Presentation on theme: "1. 2 When introducing a new contraceptive technology, it is particularly important to: [ identify factors that influence contraceptive choice and potential."— Presentation transcript:
2 When introducing a new contraceptive technology, it is particularly important to: [ identify factors that influence contraceptive choice and potential use of new contraceptive technology [ understand users attitudes towards new contraceptive technology and other contraceptives [ understand users views on the service delivery system Introducing a New Technology
3 v Identify the service delivery, training and management requirements for providing good-quality new contraceptive technology services v use the results of these enquiries to develop a strategy for introducing a new contraceptive technology and eventually making it widely available
4 I deally, a new technology such as emergency contraception should be introduced as part of the range of contraceptive methods offered by the national reproductive health programme. T hen information on the new technology e.g. Emergency contraception methods should be included in the basic and ongoing training curricula of providers, in the IEC materials and in the planning and preparation of the logistic and distribution systems.
5 F Involving providers and managers Strategies for introducing new contraceptive technology into reproductive health programmes need to be discussed with providers and managers responsible for implementing and others involved in policy decisions.
6 p Involving the community Involving the community in the design of reproductive heath programmes and services is a key factor in their success. The needs and concerns of clients and potential users must be taken into consideration.
7 F Steps in the introductory process The following steps are recommended: lthe order may vary ldepends on the stage of development of programme and lthe cultural environment within which it is being introduced
8 o Assess users needs and attitudes o Assess the regulatory requirements o Assess the service capabilities - providers views and knowledge of the method; the mechanisms already available; the need for training
9 u Enlist support at appropriate levels u Select a product and develop a distribution plan u Train the managers and the providers
10 J Meet clients information needs J Introduce the product at the different service levels J Monitor and evaluate the services J Disseminate the results of the evaluation J Do post marketing survey
11 F Barriers to the introduction of a new contraception r Client-related barriers r Provider-related barriers r Cultural barriers r Product-related barriers
12 Client-related barriers ¨ Lack of knowledge about the new contraceptive ¨ Risk-taking behaviour common among young people
13 Provider-related barriers: Lack of knowledge among providers, programme managers and policy- makers is an obstacle to the introduction of the new contraceptive in reproductive health programmes
14 J may not have a clear understanding of the role of the new contraceptive can play J may be reluctant to provide the new contraceptive because of: k insufficient training k personal biases k their own beliefs or value systems k association with certain situations such as prostitution and rape
15 b Providers may also be anxious about safety and risks such as missing pregnancy and STDs
16 Cultural barriers Q the influence of traditional religious groups who oppose FP programmes Q influence reflected by politicians, policy- makers, health providers, teachers, school counsellors and the media
17 Certain contraceptives may be especially controversial since they may be wrongly perceived as abortifacients e.g. IUD and Emergency Contraception
18 Product-related barriers Product cost, or appearance programme costs and opportunity costs may be factors that hinder the use of a new contraceptive e.g. costs of LNG-20, counselling time required for Norplant users, appearance of the female condom etc.
19 The quality of the counselling given to women or couples greatly affects their satisfaction with IUDs and their continued acceptance and use of the method. A good follow-up and referral system reassures clients that their questions will be answered and that any problems relating to IUD use will be effectively dealt with.
20 When individuals or couples decide where to go for services or contraceptives, the factors that they will take into consideration will include: Service Quality related factors: ptheir perception of the quality of care provided; pthe cost of services; pthe attitudes of the personnel of the services;
21 Service Quality related factors: Contd… wthe extent to which privacy is ensured and anonymity (when required) guaranteed; wthe availability of supplies and other needed services at the same place; wthe distance to alternative services; and wthe experiences of their peers
22 When clients decide which of the variety of methods offered to choose, they will take a number of factors into consideration, including: Method related factors: o the effectiveness of the method; o the side-effects; o the safety of the method; o cultural and religious acceptability;
23 Method related factors: Contd… y the mode of administration; y the ease and frequency of administration; y reversibility; y the need for close medical supervision; and y the cost
24 Costs The cost of providing IUDs through a family planning programme vary widely from one country to another and from one type of programme to another, and are affected by many factors, including the cost of: y staff (salaries, etc.) and training; y medical supplies;
25 Costs Contd… y transportation and storage of supplies; y maintenance of premises and equipment; y utilities (electricity, fuels, etc.); y the logistic system
26 Other determinants of the total cost of contraceptive provision include: C the development of information materials; C the location of the services; C the size of the services (the cost per client is generally lower where the case- load is high);
27 W The treatment and management of method related side-effects; W the costs associated with changes in contraceptive method mix: methods that require regular re-supply, e.g. injectable, oral and barrier contraceptives, are likely to be more expensive over time than permanent (sterilization) or long-term methods (IUDs and implants); W the cost of treating conditions revealed during client screening
