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Implants: An Improved and Increasingly Popular Method

June 21-25, 2010
http://my.ibpinitiative.org/ LA_PM_CoP 

The purpose of this one-week forum is to share professional and country-based experiences in providing implants or advocating and programming for the availability, accessibility, and use of implants.

Discussion Statistics


Number of participants: 132
Number of participants' countries: 31
Number of contributions: 5 contributions
% of contributions from developing countries: 80%
Number of countries contributing: 4 countries

Contributing countries: Sri Lanka, Ethiopia, New Zealand, Rwanda

Purpose and Objectives

Purpose:

The purpose of this one-week forum is to share professional and country-based experiences in providing implants or advocating and programming for the availability, accessibility, and use of implants.

Objectives:

 To cover essential knowledge about implants for policy makers, program managers and service providers, programmatic considerations including cost and scale-up of programs, and country experiences.                       


Day 1:  Experience with implants in different countries.

Questions:

  1. What types of implants are currently being used in your country? What are
  2. some of the challenges and successes of providing implants in your country?
  3. Is cost limiting the availability of implants in your country? What costs, beyond the cost of the implant, are often overlooked when considering the overall cost of insertion?
  4. What trainings are offered to service providers performing insertion and
  5. removal of implants? What has been your experience with building the capacity of service providers?

Full text daily digest                                                                     

Day 2: Availability of implants

Questions:

  1. What are the trends in implant provision in your country? Is demand for implants expected to increase in coming years?
  2. Are implants available throughout your country or only in specific areas?
  3. How much do implants cost the client in your country? How does that compare to the cost for her to receive injectables, IUDs or sterilization, or for her male partner to receive a vasectomy?

Day 2 Summary:

A participant from Sri Lanka discussed the situation with contraceptive implants in her country. Her full descriptions can be found in the Program Examples below.

Full text daily digest      


Day 3: Contraceptive programs in different countries

Questions:

  1. What solutions have you found to ensure an adequate supply of contraceptives to maintain community confidence and demand?
  2. What solutions have you found for other challenges that you face in providing implants?
  3. How have you handled refresher trainings for providers in your country?
  4. Have you started training providers other than doctors to provide implants?                                

Day 3 Summary:

A participant from Ethiopia discussed the situation with contraceptive implants in her country. Her full descriptions can be found in the Program Examples below.

Full text daily digest      

Day 4: Applying lessons learned from IUD programs to implant programs

Questions:

  1. Given the challenges in contraceptive security ($2 million shortfall this year alone in Nigeria), the fact that implants have a higher upfront cost than other methods, and that these methods need to be provided in the context of choice over when to remove, what solutions do you suggest that will enable country programs to purchase sufficient numbers of implants to meet the expected demand?
  2. The family planning community has learned lessons from programs that handled multiple IUDs. What lessons can be shared with programs that handle more than one implant to ensure that clients receive the correct information?
  3. The family planning community has also learned lessons from removals of NORPLANT. Programs need to be prepared for removal of implants at any point that a client wishes, not just at the average expected use of 3/5 years. What lessons or guidance can be shared with country programs that need to be prepared for removing implants?                             

Day 4 Summary A:

Another participant provided some more information about the provision of implants by health extension workers (HEWs) in Ethiopia. He mentions that HEWs are providing implants at health posts, which brings services closer to households. Read more about implants in Ethiopia in the Program Examples below.

Full text day 4 summary A    
 

Day 4 Summary B:

Participants from Ethiopia, Rwanda, and New Zealand shared their country experiences. Contributors highlighted implant use in their countries, myths and misconceptions, and challenges in educating both providers and clients about implants. Technical experts Dr. Irina Yacobson and Dr. Roy Jacobstein responded to each contribution. Also, Ms. Laura Raney, Sr. Technical Officer for FHI addressed the similarities and differences of implants, including Sino Implant (II).

Full text day 4 summary B      

Day 5:  Implants Toolkit

Questions:

  1. Have you accessed the Implants Toolkit?
  2. If so, do you find it useful?
  3. Are there materials or topics that you believe to be missing from the toolkit?
  4. How could the implants toolkit be used to address inconsistencies in provider training?
  5. How do you plan to use the Implants toolkit in your work?                           

Day 5 Summary A:

Since the forum began, we have discussed training of providers, counseling, cost, programmatic considerations, myths and misconceptions, and challenges in educating both providers and clients about implants as a contraceptive method.

