Mali|Post-Partum Family Planning Improvement Collaborative
Improve contraception use and post-partum family planning (FP) services by providing technical support through the Improvement Collaborative approach.
• Improve the effectiveness of family planning counseling and service during post-partum care by building on selected ongoing Quality Improvement (QI) maternal health programs at health facilities to increase the number of postpartum women using modern family planning methods.
Because of Mali’s high fertility rate and unmet demand for family planning, in 2011 HCI introduced a postpartum family planning demonstration collaborative that includes 41 facilities in two districts of the Kayes Province. Quality Improvement (QI) teams in 41 participating health facilities reported that while most health facilities offered FP services, these services were not regarded as an essential component of post-partum care. The teams have proceeded to use quality improvement techniques to link FP units with post-partum wards in the health facilities. This link, coupled with improving the FP counseling skills of clinical staff and assuring a space to provide private counseling to the post-partum woman jointly with her husband have been the key interventions for this ongoing work.
Percent of women receiving post-partum family planning counseling
Assessment of adequate FP knowledge of women counseled at postpartum service points
Percent of counseled women who use modern family planning methods
Pregnancy rate of women after one year of receiving the postpartum counseling
Upon completion of the current FP improvement collaborative in Mali (and a similar intervention being conducted in Afghanistan), HCI will document results and lessons learned to utilize for a wider spread strategy. Included in this strategy, to maximize limited resources for more effective spread, HCI will identify opportunities to integrate FP into existing health services. HCI will also utilize project data to add to mounting evidence that FP is one of the most effective interventions to improve maternal and child survival in several developing countries.
This work began in 41 sites in the Kayes and Diema districts, Kayes Province and is being expanded to the Ségou Region.
Coaching visits are provided once per trimester to assist teams with the implementation of technical and QI components from the previous learning sessions. The length of the coaching visit is a day per site (there are 19 sites in Kayes District and 22 sites in Diema district).
During learning session one, focusing on the AMTSL/EONC/ENC technical components, teams present current progress through graphical depiction of run charts showing progression of the key indicators and the changes tested to achieve these results. Recommendations from key players, heads of the ASACOs (Community Health Associations), coaches, district health management teams, and the regional health director were shared and teams also work to synthesize best practices and lessons learned thus far in the following areas:
1. Changes to improve the availability of competency of providers
2. Changes to ensure continuous availability of medicines and equipments
3. Changes in the organization of health care services
4. Other changes
In addition to the organized learning sessions, the teams communicate via phone to exchange ideas during the action periods.
Within a short time, FP counseling, which did not exist as part of standard postpartum care, was successfully integrated into the regimen and by September 2011, over 80% of post-partum women receive family planning counseling before discharge. As of December 2011, of those women counseled at the 41 sites, 98% accepted use of a modern FP method. (See figure below)
Selected best practices thus far:
i. Counseling for all women who either give birth at the facilities or come for postpartum visits
ii. Provision and display of job aids/posters to all sites
iii. Integration of FP into all preventive activities namely ANC and follow-up immunization of healthy babies
v. Public awareness of PPFP