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Successful strategies, public health impact, lessons learned and remaining challenges

Laurentiu Stan JSI Research and Training Institute, Inc. Successful strategies, public health impact, lessons learned and remaining challenges. The Together for Health ( TfH ) Project Background. Together for Health (TfH). Six-year project (Oct. 2005 – Nov. 2011) – $12.3 million

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Successful strategies, public health impact, lessons learned and remaining challenges

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  1. Laurentiu Stan JSI Research and Training Institute, Inc. Successful strategies, public health impact, lessons learned and remaining challenges

  2. The Together for Health (TfH) Project Background

  3. Together for Health (TfH) • Six-year project (Oct. 2005 – Nov. 2011) – $12.3 million • Implemented by JSI Research & Training Institute Inc. in collaboration with: • The Academy for Educational Development • Harvard School of Public Health • Goal: Abortions , unintended pregnancies • Sexually transmitted infections • …by improved provision & access to quality FP/RH services, in public and private sectors

  4. FP/RH Service Provision in Ukraine at baseline • Numerous health professionals (> 12,200 ObGyn’s) and health facilities • FP/RH service provision: mainly by Ob-Gyn’s through a vertical network of FP centers and WCC • GOU concerned of needs for health reforms: • Emerging primary health care • Decentralization towards regional level and below • Over-reliance on traditional methods & abortions • Providers & population perpetuated misconceptions about contraception, especially hormonals • Low access to modern contraceptives (no donations, reduced GOU procurements) & geographic inequalities

  5. Suboptimal access to information on FP/RH in the health sector for its clients Source: UDHS, 2007

  6. TfH Objectives & Intended Results • Increase health providers’ knowledge & skills (clinical and counseling)  training • Improve clients’ knowledge and attitudes regarding FP/RH services & supplies  IEC/BCC interventions • Improve availability, accessibility & affordability of contraceptives  commodities • Strengthen capacity of public & private sectors to support policies & systems for improved RH  policy

  7. TfH Coverage by 2011(15 out of 27 regions - 65% of Ukrainian population)

  8. TfH Implementation Strategies (1) - Working under the Umbrella of…. ….State Program Reproductive Health of the Nation (SPRHN) To support its FP/RH objectives and activities, at the national and oblast levels.

  9. Change Behavior of Population/ Clients Contraceptive Availability in Pharmacies and Public Sector Capacity Building of Health Providers TfH Implementation Strategies (2) - Comprehensive approach, branding of the FP program/interventions “Have you asked the doctor about FP methods?” “Ask the doctor about FP methods”

  10. The Together for Health (TfH) Public Health Impact

  11. Building capacity for quality service provision in Primary Health Care • over 9,000 health professionals trained since 2006 • ~ 2/3 were PHC providers (FDs and non-Ob-Gyns’) Source: TfH, 2011

  12. Improved availability of FP services and supplies at the community level Increased availability of free contraceptives at health facilities Source: TfH, 2011

  13. Percent reduction of abortion rates in project-assisted regions, 2005-2010 Source: Ukraine MOH, 2005-2010

  14. Average annual reduction of abortion rates in project assisted regions

  15. Contraception, steadily replacing abortion Source: Support for Market Development, 2005 – 2011 Ukraine MOH, 2005 – 2010

  16. Contraception, steadily replacing abortion with positive demographic changes(Ab. decrease; contraceptive increase; birth rates increase) Khmelnytsky - 16% Ab. Rate decline + 7% Birth Rate increase Dnipropetrovsk - 25% Ab. Rate decline + 8% Birth Rate increase Source: Ukraine MOH, 2005-2010

  17. Decline of incidence of child abandonment (ICA) higher in the TfH-assisted regions Source: Ukraine MOH, 2005-2010

  18. The Together for Health (TfH) Key Lessons Learned

  19. Importance of FP/RH in the Gov’t health agenda dictates allocations at national & regional levels Proportion of expenditures vs. alloted (FP Objective)Central budget; TfH vs. non-TfH Regions (Local budgets)Cumulative data 2008-2010 Source: MOH/TfH, 2011 Source: TfH, 2011

