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Integrating Family Planning with Obstetric Fistula Services

This article discusses the importance and process of integrating family planning services with obstetric fistula services. It provides a five-step approach to integrating these services, including identifying the level of integration, assessing capacity, building systems, identifying resources, and phasing in family planning methods. It also provides examples of integration in action in Zamfara, Sokoto, and Kebbi. The challenges and recommendations for integration are also discussed.

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Integrating Family Planning with Obstetric Fistula Services

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  1. Integrating Family Planning with Obstetric Fistula Services: Achieving Reproductive Intentions Bethany Cole, Global Projects Manager, Fistula Care Plus Dr Adamu Isah, Deputy Project Manager, FC+ Nigeria ECOWAS Forum on Good Practices in Health Ouagadougou, Burkina Faso | 31 July 2015

  2. Fistula Care Plus Goal: To strengthen health system capacity for fistula prevention, detection, treatment, and reintegration in priority countries Bangladesh, Democratic Republic of Congo, Niger, Nigeria, and Uganda

  3. Five-Step ApproachIntegrating FP and Fistula Care Services STEP 1* STEP 2* STEP 3 STEP 4 STEP 5 Identify/ refine level of integration that can be adopted Assess fistula center’s capacity to support FP** Build or strengthen systems to support new services Identify resources to support integration Phase in FP methods to expand mix w/o stressing center’s capacity * Steps 1 and 2 interchangeable depending onstakeholders’ pre-existing desires for level of integration. ** Includes orientation of stakeholders to staff tasks and system functions required tosupport levels of integration. SYSTEMS • Supervision • Logistics • Referral • Training • Record-keeping • Policy RESOURCES • Partnerships • Capacity-building

  4. Integration in Action:Zamfara, Sokoto, Kebbi

  5. Levels of FP Integration * If facilities or programs providing Level A functions are not immediately prepared to provide oral contraceptives for ongoing uses, they may provide emergency contraceptive pills with referral for ongoing FP management. If the facility or program already provides oral contraceptives (Level B), it can also offer emergency contraceptive pills.

  6. IEC Materials to Support Integration

  7. Results • Strengthened contraceptive logistics management system • Task-shifted delivery to Community Health Extension Workers • Developed champions from Ministries of Health and community levels

  8. Challenges • Limited awareness by providers on FP messages including prevention • Perceived resistance to FP services • Biased providers against offering IUD to women post-fistula repair • Dropped commitment from government

  9. Recommendations • Make FP an integral element of repair services • Promote on-site supervision • Secure commitment from nurses and midwives • Informed and voluntary decision-making, counseling, delivering FP • Involve men in RH

  10. FP Integration Guiding Principles • Provide comprehensive services relevant to clients’ desires/needs • Integrate to the capacity of the core service • Support service delivery modification • Explore roles of the community and men

  11. Summary

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