Reaching More Clients with Comprehensive Postabortion Care

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REACHING MORE CLIENTS WITH COMPREHENSIVE POSTABORTION CARE AND FAMILY PLANNING IN TANZANIA J BANTAMBYA, F MWANGA, J KANAMA, M HIZA, R KILLIAN, AND C MANCHESTER EngenderHealth RESPOND Tanzania Project

INTRODUCTION RESULTS

In Tanzania, the maternal mortality rate is estimated to be 454 deaths per 100,000 Until recently, cPAC programs were limited to large regional and district health Since 2008, RTP has contributed to: Use of task shifting or task sharing signiﬁ cantly increased the pool of providers live births. Nineteen percent of these deaths can be attributed to complications facilities, limiting the options of the majority of the Tanzanian population who live • A steady shift toward the use of MVA for treating complications of incomplete available to offer these services. As a result, more clients can be seen without delay from unsafe abortions, and with an unmet need for family planning (FP) at 25%, in rural areas (75%). Building on lessons learned during the ACQUIRE Tanzania abortions, away from sharp curettage at the health center—one of the causes of maternal mortality and morbidity. 17,428 more maternal deaths could be averted by the year 2025 through access Project (ATP), EngenderHealth is supporting the scale-up of cPAC efforts through • An increased proportion of women at supported facilities receiving safer cPAC to FP (NBS & ICF Macro, 2011). Tanzania’s Ministry of Health and Social Welfare the RESPOND Tanzania Project (RTP) to reach more women with these lifesaving services, including FP As Table 1 shows, RTP also contributed to a decline in the total number of PAC (MOHSW) has taken steps toward improving the situation for maternal, neonatal, services. As part of these services, women are provided with contraceptive clients, from 9,551 in 2010–2011 to 4,402 in 2013–2014. and child health through a national reproductive health strategy that prioritizes methods so they can properly space their next pregnancy, to ensure a healthy and • Provision of MVA equipment and enhancement of skills, which has allowed cPAC access to FP. In addition, in 2000, comprehensive postabortion care (cPAC) was safe birth. services to be decentralized to lower-level facilities. Table 1: Total number of cPAC clients, by method of evacuation, according to year included among the essential reproductive and child health interventions. From January to December 2013, RTP trained 25 providers from 11 districts in cPAC Year cPAC MVA Curettage services, and in 2014 another 66 from 17 districts were trained or refreshed in cPAC 2008 1,293 625 668 skills. The majority of service providers trained were midwives and clinical ofﬁ cers. 2009 7,481 5,183 2,298 METHODOLOGY Figure 1: Total number of cPAC clients seen, number counseled, and number 2010 9,551 6,679 2,872 discharged with an FP method, by year 2011 9,111 6,334 2,777 RTP supported the MOHSW in providing cPAC services across Mwanza, Shinyanga, • Engaged community-based organizations, including youth groups, village cPAC clients counselled on FP 10,000 9,111 2012 8,643 5,908 2,735 8,643 cPAC clients discharged with Geita, and Simiyu regions. Decentralization and task shifting have enabled scale-up community banks, women’s and men’s groups, and local theater groups, to 9,000 a method of FP 2013 5,760 4,505 1,255 7,754 Total cPAC clients served of cPAC services from 207 facilities in 2012–2013 to 239 facilities in 2013–2014. At stimulate awareness of lifesaving aspects of cPAC and confront stigmatization 8,000 7,393 6,446 2014 4,402 3,076 1,326 7,000 these facilities, RTP: around seeking and providing such services. 5,760 6,000 5,699 4,402 4,993 • Conducted trainings by national trainers using the national cPAC curriculum, • Supported Council Health Management Teams (CHMTs) to conduct routine 5,000 4,402 Finally, support to the MOHSW has resulted in an increase in the number of cPAC 3,552 which EngenderHealth revised in collaboration with the MOHSW to add essential monitoring and supervision visits at these facilities to evaluate the quality of 4,000 3,126 clients counseled about FP. Despite the decrease in PAC clients from 2010–2014, 3,000 which could be attributed to FP education and services in the community, the elements of FP. The training includes manual vacuum aspiration (MVA) as a safe cPAC services. 2,000 percentage of clients receiving FP counseling and discharged with a method has alternative approach to sharp curettage, as it requires administration of minimal • Monitored interventions through health management information systems, 1,000 local anesthetics and usually involves a much shorter recovery time, all of which which track clients accessing cPAC and the numbers receiving FP counseling and remained above 70%, higher than the World Health Organization (WHO) standard of 2010-2011 (ATP) 2011-2012 (ATP) 2012-2013 (ATP) 2013-2014 (ATP) are essential factors to consider in resource-constrained settings. accepting a method. 60% (see Figure 1). • Trained providers in these facilities on MOHSW tools to ensure data quality and accuracy. CONCLUSIONS

• Decentralization and task-shifting have brought lifesaving cPAC services closer • It is important that community support be in place so that clients are not to the community and have reduced obstacles to accessing care, such as long stigmatized for accessing postabortion care services. This involves sensitizing ACKNOWLEDGMENTS waiting times and lack of equipment and trained providers. This has been health care providers as well as community leaders and district health authorities We thank the Tanzanian Ministry of Health and Social Welfare (MoHSW), in demonstrated through an increased proportion of service providers offering these in addressing the “three delays” of seeking, accessing, and obtaining appropriate particular the Reproductive and Child Health Section, Regional and District services using MVA. health care. Although demand creation for cPAC services is one outcome of Health Management Teams, and implementing partners for their close support • RTP’s intervention included procurement of essential equipment; this is crucial community support, a reduction in the number of PAC clients is sought, so that for the RESPOND Tanzania Project is provided by the American people through to ensuring that trained providers can serve clients without delays and that complications due to unplanned or poorly spaced pregnancies can be avoided. the United States Agency for International Development (USAID). clients’ FP method of choice is available at a service point and referrals are made • Experience from RTP’s intervention has shown a decline in PAC clients, which appropriately. can be attributed to increased awareness and availability of FP counseling and The contents of this poster are the responsibility of EngenderHealth and do not services. necessarily represent the views of USAID or of the U.S. government. • The added beneﬁ t of cPAC means that women who may be at high risk for repeat abortions or pregnancy complications can prevent unplanned pregnancies. Further information: EngenderHealth, Inc., Plot #254, Mwai Kibaki Road/Kiko Avenue, PO Box 78167, Dar es Salaam, Tanzania Because RTP’s (and previously ATP’s) efforts have been largely concentrated at the same facilities, intensiﬁ ed support for FP and cPAC may have contributed to a Reference: National Bureau of Statistics (NBS) [Tanzania] and ICF Macro. 2011. Tanzania Demographic and Health Survey 2010. Dar es Salaam. reduction in the number of cPAC clients reporting at these facilities.

www.engenderhealth.org INTERNATIONAL CONFERENCE ON FAMILY PLANNING • NOVEMBER 2015