2. National VSC Meeting June 2003 Presented by Dr. Ky Kien Hong National Reproductive Health Program Voluntary Surgical Contraception in Cambodia Racha and The Partnership Focus Areas

3. National VSC Meeting June 2003 HISTORY  Permanent method  Used since abdominal surgery started  Introduced in 1997 ( NMCHC, Kampot, Pursat and Siem Reap province and RHAC)  Teams trained in Bangladesh and Indonesia  National VSC policy and guidelines published by MOH in October 1998

4. National VSC Meeting June 2003 The principals of minilaparotomy & no scalpel vasectomy Both methods: Performed under local anesthesia Small wound Limited operating duration Quick recovery Less or no stay in the hospital But requires special attention: Gentle handling, contact with client

5. National VSC Meeting June 2003 The key principals of mini-laparotomy  Local anesthesia in a “diamond” plan  Small incision  (Modified) Pomeroy technique  Additional anesthesia drops if needed  Uterine elevator and tubal hook

6. National VSC Meeting June 2003 The key principals of no scalpel vasectomy Introduced in China by Dr. Li Shunqiang in 1974 Since than over 9 million vasectomies wold wide have been performed

7. National VSC Meeting June 2003 Voluntary Surgical Contraception Criteria When can tubal ligation be performed? 1. Meet the MOH guidelines 2. Interval  Any time if you are reasonably sure the woman is not pregnant.  During 7 days beginning with the onset of menses.  During the use of birth spacing methods: Pills, Injectable, IUD, Condoms...

8. National VSC Meeting June 2003 3. Early postpartum preferably within the first 2 days (48 hours) postpartum. But can be performed up to 7 days postpartum. 4. Late postpartum once the uterus is fully involuted (6 weeks). 5. Post abortion preferably within the first 7 days post abortion, if you are sure the woman is free of infection.

9. National VSC Meeting June 2003 When can vasectomy be performed? Whenever the couple meets the MOH guidelines and conditions, and the man is willing to get the intervention. Voluntary Surgical Contraception Criteria

10. National VSC Meeting June 2003 Barriers and obstacles  Cultural Barriers: community views on fertility, fear of surgery, rumors  Physical Barriers: location of services, provision of services  Economic Barriers: posted costs, hidden costs (time, transport)  Lack of specific Counseling & IEC  Medical Barriers: screening criteria, target population.

11. National VSC Meeting June 2003 VSC Strategy Cambodia  Site visit and needs assessment  In-country, competency-based training  Theory and demonstration of techniques  Practice on models  Clinical practice guided by trained coaches 1.Site visit and needs assessment 2. In-country, competency-based training  Theory and demonstration of techniques  Practice on models  Clinical practice guided by trained coaches 3. Equipment and commodities 4. Information session at OD level 5. IEC: leaflets, banners, video,.. 6. Free services and travel 7. Supportive supervision

12. National VSC Meeting June 2003 How to move the barriers and obstacles?

13. National VSC Meeting June 2003 information sessions for leaders and authorities for health staff on the methods for better counseling How to move the barriers and obstacles?

14. National VSC Meeting June 2003 In-country Training  Started in 2001  4 sessions: 2001 (2) - 2002 – 2003 (1+1)  surgeons: 30 (ML & NSV)  counselors: 36 (ML & NSV)  average # of clients: 62 (8 for each participant)

15. National VSC Meeting June 2003 Year New Cumulative  1997: 5 5  2001: 510  2002: 616  2003: 3 (+3) 19 (22) Expansion and access

16. National VSC Meeting June 2003 VSC Expansion 1997 – 2003 in 19 Operational Districts

17. National VSC Meeting June 2003 Total number of acceptors 0 200 400 600 800 1000 1200 1400 199719981999200020012002 2003 may NSVTLTotal 3 2 6 7 416 203 252 105 2 142 134 188 256 983 1015 423 5 144 140 195 672 1186 1267 528

18. National VSC Meeting June 2003 Number Living Children Median (Mean) number Vasectomy: 5 (4.87) Mini-laparotomy: 4 (4.21)

19. National VSC Meeting June 2003 Age distribution of VSC Clients Median age Vasectomy: 36 Mini-laparotomy: 34

20. National VSC Meeting June 2003 Other Birth Spacing methods used among elective clients

21. National VSC Meeting June 2003 Clients demand for services Clients demand for services Quality Services Quality Services Support What makes a program successful?

22. National VSC Meeting June 2003 sUmGrK uN Thank for your attention