PSI/Tanzania Presentation

Private sector role in Family PlanningBy Dr. Nguke Mwakatundu,RH Director

Some Abbreviations

• CPR: Contraceptive Prevalence Rate• CYP: Couple Years of Protection• FP: Family Planning• IPC: Interpersonal Communication• IUCD: Intrauterine Contraceptive Device• LTM: Long Term Method• MWRA: Married Women of Reproductive Age• OC: Oral Contraceptive• PA: Public Announcement

National Reach

Zonal Offices

Regional Offices

National Coverage

Background and Geographical Coverage-RH Program• Familia RH program was initiated in 2007,and started

services provision in January 2009• Sales of RH products cover the whole of Tanzania

with exception of IUCDs and Implants which cover 13 regions in Tanzania.

• PSI/Tanzania distributes six FP products and offers service delivery in 17 regions of mainland Tanzania (Network facilities in 13 regions and outreach activities in 12 regions).

• Distributes one safe motherhood product and will start limited distribution of another one in Q2 2013

RH Program Objectives

• Family Planning To contribute towards increase of national CPR target

(target 60% use among MWRA by 2015) and reducing total fertility rate from 5.4 to 3.1 by 2015

To promote usage of FP methods especially long-term methods (Implants and IUCD’s).

• Maternal mortality To contribute towards reducing maternal mortality to

193/100,000 live births by 2015(Currently at 454/100,000) To reduce maternal deaths due to post partum

haemorrhage (PPH) and incomplete abortions using misoprostol.

To increase access to safer delivery -Clean delivery pack

Program Components

• Product procurement, packing and distribution• Social marketing of 6 FP products,1 safe motherhood product,

and another safe motherhood product from Q2 2013 • Distribution at national and regional level in all authorized

outlets.

• Increased access to services (esp LTM)• Comprehensive partnership with private sector facilities• Service provision through outreach teams

• Behaviour Change Communication• Inter Personal Communication in communities• Medical detailing to health facilities and pharmacies• Community events• Public Announcements

Program Components

• Supportive environment • Curriculum revision• TOT’s• Working with universities, professional associations (e.g.

AGOTA)• Working with the Ministry of Health at national and local level to

improve the environment for better access to FP and safe motherhood services

• Integration• FP / HIV : Counselling, referral for testing and free condom

distribution• Treatment of Incomplete abortion / FP• Postpartum FP

Familia Products Range

• Family Planning Products: IUCD’s Implants Condoms(male and female) Injectables Oral Contraceptives Emergency contraceptives(supplier brand)

• Safe Motherhood Products Misoprostol (supplier brand) Clean Delivery Pack

page 10

Pharmaceutical Regional

Distributor Urban retailer

District/Rural Centers

wholesaling outlets

Urban wholesaling

outlets

Rural retailer

Institutions, NGOs, CBOs

etc

Health facilities

PSI/Tanzania Current distribution modelTarget G

roups

Clinics, VCT, HBC, CHWs,

Peer educators

MDCs

Behavioural Change Communication Activities• IPC activities: Household

Visits, Neighbourhood Meetings, Clinic meetings

• Women groups meetings : Markets places, Saloon s visits, kitchen parties

• IEC materials: posters, brochures

• Public Announcements (PA)• Mass media: radio spots,

newspapers

page 11

Private Sector PartnershipService Delivery

Approach

• Social franchising model• Selection of health facilities based on specific criteria• Signature of MOU• Comprehensive training in clinical skills for LTM• Equipment for LTM provision• Access to products, expendables and job aids• Monthly event days post-training for capacity building• On going coaching and mentoring for quality• Branding and local promotion of services through

posters, wall paintings, PAs• Referral system to facility using IPC agents

Branding of Facilities

Wall Paintings

Public Sector Approach• 10 outreach teams supporting the public sector in 12

regions.• Each team is of 2 nurse midwives partnering with

public sector providers trained in LTM• Selection of location / health facilities driven by

district authorities• Demand creation prior to the event using posters;

public announcements; local leaders; facility providers

• Equipment, supplies and IP material brought by PSI team

• All FP clients are screened for HIV and referred for testing if they are at risk

• Free condoms offered to all clients in need

Major Achievements in 2012• More than doubling in provision of LTM’s(102,778

insertions in 2012 Vs 48,518 in 2011)• Increased provision of LTM’s in private sector by 92%(58327

combined IUCD’s and Implants Vs 30446 in 2011)• Increased provision of LTM’s in the public sector by

145%(44451 combined IUCD‘s and Implants Vs 18072 in 2011)

• Over 317 providers in the private sector network as of Dec 2012 from 255 at end of 2011, 24% increase in number of providers in the private sector network.

• 250 IPC workers supporting the private sector network as of Dec 2012

• Over 300,000 women reached through IPC in 2012

Major Achievements cont.

• Increase in number of outreach teams from 5 to10 teams supporting the public sector in 12 regions.

• Increase in number of women counselled for HIV during FP counselling by 55% (82,891 in 2012 from 53,593 in 2011)

• Increase in number of women referred for testing for HIV by 66%(16,849 in 2012 from 10,134 in 2011)

• Increase in number of free condoms distributed by 98%(486,315 in 2012 from 245,541 in 2011)

LTM’s Insertions-Private Sector

2009 2010 2011 20120

5000

10000

15000

20000

25000

30000

35000

40000

45000

1470012578

21833

40741

3677 3650

8613

17586

IUCD insertions

Implant insertions

LTM’s Insertions-Outreach

2010 2011 20120

5000

10000

15000

20000

25000

30000

994

12911

28459

239

5161

15992

IUCD insertions

Implant insertions

IUCD’s and Implants Distribution

2009 2010 2011 20120

5000

10000

15000

20000

25000

30000

400

10235

15418

27155

0

2060

4400

21370

IUCD's distributed

Implants distributed

OC’s distribution

2009 2010 2011 20120

200000

400000

600000

800000

1000000

1200000

1400000

1600000

525072

718092663552

1428336

OC's Sales

OC's Sales

Injectables distribution

2010 2011 20120

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

4,100

18,090

170,650

Injectables sales

Injectables sales

Familia condoms distribution

2009 2010 2011 20120

5,000,000

10,000,000

15,000,000

20,000,000

25,000,000

6,785,032

20,088,720

4,262,400

10,929,600

Familia condoms distribution

Familia condoms distribution

Misoprostol distribution

2009 2010 2011 20120

50000

100000

150000

200000

250000

300000

350000

191710172080 177960

310408

Misoprostol distributed

Misoprostol distributed

CYP’s growth

2009 2010 2011 20120

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

CYP's other FP methods

CYP's condoms

MoHSW70%

PSI24%

T-MARC7%

National CYP Contribution, Jan-Dec 2011 by organisation

2013 Priorities

• Integrating other services to be delivered in the Familia social franchise

• Increasing productivity of private network providers and IPC workers

• Increasing sales of FP products• Introducing Clean Delivery Pack

THANK YOU