Bill & Melinda Gates Foundation

Task Shifting for Comprehensive Access to Contraceptives in Ethiopia

July 22, 2013

What if you lived in a rural part of Ethiopia where the closest health clinic was kilometers away from your home and you wanted to exercise choice in selecting a contraceptive method? Ideally, you would like one that allows you to visit the family planning clinic less frequently, is reliable, and is a modern method such as oral contraceptive pills, condoms, injectables, intrauterine device, sterilization or implants. What if you learn that you can gain access to a long-acting contraceptive method at the community level but have to travel to a health facility for several hours to have it removed because there is no way to do so at the community level? What do you do? What millions of women are forced to do every day…You go without.

In rural Ethiopia, poor health infrastructure and lack of trained health providers make this scenario all too real for the overriding majority of women. More than 80 percent of the population lives in rural communities, where reliable access to reproductive health care is nearly impossible to find.

That’s where the USAID-funded Integrated Family Health Program (IFHP) comes in. The project, implemented by Pathfinder International and John Snow, Inc. in partnership with local organizations, supports the Government of Ethiopia with creative solutions to improve access to family planning and reproductive health services in Ethiopia’s rural and underserved populations. I recently traveled to Ethiopia to meet our team and learn more about how the Integrated Family Health Program brings contraceptive services to women in the communities where those services would otherwise be nearly impossible to reach.

While nearly 75 percent of currently married women of reproductive age in Ethiopia have reported a desire to delay childbirth for at least two years or stop bearing children altogether, only 28 percent use a modern method for contraception to prevent pregnancy (Ethiopia Demographic and Health Survey, 2011). This low use of modern methods could have been attributed to limited availability in rural areas with pills, condoms, and injectables being the primary methods available. However, in 2009, long-acting methods such as implants, were introduced at health posts in rural communities. This was done by creating a service delivery model that scaled-up and brought higher quality, coordinated care services closer to the people who need them.

Clients often prefer to access services at their village health post, rather than make the time-consuming journey to a distant health facility. To ensure health posts can meet clients’ needs, the Integrated Family Health Program has developed a back-up support system to provide quality implant removal services. Backup services are community visits by small teams of skilled providers offering more complicated services such as the insertion and removal of implants and IUDs, support for immunization, and provision of voluntary counseling and testing to complement prevention of mother-to-child transmission of HIV and other HIV prevention activities.

Dr. Mengistu Asnake, our Chief of Party for IFHP, informed me that this model backup for long-acting family planning support system is unique to the Integrated Family Health Program. To date, IFHP has supported more than 45,000 removals at health centers and during the backup services for long-acting contraceptive methods.

As I left Ethiopia, I felt confident knowing that the program and the Federal Ministry of Health were committed to providing comprehensive sexual and reproductive health services. The women I met were happy to have a range of choices in their method mix and access to long-acting contraceptive methods at the community level, which empowered them to exercise choice and agency. However, it also emphasized the need for more systems like the backup service used in Ethiopia to bring qualified staff to the community for removals and complex procedures in order to truly provide comprehensive reproductive health care for women in rural, hard-to-reach settings.

 
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