  20. Partnership and coordination with various stakeholders • National level institutions - to foster nationwide dissemination and programs’ sustainability • Local level counterparts (governmental & NGOs) - to coordinate efforts and maximize results (e.g. best reach the most vulnerable groups) • Private sector partners - to ensure coordinated messages, dissemination to non-project areas, and for leveraging additional resources • Higher educational institutions - to ensure institutionalization of FP/RH education for doctors and nurses. THREE EXAMPLES SELECTED FURTHER 

  21. USAID’s TfH Partnership with national level institutions and authorities Professor Nina Goyda, Pro-Rector • Sustainable policy development: programs, protocols, guidelines (SPRHN approval and implementation) • Nationwide dissemination—reaching additional beneficiaries from ALL regions • Facilitation of communication between providers – regional authorities – national level health authorities • Institutionalization of project-developed approaches: service provision systems, curricula, M&E tools, etc. • Ensure coordination of messages when reaching various types of professionals: university professors, doctors, health managers and administrators

  22. USAID TfH’s Partnership & coordination with Regional level NGOs to reach certain targeted groups/communities Maria Didenko, board member of NGO "Youth center for development", BCC trainer • At local level, NGOs and non-health structures are key partners to reach target population groups • However, NGOs experience with FP/RH and health providers is still in its infancy • NGOs can serve a networking forum with other NGOs active in social areas and on HIV/AIDS prevention • Social services for youth and the Department of education are key partners with experience in reaching certain vulnerable groups/target communities

  23. USAID’s TFH Partnership & coordination with private sector Bayer Health Care Dr. Vladislav GolovinovProduct Manager, Business Unit Women's Healthcare • Development and dissemination of evidence-based information and resources for health professionals • Awareness raising and educational campaigns for youth • Continuous medical education events (CMEs) • Worldwide partnership to assist governments and health ministries to provide access to subsidized contraceptives to vulnerable groups

  24. Create the momentum and build upon it • Substantial experience accumulated during the TfH implementation- basis for further improvements • To achieve change there is a need for a range of actions with continuous investment /TA ~ ”reinvent ourselves” • Providers’ capacity building • Behavior change of population • Policy / SPRHN • Advocacy for adopting new approaches to sustain current public health achievements

  25. Main challenges ahead in improving FP/RH in Ukraine

  26. Ukraine, still high abortion-related Maternal Mortality • Ukraine DHS,2007 : “…almost half of the women undergoing one abortion reported having had 2-3 during their lifetime”  Enhanced focus on behavior change and on standards of abortion procedures Source: Ukraine MOH, 2005 - 2010

  27. Need to deeper focus on rural population • Ukraine DHS, 2007: “…women who live in the capital and large cities have lower first abortion rates than those in smaller cities or towns” (Levchuck, 2009) • Ukraine MOH data from 2009: “… percentage of live births to mothers aged 19 years old and younger is almost double in rural areas (12.8%) than in urban areas (6.7%)” (Tefft, 2011)

  28. Population ability to pay for contraceptives is much lower than in 2005(Source: Support for Market Development and Statistic Committee) Minimum wage could buy: 66 cycles of lowest priced OCs in 2005 44 cycles of lowest priced OCs in 2010

  29. Advocacy for improved funding for FP/RH within governmental programs • Need for a renewed call to action for “revival” of the SPRHN and Regional FP/RH programs • Inclusion of FP/RH interventions within the governmental and donors‘ initiatives: • Presidential Initiative “New Life” • Government efforts to reform the health system • UN/WHO lead “Beyond the numbers” initiative

  30. Building Partnerships HEALTH MANAGERS HEALTH PROFESSIONALS Academic institutions COMMUNITIES Health professionals POLICY MAKERS COMMUNITIES Policy makers HEALTH MANAGERS ACADEMICINSTITUTIONS

  31. ДЯКУЄМО! Ця презентація була розроблена завдяки щедрій підтримці американського народу з допомогою Агентства США з Міжнародного Розвитку. Відповідальність за зміст цієї презентації несе Корпорація Інститут Дослідництва та Тренінгів JSI; інформація, яка відображена в цій презентації не завжди поділяє погляди Агентства США з Міжнародного Розвитку або уряду Сполучених Штатів.

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