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Evaluation of a pilot program for task sharing short and long-acting contraceptive methods in Burkina Faso.

ABSTRACT: Background: The Family Health Directorate of the Ministry of Health (MoH/FHD) and Marie Stopes Burkina Faso (MS BF), with implementing partners, Association Burkinabé pour le Bien-être Familial (ABBEF) and Equilibres & Populations (Equipop) collaborated to conduct a pilot project in Burkina Faso focused on "increasing access to family planning (FP) services through task-sharing short- and long-acting family planning methods to primary care cadres." Four cadres of providers were trained to provide intrauterine devices (IUDs) and implants, while community health workers (CHWs) were trained to provide pills and subcutaneous injectables. FHI 360 and the Institut Supérieur des Sciences de la Population (ISSP) evaluated the project's impact on method uptake, client satisfaction, safety, acceptability and the feasibility of task sharing. Methods: The evaluation employed service statistics, client exit interviews (quantitative) and in-depth interviews (qualitative). New FP clients, community representatives, MoH officials, and pilot project-trained FP providers from Dandé and Tougan districts participated in these interviews. Results: Providers, community representatives and government officials all spoke favorably of the pilot project and considered it a boon to women and the communities in which they lived. FP clients were satisfied with their methods and the services they received from their respective providers, and they reported no safety concerns. However, service statistics did not show a clear and steady increase in method uptake for the four methods beyond spikes coinciding with pre-existing free contraceptive weeks. Conclusions: Results of the evaluation were largely positive. These evaluation findings are being used to guide decisions about scale-up.

SUBMITTER: Chin-Quee DS

PROVIDER: S-EPMC7029614 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Evaluation of a pilot program for task sharing short and long-acting contraceptive methods in Burkina Faso.

Chin-Quee Dawn S DS Ridgeway Kathleen K Onadja Yentéma Y Guiella Georges G Bai Guy Martial GM Brennan Claire C Page Georgina G

Gates open research 20190625

<b>Background:</b> The Family Health Directorate of the Ministry of Health (MoH/FHD) and Marie Stopes Burkina Faso (MS BF), with implementing partners, Association Burkinabé pour le Bien-être Familial (ABBEF) and Equilibres & Populations (Equipop) collaborated to conduct a pilot project in Burkina Faso focused on "increasing access to family planning (FP) services through task-sharing short- and long-acting family planning methods to primary care cadres." Four cadres of providers were trained to ...[more]

PMID: 32118198

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Project description:BackgroundIn Burkina Faso, gender inequality prevents women from meeting their reproductive needs, leading to high rates of unintended pregnancies, abortions and deaths. Evidence shows that empowering women may increase the proportion of demand for family planning satisfied using modern methods (mDFPS), but few studies have measured this process in multiple spheres of life. We investigated how empowerment influences the mDFPS among married women of reproductive age (MWRA) in Burkina Faso.MethodsWe analyzed data from the 2010 Burkina Faso Demographic and Health Survey (DHS) on 4714 MWRA with reproductive needs living in 573 communities. We used principal component analysis (PCA) and Cronbach's alpha test to explore and assess specific and consistently relevant components of women's agency in marital relationships. Aggregated measures at the cluster level were used to assess gender norms and relationships in communities. Descriptive statistics were performed and multilevel logistic regression models were carried out to concurrently gauge the effects of women's agency and community-level of gender equality on mDFPS, controlling for socioeconomic factors.ResultsOverall, less than one-third (30.8%) of the demand for family planning among MWRA were satisfied with modern methods. Participation in household decision-making, freedom in accessing healthcare, and opposition to domestic violence were underlying components of women's agency in marital relationships. In the full model adjusted for socioeconomic status, freedom in accessing healthcare was significantly (aOR 1.27, CI 1.06-1.51) associated with mDFPS. For community-level variables, women's greater access to assets (aOR 1.72, 95% CI 1.13-2.61) and family planning messages (aOR 2.68, 95% CI 1.64-4.36) increased mDFPS, while higher fertility expectations (aOR 0.75, 95% CI 0.64-0.87) reduced it. Unexpectedly, women in communities with higher rates of female genital mutilation were more likely (aOR 2.46, 95% CI 1.52-3.99) to have mDFPS.ConclusionsEmpowering women has the potential to reduce gender inequality, raise women's agency and increase mDFPS. This influence may occur through both balanced marital relationships and fair community gender norms and relationships. Progress toward universal access to reproductive services should integrate the promotion of women's rights.Trial registrationNo clinical trial has been performed in this study.

Project description:Method-related concerns represent an important cause of contraceptive non-use and discontinuation. User preferences must be incorporated into the design of new contraceptive technologies to ensure product success and improve family planning outcomes. We assessed preferences among potential users in Burkina Faso and Uganda for six contraceptive methods currently under development or ready for introduction: a new copper intra-uterine device (IUD), a levonorgestrel intra-uterine system, a new single-rod implant, a biodegradable implant, a longer-acting injectable, and a method of non-surgical permanent contraception. Questions were added to nationally-representative PMA2020 household surveys that asked 2,743 and 2,403 women in Burkina Faso and Uganda, respectively, their interest in using each new method. We assessed factors associated with interest through multivariable logistic regression models. We conducted qualitative interviews and focus groups with 398 women, 78 men, and 52 family planning providers and key informants to explore perceived advantages and disadvantages of the methods. Respondents expressed interest in using all new methods, with greatest interest in the longer-acting injectable (77% in Burkina Faso, 61% in Uganda), followed by a new single-rod implant. Least interest was expressed in a new copper IUD (26% Burkina Faso, 15% in Uganda). In both countries, women with less education had higher odds of interest in a longer-acting injectable. Interest in most new methods was associated with desiring a method lasting longer than one year and acceptance of lack of menstrual bleeding as a contraceptive side effect. Perceived advantages and disadvantages were similar between countries, including concerns about menstrual side effects and fear of the biodegradable nature of the biodegradable implant. Potential users, their partners, and providers are interested in new longer-acting methods, however, familiar forms including the injectable and implant may be the most immediately acceptable. A biodegradable implant will require clear counseling messages to allay potential fears.

