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2011 Survey of Availability of Modern 2011 Survey of Availability of Modern Contracep•ves and Essen•al Life-Saving Maternal and Reproduc•ve Health Medicines in Service Delivery Points in Sierra Leone: ANALYTICAL REPORT AND TABLES March 2012 UNFPA SIERRA LEONE PREFACE This is the second annual report of the ‘Survey of Modern Contra ceptives and Essential Lifesaving Maternal and Reproductive Health Medicines in Service Delivery Points’ in Sierra Leone. As part of the reporting system of the Global Programme on Reproductive Health Commodity Security (GPRHCS), it generates time series data on reproduct ive health commodity security including the three country level indicators of: (a) Percentage of Service Delivery Points (SDPs) offering at least three modern contraceptive methods; (b) Percentage of SDPs where five selected lifesaving (including th ree essential) lifesaving maternal/reproductive health medicines are available in all facilities providing delivery services, and (c) Percentage of SDPs with ‘no stock-outs’ of modern contraceptives in the last six months prior to the survey (April-September 2011). Government of Sierra Leone and UNFPA appreciate the invaluab le contributions of individuals and institutions towards the success of the 2011 su rvey round in Sierra Leone. We are grateful to the Steering Committee of the surveys on rep roductive health commodity security (RHCS). The co-Chairs of the Reproductive Health Division (RHD) and Parliamentary Committee on Health and Sanitation (MoHS) with th eir membership comprising of stakeholders in the health sector are appreciated f or their oversight functions. We also recognize the technical inputs of the Technical Commit tee that is chaired jointly by the Department of Policy, Planning and Information (DPPI) of Mo HS and Statistics Sierra Leone (SSL). The survey would not have been successful without t he willingness of the District Health Medical Teams (DHMTs) to provide the required piece s of information. Many thanks to the RHCS Advisor of UNFPA for managing the exercise a nd to the Principal Investigator and Senior Data for Development Specialist, Mr. Ib rahim Mohamed Sesay, and Research Assistant, Mrs. Cecilia M.S. Sesay, for an excellent technica l and professional job. There are two volumes to the report: “Volume One – Analytical Report” presents the issues revealed by data analysis and suggests policy options for planni ng and programming of modern contraceptive commodities and services, and provision of essenti al lifesaving maternal/reproductive health medicines. “Volume Two – Tables” i s an inventory of publication tables and other data on the health facilit ies in the country. The information shared in the report will inform the repositioning of family planning and deepening of programming for emergency obstetric care in Sierra Leone. The present ation is technical but highly reader-friendly. We, therefore, recommend this report to all health sector stakeholders, especially policymakers, practitioners in the health se rvice delivery system and civil society. Ratidzai Ndhlovu (Mrs.) Zainab Hawa Bangura (Mrs.) UNFPA Representative, Minister of Health and Sanitation Republic of Sierra Leone Republic of Sierra Leone March 2012 i | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracep•ves and Essen•al Maternal and Reproduc•ve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT VOLUME ONE: ANALYTICAL REPORT TABLE OF CONTENT Content Page Preface . i Table of Contents . ii List of Tables . List of Figures . iv List of Abbreviations and Acronyms . v Executive Summary . vi PART I: INTRODUCTION . 1 1.1 Country Background Information . 1 1.2 Rationale and Objectives of the Survey . 2 1.3 Survey Organization and Management . 3 1.4 Methodology and Limitations . 4 1.4.1 Survey Design and Sampling of Facilities . 4 1.4.2 Sampling Frame . 5 1.4.3 Use of Sampling Formula to Obtain Sample Size . 5 1.4.4 Sample Selection . 5 1.4.5 Factor to inflate sample size . 10 1.4.6 Final Step: Systematic Random Sampling of Types of SDPs for Each Administrative Unit . 11 1.4.7 Survey Instrument . 12 1.4.8 Data Collection . 12 1.4.9 Data Analysis and Presentation . 12 1.4.10 Limitations of the Survey . 13 1.5 Outline of Report . 13 PART II: SURVEY FINDINGS . 15 2.1 General Information about the Facilities . 15 2.1.1 Classification of Health Facilities . 15 2.1.2 Geographic Distribution of Facilities . 16 2.1.3 Management of Facilities . 18 2.1.4 Distance of SDPs from Source of Supplies . 19 2.2 Modern Contraceptives Offered by Facilities . 19 2.2.1 Contraceptives Offered by Type of Facilities . 19 2.2.2 Facilities Offering at Least Three Types of Modern Contraceptives 21 2.2.3 Reasons for Not Offering Certain Contraceptives . 27 2.3 Availability of Maternal and RH Medicines . 