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Are public health facilities ready to provide IUCD

services?

A survey of public facilities in Uganda

Authors: R. Twesigye, Peter Buyungo and H. KaulaResearch Department

Uganda Poor Maternal Health Numbers

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Why Family planning in Uganda?

6.2 - Total Fertility Rate

– Third highest in the world

438 deaths per 100,000 (MMR)

- Way off 2015 UN MDG target of 131

Source: UDHS, 2011

6.2

438

Contraceptive use in Uganda

Spacing and limiting births reduces the risk of maternal mortality

Uganda Family planning unmet need is at 34%

Total demand for family planning is at 64.3%64.3%

34%

Use of modern FP methods among married women in Uganda, UDHS 2011

Overall

IUD

Implants

Pills

Injectables

0 5 10 15 20 25 30

26

0.5

2.7

2.9

14.1

CPR method mix is currently

dominated by short term methods

Use of Modern FP methods among women (15-19yrs) in Program area, Uganda (n=2040, 1510),

2012-2014

Currently use IUDs Currently use Implants Currently use Injectables0

5

10

15

20

25

30

35

40

45

1.24.5

20.5

2.9

16.3

412012 2014

Rationale

To reduce the high TFR and MMR

improved access to a wide range of modern FP methods

including long acting and reversible contraceptive (LARCs) like IUCDs that are most

effective

Public health facilities (PHFs) are a key source of modern contraception

47% of current users

One of the tenets of good FP is to ensure ‘choice’ – any source must be ready to

offer this choice

Why Public Health facilities?

Research conducted

• A study was conducted in 2013 to establish the level of readiness of PHFs to provide IUCDs services so as to guide interventions to improve their capacity

• Study Specifically aimed at assessing– Availability of IUCDs – Availability of a provider trained to insert IUCDs– Availability of functioning equipment for inserting IUCDs– Availability of required supplies for IUCD insertion in PHFs

Methodology

• Sampling: • 30 districts representative of all regions • All public health facilities eligible to provide IUCDs (i.e level

III and above) • 356 facilities were surveyed

• Respondents: in – charges of family planning sections • Methods: Face to face structured interviews and observations• Fieldwork: November 2013

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KEY FINDINGS

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Outlet characteristics

Hospital5% Health Centre IV

13%

Health Centre III83%

Type of facility (%) n=356

Family planning services available (%) n=356

Male condoms

Progestin only injectables

Progestin only pills

Implant

IUD

Combined injectable

Cycle beads

Male sterilization

Female sterilization

78.1

75

50.4

48

34.8

26.1

4.8

3.9

3.7

IUDs in stock

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Hosp / HCIV N=62 (%) HCIII N=294 (%) All N=356 (%)

67.7

27.934.8

% facilities with IUDs in stock*

Staff trained

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Hosp / HCIV N=62 (%) HCIII N=294 (%) All N=356 (%)

83.9

60.9 64.9

% of facilities with at least one staff trained to insert IUDs*

%

Equipment

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Hosp / HCIV N=62 (%) HCIII N=294 (%) All N=356 (%)

35.5

6.511.5

% of facilities with all required equipment to insert IUDs (func-tional)*

%

Instrument tray and trolley; Examination couch; Tenaculum / Vulselum; Uetrine sound; Long scissors for cutting IUCD string; Sponge holding forceps; Kidney dish; Gallipots; Autoclave / sterilizer; Speculum sims cusco

Supplies

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Hosp / HCIV N=62 (%) HCIII N=294 (%) All N=356 (%)0

10

20

30

40

50

60

70

80

90

100

58.152.7 53.7

% of facilities with all required supplies to insert IUDs

Facility type

%

Jik / chlorine for decontamination; Surgical gloves; Disposable gloves; cotton; Gauze; Surgical blades; Plaster (adhesive elastoplasts); Color coded waste bins; Safety box for disposal of sharps

Overall service readiness

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Hosp / HCIV N=62 (%) HCIII N=294 (%) All N=356 (%)

16.1

0.7 3.4

% of public facilities reporting all 4 components of IUD pro-vision at time of survey

Trained Equipment Supplies IUDs

Conclusions• Opportunity exists – since two thirds of facilities have

trained providers

• Significant gaps are evident at HC III level hence a need to focus interventions to this level.

• Components that require improvement are: –Equipment, stocks and supplies

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Recommendations

• A total market approach harnessing public and private sectors resources will be key in covering unmet need for FP in Uganda

• Non government agencies will be required to support PHFs;

–to acquire complete sets of equipment; –to strengthen their forecasting and procurement systems so

as to ensure reduced cases of stock out of essential supplies for provision of IUDs

Acknowledgements

• Ministry of Health • District Health Officers in the study districts

• Health Facility – In – charges• Study respondents

• Makerere University, Kampala Department for Social Work and Social Administration (SWSA)

• MUREC & UNCST• Illustrations - http://www.carmma.org/

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Thank you!

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