Project description:ObjectivesThis analysis aimed to estimate the average annual cost of available reversible contraceptive methods in the United States. In line with literature suggesting long-acting reversible contraceptive (LARC) methods become increasingly cost-saving with extended duration of use, it aimed to also quantify minimum duration of use required for LARC methods to achieve cost-neutrality relative to other reversible contraceptive methods while taking into consideration discontinuation.Study designA three-state economic model was developed to estimate relative costs of no method (chance), four short-acting reversible (SARC) methods (oral contraceptive, ring, patch and injection) and three LARC methods [implant, copper intrauterine device (IUD) and levonorgestrel intrauterine system (LNG-IUS) 20 mcg/24 h (total content 52 mg)]. The analysis was conducted over a 5-year time horizon in 1000 women aged 20-29 years. Method-specific failure and discontinuation rates were based on published literature. Costs associated with drug acquisition, administration and failure (defined as an unintended pregnancy) were considered. Key model outputs were annual average cost per method and minimum duration of LARC method usage to achieve cost-savings compared to SARC methods.ResultsThe two least expensive methods were copper IUD ($304 per women, per year) and LNG-IUS 20 mcg/24 h ($308). Cost of SARC methods ranged between $432 (injection) and $730 (patch), per women, per year. A minimum of 2.1 years of LARC usage would result in cost-savings compared to SARC usage.ConclusionsThis analysis finds that even if LARC methods are not used for their full durations of efficacy, they become cost-saving relative to SARC methods within 3 years of use.ImplicationsPrevious economic arguments in support of using LARC methods have been criticized for not considering that LARC methods are not always used for their full duration of efficacy. This study calculated that cost-savings from LARC methods relative to SARC methods, with discontinuation rates considered, can be realized within 3 years.

Project description:Background:High total fertility rates in Burkina Faso and Mali are leading to population growth beyond the agricultural and fiscal means of its citizens. Providing access to affordable family planning methods is a key step in driving the demographic transition where fertility and mortality rates decline. Furthermore, both nations face significant challenges as climate change is projected to disproportionately impact the western Sahel region undermining environmental, social and economic stability within the region. This analysis was included in formative research to inform family planning programming. The aim of this study was to examine possible indicators of long acting and permanent contraceptive method (LAPM) and short-term method (STM) use for young women in Burkina Faso and Mali. Methods:Secondary data analysis was conducted using the three most recent Demographic and Health Survey (DHS) datasets for Burkina Faso (1998, 2003, 2010) and Mali (2001, 2006, 2012). Women ages 15-24, at risk for unwanted pregnancy were included in these analyses. Summary descriptive statistics across all time points are reported and multinomial logistic regression was used with the most recent data to determine potential indicators of different types of modern contraceptive methods. Results:In Burkina Faso in 2010, 24% of women ages 15-24 were using modern contraceptives. Only 2.9% reported using LAPMs in 2010, an increase from 0.3% in 1998. In Mali, modern contraceptive use increased more recently, rising from 9.4% in 2001 to 10.2% in 2006 to 15.3% in 2012. LAPM use also increased from 0.3% in 2001 to 4.1% in 2012. Significant indicators of LAPM contraceptive use in both countries included educational attainment, ideal family size, home ownership and husband's desire for more children. Conclusions:Young women in Burkina Faso and Mali are increasingly using modern contraceptives for family planning; however, the LAPM contraceptive prevalence rate remains low. Our analysis indicates that social norms around ideal family size for both men and women continue to drive young women's choices around family planning and impede use of LAPMs. To increase modern contraceptive use and curb fertility rates, local governments and development organizations should focus on women's empowerment and include male partners.

Project description:BackgroundThe greatest challenge facing expanded programs on immunization in general, and in Burkina Faso in particular, lies in their capacity to achieve and sustain levels of immunization coverage that will ensure effective protection of children. This article aims to demonstrate that full immunization coverage of children, which is the primary indicator for monitoring national immunization programs, is sufficient neither to evaluate their performance adequately, nor to help identify the broad strategies that must be implemented to improve their performance. Other dimensions of performance, notably adherence to the vaccination schedule and the efficacy of the approaches used to reach all the children (targeting) must also be considered.MethodsThe study was carried out using data from surveys carried out in Burkina Faso: the 1993, 1998 and 2003 Demographic and Health Surveys and the 2003 national Survey of Immunization Coverage. Essentially, we described levels of immunization coverage and their trends according to the indicators considered. Performance differences are illustrated by amplitudes and maximum/minimum ratios.ResultsThe health regions' performances vary according to whether they are evaluated on the basis of full immunization coverage or vaccination status of children who have not completed their vaccinations. The health regions encompass a variety of realities, and efforts of substantially different intensity would be required to reach all the target populations.ConclusionDecision-making can be improved by integrating a tripartite view of performance that includes full immunization coverage, adherence to the vaccination schedule (timely coverage), and the status of children who are not fully vaccinated. With such an approach, interventions can be better targeted. It provides information on the quality and timeliness of vaccination and identifies the efforts required to meet the objectives of full immunization coverage. ABSTRACT IN FRENCH: See the full article online for a translation of this abstract in French.

Dataset Information

Evaluation of a pilot program for task sharing short and long-acting contraceptive methods in Burkina Faso.

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Evaluation of a pilot program for task sharing short and long-acting contraceptive methods in Burkina Faso.

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