In 2009, Pathfinder International and its partners implemented the Strengthening Communities through Integrated Programming (SCIP) project in Nampula province, Mozambique with a goal of increasing access to contraceptive services at both health facility and community levels. This goal was determined through formative research that indicated (1) that the range of contraceptive methods available in the country was low, (2) nationwide shortages of both short- and long-acting methods restricted availability, (3) distance to health service facilities limited contraceptive access and uptake, and (4) pervasive sociocultural barriers, such as myths and misconceptions about contraception and limited male involvement in sexual and reproductive health further compounded identified obstacles. To help prevent supply shortages, the project team worked with national and provincial commodity supply task forces to forecast needs, while also working with health facilities on a quarterly basis to correctly complete stock order forms. Through working with staff at healthcare facilities, the SCIP team found that many providers were uncomfortable administering long-acting methods of birth control such as IUDs. In response, SCIP worked with the Ministry of Health to develop trainings on IUD insertion and removal that were offered to the 99 health providers that staffed 139 SCIP-supported healthcare facilities. A similar training was also developed and implemented when contraceptive implants were introduced into the health system. To ensure that the trainings did not lead to biases in the form of contraceptive administered by providers, each training included a module that reviewed all other methods available, contraindications of each, and the importance of balanced contraceptive counseling. Day-long mentorship visits were then conducted by SCIP provincial nurse supervisors on a quarterly basis to help reinforce newly acquired skills. To improve access to contraceptives at the community level, Pathfinder worked with its government counterparts to expand the range of contraceptive methods offered through mobile brigades and integrate contraception into biannual maternal and child health (MCH) weeks.
Throughout the duration of this project, steps were also taken to ensure that programming and strategies implemented would be sustainable long-term. Pathfinder worked to identify and strengthen existing community structures such as community leadership councils and health facility co-management committees that had been tasked with overseeing local health initiatives. SCIP project nurses would meet with these groups to facilitate discussions about social norms and beliefs that interfered with contraceptive decision making and trained community leader facilitators on the importance of male involvement in sexual reproductive health, emphasizing contraception. Additionally, Pathfinder built the capacity of 100 health facility co-management committees so that they could act as the link between health and community systems, gauging community demand for contraceptive methods. The project also supported over 33,000 community health workers and volunteers who sensitized community members on health issues including contraception, directly distributed pills and condoms, and referred clients to facilities for other methods and for initial contraception consultations.
Couple years of protection (CYP), which was calculated by multiplying the total amount of all contraceptive methods distributed in SCIP-supported sites by the relative effectiveness of each method to estimate the total years a given couple would be protected from pregnancy, was a key measure used to evaluate the effectiveness of this program. Over the life of the SCIP project, CYP increased by nearly 400%. Additionally, a statistically significant increase was found in the use of contraception, from 7.2% at baseline to 17.6% when the project concluded. These results suggested that both access to and choice of contraceptive methods improved as a result of this intervention.
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