotion- Contribution to knowledge Practice-2nd-Edition-2, Marketing Project in Nigeria (ESMPIN), a service provider. More pronounced results between male involvement and acceptance Findings from our study have highlighted (accessed 13/09/16) social marketing project funded by United have been recorded by seeking integration
of family planning services? What is the the need to recognize the importance 4 WHO, (2015) World Health States Agency for International Development with relevant people, groups and institutions, magnitude of the effect of male involvement of male involvement in accelerating Statistics, Geneva: WHO (USAID) and led by Society for Family rather than working in isolation. on family planning service uptake? Empirical improvements in family planning service 5 UNICEF, (2013) State Health have worked to create demand for Despite the successes recorded in im- of the World Children’s responses to these questions will influence uptake. This knowledge remains relevant in Report, New York family planning services but results were plementing ESMPIN, this study shows the perception of men’s importance in developing family planning intervention 6 Nigeria, (2013) National suboptimal due to inadequate access due that collaboration between stakehold- accelerating family planning service uptake. strategies. The success or failure of any Demographic Health to cost and FP provider unavailability. A ers and partners remains important in Survey, NPC, Abuja family planning program would be strategy for working in collaboration with achieving improved health performance, Methodology 7 WHO, (2015) Trends dependent on the extent to which men in Maternal Mortality, a service delivery partner was therefore particularly between projects imple- The study was conducted in nine communities of reproductive age (MRA) are integrated WHO, Geneva tried to determine if this would improve the menting complementary activities. 48 ESMPIN Book of Abstracts SECTION Book of Abstracts ESMPIN 3
ESMPIN PARTNERS
USAID The Association for Reproductive and through interpersonal We partner to end extreme and Family Health (ARFH) communication. In Nigeria, we poverty and promote ARFH, established in 1989, work in partnership with more than resilient, democratic is a leading fully indigenous 300 radio and TV broadcasters – societies while advancing our nonprofit and non-governmental more than any other development security and prosperity. organization in Nigeria, committed organization in the country. Since to improving the quality of life 1999, we have delivered more than Society for Family Health (SFH) of individuals and families by 16 health governance projects SFH is an indigenous, nonprofit, promoting and increasing access reaching and engaging Nigerians non-political, non-governmental to quality health information and across all 36 states and the organization in Nigeria with a services. ARFH has a multi-skilled Federal Capita Territory. About 8.6 mission to empower Nigerians, workforce of 170 staff with the million Nigerians listen to Ya Take Go Deeper particularly the poor and capacity to design, implement and Ne Arewa in the north, a Hausa vulnerable, to lead healthier evaluate model initiatives, many radio programme produced under For more ESMPIN project lives. Working with private and of which have gained national the Expanded Social Marketing resources, please find the public sectors, SFH uses social and international recognition Project in Nigeria (ESMPIN). marketing and evidence-based and are being replicated. Within following online briefs: behavior change communication the 28 years of existence, the Population Services to improve access to essential organization has successfully International (PSI) ESMPIN INTEGRATED HEALTH health information, services and managed and implemented over PSI makes it easier for people IMPLEMENTATION PROJECT products to motivate the adoption 150 innovative reproductive health in the developing world to lead http://bit.ly/2mPc47Z of healthy behaviors. SFH and development projects across healthier lives and plan the families implements and demonstrates the 36 states and the FCT and they desire by marketing affordable significant impact in various other neighbouring countries, products and services. A global SUCCESS STORIES health fields including maternal most of which have gained health network of more than 50 http://bit.ly/2mhWcgb and child health, malaria national recognition, shaped local organizations, PSI focuses prevention and treatment, HIV national responses to public health on serious challenges like a lack & AIDS prevention, reproductive challenges and a number are of family planning, HIV and AIDS, BOOK OF ABSTRACTS health, family planning and presently replicated nationwide. barriers to maternal health, and the http://bit.ly/2mlclSL safe water systems. SFH also greatest threats to children under provides health products and BBC Media Action five, including malaria, diarrhea, BOOK OF STANDARDS clinical services to Nigerians in Established in 1998, BBC Media pneumonia and malnutrition. A urban and rural areas, especially Action is the international charity hallmark of PSI is a commitment http://bit.ly/2mNtaD9 among the most vulnerable. of the BBC. Working with media to the principle that health services SFH in collaboration with and communication to help reduce and products are most effective TECHNICAL BRIEFS Population Services International poverty and support people in when they are accompanied http://bit.ly/2mldoSC (PSI) embraces opportunities claiming their rights, our aim is by robust communication and for furthering its mission to inform, connect and empower distribution efforts that help through partnerships with people around the world. BBC ensure wide acceptance and proper GUARD BOOKS several international donors, Media Action reaches some 200 use. PSI works in partnership http://bit.ly/2mSLIBb Ministries of Health and other million people through local with local governments, organizations to create health broadcast partners, BBC channels ministries of health and local solutions that are built to last. (especially the BBC World Service), organizations to create health POLICY BRIEFS online, mobile and print platforms solutions that are built to last. http://bit.ly/2m2FoHX ESMPIN Expanded Social Marketing Project in Nigeria
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