Reproductive health and family planning: international approaches and accomplishments in Ukraine

1. S.І. Ostashko Head of Maternal, Child and Sanatoria Care, MOH Ukraine Reproductive health and family planning: international approaches and accomplishments in Ukraine

2. The UN Millennium Development Goal 5: Improve Maternal Healthoutlines the importance of RH&FP to improve maternal health • Targets: • 5А: Reduce by half the maternal mortality rate • 5B: Achieve, by 2015, universal access to reproductive health • Indicators: • Maternal mortality rate • Abortion rate • Use of contraception • Teenagers birth rate • Antenatal care • Unmet need for family planning

3. WHO global Reproductive Health strategy adopted by WHO's191 Member States in 2004 • Quality FP services • Maternal and perinatal health • Prevention of sexually transmitted infections (including –HIV and cervical cancer) • Elimination of unsafe abortion • Promotion of healthy lifestyle and sexual health

4. Importance of FP/RH in the Government health agenda • Take an inter-sectoral approach; • Support government health sector reform efforts: • New Presidential perinatal initiative; • Support the functions of family doctors and other primary care professionals to provide preventive (RH/FP/MCH) services; • Emphasize education and prevention measures, especially for pregnant women, adolescent and youth;

5. State Program “Reproductive Health of the Nation” up to 2015 • Supports GOU efforts to achieve MDGs; • Built on WHO recommendations from global RH strategy and UN MDGs; • Concept Paper #244, April 27, 2006; • State Program “Reproductive Health of the Nation” up to 2015 (SPRHN) approved by CabMin Resolution 1849, December 27, 2006. Goal: To improve the reproductive health of the Ukrainian population in the context of ensuring the country’s demographic and socio-economic potential.

6. TfH support for SPRHN development and implementationStandard package of documents and tools developed for submission of Regional RH programs to Regional Councils 21 Regional RH Programs Adopted

7. SPRHN objective# 3: Activities aimed at sustainable improvement of the Family Planning system in Ukraine • Improve access to FP/RH services at the primary health care level: training and support for family doctors and mid-level personnel in ambulatories and FAPs; • Scale up the knowledge of specialized health providers to provide quality postpartum and post-abortion services; • Conduct behavior change activities and campaigns, especially for youth, on prevention of unintended pregnancy and STI/HIV; • Improve access to contraceptive supplies, by procurement and distribution of modern methods to the most vulnerable and poor population outlined in SPRHN.

8. SPRHN initial budget for FP activities(approved by the resolution #1849/Dec. 2006 of the Cabinet of Ministers) Medical education Local budgets 7,6 mln UAH (1mln USD) Renovation & Equipment State budget: 0,8 mln UAH (0,1 mln USD) FP SPRHN budget State budget 12,3 mln UAH (1 mln USD) Local budget: 93,8 mln UAH (20,5 mln USD) Contraceptives Procurement State budget: 10,4 mln UAH (1,4 mln USD) Local budgets: 81,1mln UAH (10,3 mln USD) MIS Local budgets: 1,3 mln UAH (0,2 mln USD) Youth education State budget: 0,5 mln UAH (0,06 mln USD) Local budgets: 3,8 mln UAH (0,7 mln USD

9. SPRHN: Key policies and capacity building tools developed with TfH assistance • Evidence-based FP protocols (MOH #905/2006); • Family doctors authorized to provide FP counseling and free contraceptives (MOH # 539/2007 and # 417/2011); • A first monitoring system of SPRHN funding (MOH # 671/2009); • A contraceptive-supply management system reaching primary health care (MOH #671/2009) • Partnership with NGOs and other ministries to conduct oblast lead educational campaigns; • Key reference manuals and post-graduate training programs approved by MOH and MOE.

10. SPRHN expenditures- FP ObjectiveImprove FP system – decrease abortion rate and increase contraception prevalence Over 17 million UAH spent between 2008-2010

11. In 2006, about 500 facilities, majority in urban areas, were providing FP/RH services

12. Increased access to FP services – in 2011, about 3,500 facilities are providing FP/RH services Between 2005-2011, over 5,000 primary health care professionals were trained and starts providing counseling and contraceptives

13. Family doctors authorized to provide FP counseling and free contraceptivesActive users of free contraceptive (Government procurement and USAID contraceptive donation, 2008-2011)

14. The abortion rate is declining but remains twice the EU average

15. Unwanted pregnancies in teenagers (between 15-17 y.o.) 35%reduction during 2000-2010 (rate per 1,000 women within the age group)

16. Impact produced by national maternal and infant health programs, in line with MDG and SPRHN Source: MOH statistics

17. Challenges and future priorities in FP/RH (1) Ukraine still has cases of MM due to abortion; Latest MOH statistic shows that every fourth pregnancy end-up in abortion; The rural/urban disparities are still high—lower access to health education and services, higher number of unwanted pregnancies in teenagers; Sustain and expand the TfH gains in building capacity of primary health care providers; Integration with health reform systems and processes;

18. Future priorities in FP/RH (2) Sustain and roll-out the successful approaches and systems established during TfH: • Re-shape the policy dialogue for national and local implementation of SPRHN in coordination with current reform efforts; • Expand nationwide and institutionalize the tools and systems developed within TfH: • the web-based reporting system for free contraceptives; • the M&E tool for reporting on SPRHN funding/expenditures; • the post-graduate training system that supports expansion of services at the PHC level; • Evaluate and review the MOH decrees adopted during TfH (pertaining to FPservice provision);

19. Future priorities in FP/RH (3) Integrate modern FP knowledge and counseling skills into the trainings of the medical students; Optimize and strengthen the FP/RH services management and technical coordination at national and local levels; Identify and support mechanisms to conduct behavior change campaigns nationwide; Evaluate the SPRHN implementation and results to introduce changes according to the needs of population and to further prepare for a follow-on program after 2015.

20. On behalf of Ministry of Health of Ukraine,let me express sincere gratitude to: US Agency for International Development, JSI Research and Training Inc. Together for Health team and project counterparts for fruitful, inspired collaboration and brilliant contribution made to improvement of reproductive health and family planning in Ukraine Thank you for your attention!