28 Managers can improve the overall quality of their family planning programmes by improving service delivery procedures and logistics and thereby: o ensure a dependable flow and adequate stock of supplies; o maintain the quality of supplies; and o keep an adequate stock of materials and instruments for administering the IUDs
29 They should also ensure that: J unbiased counselling is available; J well-trained staff are available; J a reliable follow-up and recall system is provided; and J good quality care is provided
30 Development of a community information programme Possible communication channels include the following: k Associations of health professionals and the journals they produce k the mass media, including radio, television, the cinema, newspapers and audio- and videotapes k Printed materials developed specifically for IUDs and designed to be relevant to local conditions k Personal communication. Informal meetings at clinics to set up a network of satisfied IUD users k Traditional or folk media
31 Audiences The largest and most important audience is the general public, including potential users who may be strongly influenced by rumours and misinformation. There are other groups whose views on a new contraceptive method also can greatly influence its ultimate acceptance
32 Z Traditional midwives and healers may be the only available source of assistance on health-related matters. Without their cooperation the programme may not succeed Z Health professionals, even those not directly involved in IUD provision, need to understand the method so that misinformation is not spread from sources normally regarded as reliable
33 n Members of the government, community leaders and religious leaders are traditionally looked to for advice n Womens organizations
34 mMedia personnel can have a profound influence on the acceptance or rejection of new methods of contraception. Providing them with accurate information can often make the difference between the successful introduction of such a method and failure. mInternational agencies involved in family planning issues - the policy-makers who allocate funds and establish programmes - need to have accurate and complete information about contraceptive methods particularly new methods.
35 Handling Criticism, misinformation and rumours Neither negative reactions nor misinformation can be ignored; misinformation is often better remembered than the actual facts, which are usually much less sensational. The best defence is to ensure that everyone who deals with IUDs understands them as thoroughly as possible. Sound knowledge can do much to dispel rumours.
36 Obstacles to the introduction of IUDs w Political, cultural and religious attitudes and beliefs; w professional and social attitudes to family planing in general and IUDs in particular; w local laws, regulations, medical norms and codes of ethics
37 Side-effects such as prolonged or irregular bleeding which alter a womans normal menstrual cycle, may prove to be other obstacles to the introduction of IUD services. Managers must be aware of local beliefs and perceptions regarding menstruation and help to allay unnecessary fears and alarm.
38 Studies have shown that educating men about IUD makes an important contribution to ensuring overall acceptability of the method. Men worry particularly about their partners health and the side-effects sometimes caused by contraceptives.
39 Checklist for introduction of IUDs into a family planning programme Activity 1. Survey community; identify potential constraints 2. Ensure that national and local legislation and regulations permit use of IUDs; obtain necessary approvals 3. Estimate potential demand and expected case-load 4. Arrange programme financing; develop budget 5. Identify clinic facilities 6. Establish essential policies: * client selection criteria * counselling and informed choice * medical service standards 7. Staff the programme: * staffing requirements - patterns, types, numbers * recruitment and selection
40 * training * supervision 8. Arrange for equipment, supplies and services: * procurement of required equipment, instruments, medicines and supplies * storage and inventory control * procedures for decontaminating, cleaning, disinfecting or sterilizing instruments 9. Develop a community information and communication programme 10. Develop and print record forms, information materials and documents * medical history/client record form * client brochures (e.g. fact-sheet) 11. Establish client-flow system and procedures:
41 * reception, intake, registration * record of patient history * client medical assessment and counselling * informed decision-making * physical examination and medical screening, including laboratory examinations (if necessary) * referral for further assessment * follow-up procedures 12. Establish client-referral channels; develop links with other medical, family planning and community institutions and professionals 13. Other: * strategies for advertising and use of mass media * financial accounting procedures * data collection (service statistics) and programme evaluation
42 Facilities y A comfortable waiting-room or holding area for clients; y A room for counselling, preferably isolated or private; y A private examination room, with adequate natural or artificial lighting and a sink, where clients can undergo general and pelvic examinations and IUDs can be inserted and removed; y An area where vaginal and/or cervical specimens can be examined microscopically y A sluice area (cleaning area, utility room, etc.) where instruments and reusable gloves can be cleaned and linen washed;
43 k Toilet and washing facilities for clients and staff, with adequate water supplies; k An area for high-level disinfection or sterilization of instruments, and space for their storage; k A storage area for medical supplies, which should be cool, dry, secure and well ventilated; k An area for office work, completion and storage of records and storage of information materials.
44 Community Client Information and Communication Health facility Counselling Client screening IUD unacceptable; alternative methods reviewed Follow Up Client assessment (physical/pelvic/ microscopic examinations) IUD unacceptable alternative methods considered and/or further medical assessment Insertion/removal Post-insertion counselling Client Flow for IUD Services WHO 96867
45 Extracted and Adapted from: 1.Emergency Contraception: A guide for Service Delivery WHO/FRH/FPP/ Intrauterine Devices: Technical and Managerial Guidelines for Service, WHO 1997