28 2.3.1 Maternal and RH Medicines Available by Types of Facili ties . 28 March 2012 ii | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracep•ves and Essen•al Maternal and Reproduc•ve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT Content Page 2.3.2 Availability of Five Essential Life Saving Maternal an d Reproductive Health Medicines . 29 2.3.3 Reasons for Not Offering Certain Lifesaving Maternal and Reproductive Health Medicines . 31 2.4 Incidence of ‘No Stock Outs’ of Modern Contraceptives . 32 2.4.1 ‘No Stock Out’ at Time of Survey . 32 2.4.2 ‘No Stock Out’ in the Last Six Months . 34 2.4.3 Reasons for ‘Stock Out’ . 36 PART III: CONCLUSION . 38 3.1 Summary of Findings . 38 3.2 Recommendations . 38 March 2012 iii | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracep•ves and Essen•al Maternal and Reproduc•ve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT LIST OF FIGURES Figure Content Page Figure 1: Map Showing Sampled SDPs in the 2011 Survey of Availability xii of Modern Contraceptives and Essential Lifesaving Maternal and Reproductive Health Medicines in Service Delivery Points in Sierra Leone . Figure 2: Distribution of SDPs by Rural-Urban Location . 18 Figure 3: Percentage Distribution of SDP’s by Type of Management . 18 Figure 4: Percentage Distribution of SDPs by General Availability of Modern Contraceptives . 20 Figure 5: Percentage Distribution of SDP’s Offering at Least Three Modern Contraceptive Methods by Rural-Urban Residence . 22 Figure 6: Percentage Distribution of SDP’s Offering at Least Three Modern Contraceptive Methods by Distance from the Nearest Warehouse –within distance analysis . 27 Figure 7: Percentage distribution of SDP’s with Five (including 3 essenti al) Lifesaving Maternal/Reproductive Health Medicines Available by Type of Facility . 30 Figure 8: Percentage distribution of SDP’s with Five (including 3 Essentia l) Lifesaving Maternal/Reproductive Health Medicines Available by District . 30 Figure 9: Percentage distribution of SDP’s with No Stock outs of Modern Contraceptives in the Last Six Months by Urban and Rural Residence . 35 Figure 10: Percentage distribution of SDP’s with No Stock outs of Modern Contraceptives in the Six Months before the Survey by Level of SDP . 37 March 2012 iv | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracep•ves and Essen•al Maternal and Reproduc•ve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT LIST OF ABBREVIATIONS AND ACRONYMS CHC Community Health Centre CHO Community health Officer CHP Community Health Post CSB Commodity Security Branch (UN Headquarters) DHMT District Health Management Team DMOs District Medical Officers DPPI Department of Planning, Policy and Information GPRHCS Global Programme to enhance RHCS HIV/AIDS Human Immuno Virus/Acquired Immuno Deficiency Syndrome IUDs Intra Uterine Devices MCH Aides Maternal and Child Health Aides MCHP Maternal and Child Health Post MDGs Millennium Development Coals MoHS Ministry of Health and Sanitation NGO Non-Governmental Organization P.C.M.H Princess Christian Maternity Hospital PHUs Peripheral Health Units RH Reproductive Health RHCS Reproductive Health Commodity Security RHD Reproductive Health Division SDPs Service Delivery Points SECHN State Enrolled Community Health Nurse SPSS Statistical Package for Social Scientists SSL Statistics Sierra Leone TBAs Traditional Birth Attendants UNFPA United Nations Population Fund March 2012 v | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracep•ves and Essen•al Maternal and Reproduc•ve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT EXECUTIVE SUMMARY Background, Rationale and Methodology of the Survey Sierra Leone, with a projected current population of about 6.1 million, has about the highest maternal (857/100,000 live births), infant (89/1,000), under-f ive (140/1,000) and child mortality (56/1,000) in the world. About 27 per cent of de aths to women of childbearing ages (15-49) are due to maternal causes, 86 per cent of these occur to women between 15 and 34 years of age and unsafe abortion accounts for 13 per cent o f all maternal deaths. Maternal death rates are high because of limited access to compreh ensive reproductive health services. This is made worse by inadequate access to emergen cy obstetric and neonatal care and family planning services. In 2008, partly a s a result of cultural inhibitions, only 10.2 per cent of all women were reported as using any mod ern method of contraception. The population exhibits a youthful age structure with 42.1 per cent under 15 years of age. This large youth population sets into motion high growth i nertia over the coming generation even if fertility were to be reduced to a replacement level. Generally, condom use among young people is low at 22.4.
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