08_XXX_MM1 Survey on The Role of Primary Health Care Providers in Sexual and Reproductive Health Pisa August 2010 Laura Guarenti Reproductive Health and Research WHO Geneva

08_XXX_MM2 Purpose of the survey In preparation of the SRH core competencies for PC, to gather information about SRH provided services:  What services  Where delivered  Which providers September - October 2009

08_XXX_MM3 Why focus on PHC? PHC (1978) Why focus on PHC? ALMA ATA declaration on PHC (1978) VII " PHC relies, at local and referral levels, on health workers, including physicians, nurses, midwives, auxiliaries and community workers as applicable, as well as traditional practitioners as needed, suitably trained socially and technically to work as a health team and to respond to the expressed health needs of the community" renovated in the 2008 WHR "PHC Now more than ever"

08_XXX_MM4 Through PHC to attain the MDG 5B "Universal Access to RH" Through SRH care provided within Primary Health Care systems Within PHC it is possible to make Reproductive Health services accessible to the people in greatest need SRH services, if properly provided, promotes and fulfils the human rights of the users: the best contribution to achieving the international goals

08_XXX_MM5 Why define SRH competencies for PHC? I.Because SRH is the core of the renovated PHC within a well functioning health system II.To have a definition of the basic knowledge, skills and attitude needed to provide high quality SRH care III. Lack, at the international level, of a comprehensive SRH competencies list, instrumental while improving the service, to reach MDG 5B

08_XXX_MM6 IV. Support countries in the design or re-design of the SRH care provision within the context of PHC V. To have a basis/core list for development of discipline-based or programme-based sets of competencies,a basis for development of curricula which can be easily translated into learning objectives therefore support capacity building for health workforce for PHC Cont…

08_XXX_MM7 PHC to meet the UNMET NEED for SRH and DEFICIT in PROVIDERS High maternal mortality HIV epidemic, Large unmet need in family planning, High sexually transmitted infection prevalence,

08_XXX_MM8 Focus of the questionnaire  Job positions  Training - Community Health Workers (CHWs) and Midwives  Where services are delivered  Service provision in 7 technical areas

08_XXX_MM9 Seven Technical Areas Ante-natal; Childbirth; Newborn; Family planning and infertility; Abortion, STI-RTI (including HIV and VCT), as well as Screening for sexual violence and cancers Sexual health education and counselling.

08_XXX_MM10 Distribution and responses by WHO Regions To COs filled To COs filled RO for Africa RO for the Americas 13 9 RO for Europe 9 7 RO for South East Asia 8 8 RO for the Western Pacific 9 9 RO for the Eastern Mediterranean 21 9 TOTAL 97 69% (n: 67)

08_XXX_MM11 Overall FP and infertility services by different providers by Regions

08_XXX_MM12 Overall provision of ANC services by different providers by Regions

08_XXX_MM13 Overall Childbirth and immediate Post Partum services by different providers by Regions

08_XXX_MM14 Selected Sexual and Reproductive Tract Infection services by different providers by Regions 1 - Management of symptomatic STI/RTIs by syndromic approach 2 - Screening for or detection of rape and other forms of sexual violence 3 - Screening for cancer of cervix using VIA / Pap. Smear.

08_XXX_MM15 Health education and counselling on sexuality and reproductive health for adolescents

08_XXX_MM16 Overall newborn services by different providers by Regions

08_XXX_MM17 Some key findings Who is providing SRH services? SRH services in general are provided by non professional and professional Doctors and midwives seems to have similar roles in prevention and education activities Nurses have an important role in all the regions in providing SRH services Midwives have a bigger role in VCT,HIV prevention and PMTCT Doctors in general seems to have more prominent role in technical activities

08_XXX_MM18 Some key findings Where the services are delivered ? CHW DTD are more involved in service provision in : WPRO, EMRO, SEARO and AFRO CHW are providing services in the Health posts in 27% of the countries 88% of the countries health professional in Health Centres offer SRH services

08_XXX_MM19 Some key findings Length of training 18 to 36 months for midwives seems to be the optimum to provide most SRH services More than 70% of the countries provide more than 2 weeks of training for CHW But 50% of SEARO, 40% EMRO and 28%WPRO receive only 1 week training

08_XXX_MM20 Some discussion points The important role of Nurses in delivering SRH should be taken in consideration when planning for SRH competency based training, job description The important role of CHW in SRH care calls for proper harmonization of training modules and curricula to be developed and applied where needed A team approach seems to be the most appropriate to face all the challenges that have to be faced to provide SRH at PHC level

08_XXX_MM21 Thank you! Grazie!

08_XXX_MM22 Some results: Delivery points of SRH in PHC AFROAMROEMROEUROSEAROWPROOverall Percent CHW D2DProfessional D2DCHW Health PostProf/ Health PostProf. /Health Centre

08_XXX_MM23 Duration of CHWs training by WHO Regions

08_XXX_MM24 Duration of midwifery training by WHO Region

08_XXX_MM25 CHW and Midwifery activities rate by duration of training

08_XXX_MM26 Specific Abortion services by different providers by Regions Specific Abortion services by different providers by Regions 1- Post abortion care 2- Surgical method of abortion 3 - Medical abortion