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FP: What’s New, What’s Hot, What’s Not: Considerations for Maximizing FP Access and Quality in LAC

FP: What’s New, What’s Hot, What’s Not: Considerations for Maximizing FP Access and Quality in LAC. Roy Jacobstein, M.D., M.P.H. LAC HPN SOTA Antigua, Guatemala December 7, 2007. Context: Modern Method FP Access, Quality and Use in LAC. LAC most advanced region

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FP: What’s New, What’s Hot, What’s Not: Considerations for Maximizing FP Access and Quality in LAC

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  1. FP: What’s New, What’s Hot, What’s Not:Considerations for Maximizing FP Access and Quality in LAC Roy Jacobstein, M.D., M.P.H. LAC HPN SOTAAntigua, Guatemala December 7, 2007

  2. Context: Modern Method FP Access, Quality and Use in LAC • LAC most advanced region • Most countries: high modern CPR, but low use in: • Haiti (23%), Guatemala (31%), Bolivia (35%), Peru (46%) • High unmet need: Haiti: 40%; Guatemala & Bolivia: > 20% • Suboptimal quality / usepatterns • Equity differentials in access & use • USAID phasing support down / out

  3. Context: Phaseout of USAIDFP Support in LAC • What are the key FP issues in your program?

  4. Holistic Programming: Key to Quality, Access, Use of FP Services Increased Access, Quality and Use Supply Demand Advocacy • Service sites readied • Staff performance improved • Training, supervision, referral, and logistics systems strengthened • Accurate • information • shared • Image of services enhanced • Communities engaged Quality client-provider interaction Increased knowledge + acceptability Increased availability Improved policy + program environment • Leadership and champions fostered • Supportive service policies promoted • Human and financial resources allocated Fundamentalsof Care Data for Decision Making StakeholderParticipation Gender Equity

  5. Considerations: FP Access • “Degree to which services can be obtained at effort & cost acceptable to a (potential) client, & within her means” • Access barriers prevent even motivated clients from using services • “Hard enough, not enough”: Programs must go beyond difficult challenge of increasing availability of commodities, equipment & supplies, & of skilled providers, to address the many access barriers • Especially a challenge with clinical services – but these are the most effective FP, the most needed, & the most underutilized in LAC

  6. Many Types of FP Access (and Quality) Barriers in LAC • Cognitive barriers • Socio-cultural barriers • Geographic barriers • Financial barriers (Cost / Affordability) • Health care system barriers • Contraceptives, equipment, supplies • Provider-level factors • Structure / organization of work • Medical (policy & practice) barriers

  7. Contraceptive Prevalence in LAC Fuente: PRB, 2007

  8. Rationales for FP - Still Valid in LAC • Reduces maternal mortality & morbidity • LAC MMR 190/100,000: ~ 1 death per 500 births • Reduces abortion(LAC [2nd] highest in world) • Young & growing population (30% < 15): greater need for FP in future is certain in LAC • Poverty / equity / gender / natl.development

  9. Population Growth in LAC 2050 808 Million 2000 513 Million Población (millones de personas) 1950 166 Million Year

  10. Suboptimal Quality & Use of FP in LAC Countries: Discontinuation Peru Guatemala data not available Discontinuation within 1 year Source: MEASURE/DHS, Peru DHS Survey, 2004-2008. Source: MEASURE/DHS, Guatemala DHS Survey, 1999.

  11. Suboptimal Quality, Access & Use of FP in LAC: Fit With Intentions Nicaragua Bolivia Resupply methods / traditional methods / non-use 49% Resupply methods / traditional methods / non-use 77% FP method use by limiters(65% of total MWRA) FP method use by limiters(71% of total MWRA) Source: MEASURE/DHS, Nicaragua DHS Survey, 2001. Source: MEASURE/DHS, Bolivia DHS Survey, 2003.

  12. Poor Fit Between FP Method Use & Reproductive Goals — Why? • In your experience, what are the main reasons for this discontinuation and poor fit in your country? • Reasons at client level? • Reasons at provider level? • Reasons at program level? • Is this problem recognized in your country? • If so, what is being done by the program / health system?

  13. Modern FP Methods(Absolute & Relative) Effectiveness Pregnancy Rates by Method Typical use “Perfect” use (but humans are imperfect)

  14. Modern FP Methods: Satisfaction, Quality, Use % Women and men continuing FP methods at one year: Source: The ACQUIRE Project 2007. Reality √

  15. Modern FP Methods: Cost Effectiveness (& Access) Commodity Cost (US$) to Health Care System Per Year of Protection, by Method Source: UNFPA 2005. Achieving the ICPD Goals: Reproductive Health Commodity Requirements 2000-2015. Assumes IUD and Jadelle used for 3.5 years; Implanon for 3 years; and female sterilization and vasectomy for 10 years.

  16. Long-Acting & Permanent Methods (LAPMs)

  17. LAPMs:Good Choices for People • Very wide eligibility: almost all can use • Meet needs of many categories / most women: • Spacers & delayers (HSTP), as well as limiters • Younger / older • Postpartum / post-abortion • HIV-infected women and PLWA • Very convenient (one act confers long protection) • Highly effective (why they want FP!)

  18. LAPMs: Good Methods for Health Systems,but … • Meet clients’ needs / provide choice • Reduce burden on other health services: • FP (re-supply clients); obstetric/maternity / pediatric • The most cost-effective FP — over time, but • Higher upfront costs • Higher continuous program effort needed (costs) • Programs often lack will or resource to provide LAPMs • Even harder in HSR, phaseout • What have you and your country program counterparts tried?

  19. New Developments in FP: Implants • Popular if cost not an issue & skilled providers available • New USAID price for implants (Jadelle: $20.80) • Da Hua Pharmaceutical / Shanghai: Sinoplant: • Same characteristics as Jadelle • Cost: wholesale ~$4.80, sells / will sell for ~$7 • 5.3 million in China & Indonesia • FHI partnering for registration in 14 countries / Gates • Potential impact: modeling: avert 26,000 unwanted pregnancies in 100,000 OC users

  20. LNG-IUS

  21. ICA Foundation: Free Subsidized LNG-IUS • Partnership: Bayer Schering & Population Council • Gives combination of donations (free) & sales at public sector price of US$40 per IUS • Projects in LAC in Brazil, Ecuador, El Salvador • Who can apply for a donation?: public health organizations (public & private sector), NGOs • For more information: • ICA Foundation, PO Box 581, FI-20101 Turku, Finland • Website: http://www.ica-foundation.org

  22. Hot Off the Press(soon in Spanish)

  23. What Can USAID Do to Help?What May Have Biggest Payoff? In light of information discussed today, & USAID phasedown / phaseout in your country: • What do you think can / should be done by the FP program in your country to meet current & future needs? • What can USAID do to help?

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