Women’s Health Project Phase-IV

Green Tara Nepal has been implementing Women’s Health Project, Phase IV in six districts of Nepal in partnership with Population Service International/Nepal.

Project Background:

Family planning is a proven strategy for reducing the risk of maternal and neonatal deaths. Effective family planning services can avert unintended and high risk pregnancies. Moreover, it also can reduce the need of unsafe abortion. Despite the fact, the utilization of FP in Nepal is still low with the variation by region, urban rural population, and different economic groups of people. 

Long-acting and permanent methods are by far the most effective types of modern contraception (with success rates of 99% or higher). They are very safe, convenient, and cost-effective in the long-run. These methods include intrauterine devices (IUDs), implants, female sterilization, and male sterilization (vasectomy).  Requiring the minimum number of visits to a health facility, having minimal side effects, being easy to use, not interfering with sexual relations, helping the user to look young for longer, etc. are associated with Long-acting methods. Therefore, it is important that efforts to promote long-acting FP methods.

Myriad of challenges are associated with demand and provision of long-acting and temporary contraceptive methods.  Factors underlying the use of long acting methods (especially IUD) are; perceptions towards ideal family size, knowledge and attitudes about FP methods, poverty, past experiences, decision-making by individuals and couples, role of men,  availability and quality of services, and sources of information.  A key factor hindering the use of FP is the fear of side effects.  Majority of women discontinued because of health reasons such as bleeding, fear of side effects.

Evidences suggest that interpersonal communication is one of the most effective means of counselling the clients on advantages of family planning.  Efficient providers and satisfied clients are the most important and trusted sources of information and advice about FP in general and about specific methods in particular. Mass media, including television and radio, have been seen as useful sources of information but are not considered to be of prime importance (PSI, IPC tool kit, 2011).

Despite a significant progress in FP program in Nepal, the contraceptive prevalence rate (CPR) has stagnated in recent years. Several challenges remain in improving FP services, especially, an unmet need where with 27% of married women do not meet their FP needs. In Nepal, individuals and couples do not have access to the full range of contraceptive options. Long-acting and permanent methods of contraception are particularly underutilized.  In the past three years, sharing of temporary FP methods was 41%, 42% and 43%, whereas the contribution of IUD was only 5%, 6%, 6%. Injectable (inj. Depo provera) was the highest contributor in 2013/14 accounting 39%, followed by condom 32%.  Low contraceptive prevalence rate (CPR) remains a challenge in effective family planning program in Nepal, especially in urban areas.  Most of the areas in cluster three (as outlined in EOI) are urban.  In 2014, the CPR in Kathmandu was only 29 whereas it was 36 in Bhaktapur, 46 in Chitwan, 52 in Lalitpur, 58 in Kavrepalanchowk and 67 in Makawanpur districts.

GTN works closely with private sectors to strengthen FP services in its Project districts.  At present, it is working closely with 51 private outlets in six districts, Kathmandu, Lalitpur, Bhaktapur, Chitwan, Makawanpur and Kavre Palanchowk.

Objectives:

·      Increase access to IUD services through PSI/Nepal’s social franchise network (OK network) from private sector

·      Promote efficiency and motivation of network providers to provide  quality IUDs services

·      Improve quality of services provided by network providers through regular monitoring, onsite coaching and supportive supervision, and client based record management system

·      Change consumer’s perceptions and demand for IUDs by implementing different community based demand generation activities

Approach/strategies

·      Need based program planning and management addressing the gaps

·      Strengthen capacity of private sector networks (owners and service providers)

·      Collaboration with public sector services

·      Partnership with government counterparts and key stakeholders

Major Activities:

Activities are centred towards clients and high-impact. Major activities are;

·      Improving Advocacy and Coordination

In order to create an enabling environment in the districts, both public and private sectors, GTN works coordination with local government authorities and stakeholders.  For this, GTN regularly carries out advocacy at local, district and policy level.  These include planning meeting, District Project Advisory Committee (DPAC) meeting, Reproductive Health Coordination Committee (RHCC), and regular meeting with District (Public) Health Office.  Advocacy meeting at community level with Health Mothers’ Groups, Female Community Health Volunteers monthly meetings at health facility, VDC/ward citizenship forum meeting, and activities of local cooperatives and clubs.

·      Increasing Access to FP services

Access and availability to quality FP service are keys for increasing service utilisation. GTN and PSI/Nepal maps OK franchise network of private service providers for accessing services.  GTN and PSI also supply commodities and logistics to the listed sites according to national standard.  Support will be continued in order to enhance capacity of service providers, and make the sites functional.

·      Improving Quality of Care

Quality of care (QoC) is a key for successful family planning program. This contributes in increasing satisfaction and positive attitudes towards the services.  Satisfied clients also advocate for services.  Therefore, GTN and PSI/Nepal pay high emphasis to improve QoC in order to ensure availability of services, proper counselling and services, informed choice, availability competent staff, adherence to proper infection practices, etc.  We use quality improvement (QI) tool developed by National Health Training Center (NHTC) in order to monitor QoC.   We also carry out supportive supervision and on-site coaching for maintaining quality of service in regular basis.

·      Mid-media activities

We organize multiple activities for promoting correct information about FP methods /IUCD.  These activities include inter-personal counseling, street drama, social events, rallies, radio-talk programme. GTN will engage IPC agents in social mobilization activities. Mass events are organized during the local festivals and gathering.  IPC agents are mobilized for promoting inter-personal communication in each OK network service sites.  Community Mobilizers, also known as (Didi) engage in the grassroots level in such activities.   We also held with clients and groups, who are reluctant to use FP methods because of myths and misconceptions.   GTN and PSI also carry out PBCC and special service campaign for increasing access service and information.

·      Improving Reporting System

Proper reporting from private sector is a big gap in national FP programme.  GTN supports to improve the coverage of FP sector from private sectors.  At the service sites, we also ensure client based record management system.

Key achievements

•       Activities are carried out in close coordination with the district health authorities

•       All the activities are being implemented as planned

•       Quality of services are offered at the high level of standards

•       Coverage of service are in line with the projections