Each of the themes addressed in the forum (essential knowledge, programmatic considerations, and country experiences) provide the foundation for the Implants Toolkit:

  • The ESSENTIAL KNOWLEDGE section of the toolkit is designed to provide policy makers, program managers, and service providers with the key, or “essential,” background and reference materials on implants.
  • The PROGRAM MANAGEMENT section of the toolkit addresses implants programs which, as with any other health care program, involve organizing the program to ensure its smooth operation.
  • The COUNTRY EXPERIENCES section includes country experiences on many of the programmatic topics covered in the toolkit, including, task-sharing, conventional service delivery models, mobile services, and social franchising.

Please go to www.k4health.org/toolkits/implants to browse the eight thematic sections of the Implants Toolkit. We hope that you will use and contribute to the Implants toolkit.

Full text day 5 summary A    
  

Day 5 Summary B:

A participant from Sri Lanka discussed the situation with contraceptive implants in her country. Her full descriptions can be found in the Program Examples below.

Full text day 5 summary B      

Program Examples

Sri Lanka: Dr. Sumithra mentioned that in Sri Lanka a client can receive an implant at no cost in a government-run clinic because of donor-funded procurements of implants. However, Dr. Sumitra also mentioned that implants are only given to women who are not suited to other contraceptive methods.

This raises two important issues tied to provision of implants; the cost of implants – both cost to the client and cost to donors and government to purchase supplies directly associated with insertion – and assessing levels of demand for implants to make sure there are adequate supplies in the future.

When providers are dealing with a limited supply of implants, we understand that they must decide who receives an implant and who does not. However, ideally, the cost of providing that method should not factor into a provider’s ability to offer any method to any women who is medically eligible and interested in that method.

Unfortunately, that is not the reality in many countries as they face occasional or regular stock-outs of different contraceptive methods and limited supplies of new and or more expensive products.

Dr. Sumithra mentioned that when it was available in the past, Norplant was very popular in Sri Lanka. Data on Norplant use during the period that it was available, as well as data on Implanon use since 2005, Jadelle use since 2009, and projections of future demand can be used to ensure that we are meeting demand.

For more information on improving logistics system performance, you can visit the Logistics section of the Implants Toolkit at http://www.k4health.org/toolkits/implants

Ethiopia: With over 77 million people, Ethiopia has the second largest population in sub-Saharan Africa and continues to grow rapidly. Almost 60% of Ethiopians live more than 10 kilometers from the nearest health facility and more than 83% live in rural areas. Although nearly 80% of currently-married Ethiopian women want to either stop or postpone childbearing, demand for contraception has grown faster than its use. According to the 2005 Ethiopian Demographic Health Survey (EDHS), the contraceptive prevalence rate (CPR) had grown from 8% to 15% with an unmet need of 34% (20% for spacing and 14% for limiting births).

Women have children young and closely spaced, and only 0.4% use long-acting family planning (LAFP) methods, such as an implant or intrauterine contraceptive device (IUCD). This low level is attributable to a shortage of trained providers, lack of supplies, and distances to equipped health facilities and related travel expenses. The expansion of services to LAFP methods such as implants will have a crucial role in addressing the unmet need.

In Ethiopia, Pathfinder International is taking two approaches to training providers on LAFP methods: (1) training clinical service providers using service delivery based training on the insertion and removal of all LAFP methods; and (2) training Health Extension Workers (HEWs) on Implanon insertion.

Post-forum survey results

N of surveys completed - 7

% who have passed content to others - 29%

% who have or will use in their work - 100%

% very satisfied with forum content - 67%

Suggestions for improvement:

  • Try to invite participants from different countries ahead of time prior to the forum. It is very helpful to read country experiences during the forum.  
                                                              
References and resources

Click here for related resources and references in the community library

Organizing groups

Family Health International, Engenderhealth, Pathfinder International, Knowledge for Health Project, based at Johns Hopkins Bloomberg School of Public Health’s Center for Communication Programs (JHU/CCP)

Contributing experts/facilitators 

Dr. Irina Yacobson, Assistant Medical Director in the Applied Research Department at Family Health International

Dr. Roy Jacobstein, Clinical Director of the Respond Project at EngenderHealth

Dr. Mengistu Asnake, Deputy Country Representative at Pathfinder International/Ethiopia

Steering committee

Family Health International, Engenderhealth, Pathfinder International, Knowledge for Health Project, based at Johns Hopkins Bloomberg School of Public Health’s Center for Communication Programs (JHU/CCP)

Moderators

Ashley Isabelle Spence, JHU/CCP