Becoming a Model Municipality: Improving Quality of Care for Family Planning in Timor-Leste

Becoming a Model Municipality: Improving Quality of Care for Family Planning in Timor-Leste

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  Timor-Leste BECOMING A MODELMUNICIPALITY: IMPROVING QUALITY OF CARE FOR FAMILY PLANNING IN TIMOR-LESTE AUTHORS: Antonia Mesquita, Julio Goncalves, Elizabeth Bunde, Marianne Viatour, and Elaine Rossi—JSI Research & Training Institute, Inc. BACKGROUND USAID’s Reinforce Basic Health Services Project, implemented by JSI Research & Training Institute, Inc., works in Covalima Municipality, Timor-Leste to improve family planning (FP) services with a specific focus on quality of care (QOC). CONCLUSIONS RESULTS Facility-level Out of the 25 health facilities in the district, all are staffed with health providers certified to provide FP counseling and short-acting methods. Among these, 17 have at least one provider certified to also provide one or both long-acting reversible contraceptive methods (implants and IUDs). All seven community health centers (CHCs) and five health posts (HPs) meet national readiness and service availability standards. Average contraceptive stockout rates across all facilities/methods have decreased from 36% to 21%. METHODOLOGY JSI developed a model municipality approach, which merges DATA-DRIVEN PROCESSES with demand generation from clients and SKILLED PROVIDERS to bring QOC to the forefront of FP services. PROGRAM INTERVENTION A model municipality: well-trained and competent health providers receiving consistent, high-quality supervision and delivering quality FP services in fully-equipped, people-friendly health facilities. 1. Conducted Baseline Survey: to identify health facility needs to improve FP services and to identify FP messages that would resonate with the community. 2. Provided Training and Supportive Supervision: in FP counseling and IUD/implant insertion to maintain provider competency and improve health facility readiness. 3. Developed and Implemented SBCC Plan: to increase community demand for and use of FP services. 4. Advocated for Community Leaders: to promote FP and help communities overcome obstacles to obtaining FP services. 5. Integrated Use of Data: to monitor results, plan improvements, and promote data-driven decision-making. Out of the 25 facilities in Covalima, the number of facilities now staffed with at least one health provider certified to provide specific services: provide safe and clean delivery20 21 15 provide integrated management of childhood illnesses provide essential newborn care 72% of all the communities in the district have participated in FP-focused community discussion groups. 1. Achieving a model municipality requires coordination between government, facilities, and communities. Couple Years of Protection (CYPs) Increased Two-fold Since Project Began 0 2,000 4,000 6,000 8,000 2,042 3,876 4,697 5,052 Baseline Year 1 Year 2 Year 3 Since the project began, there has been a three-fold increase in injectable contraceptive CYPs, a five-fold increase in pill CYPs, and a 60% increase in the proportion of CYPs attributed to implants. Community-level 72% of all the communities in the district have participated in FP-focused community discussion groups. Four villages have developed action plans to improve community access to FP services, especially around innovative transport options for couples seeking FP services. 2. Increasing clinical competency for insert- ing implants and IUDs expands contraceptive options for women. 3. Following-up with post- training support increases provider confidence and maintains skills; technical competence is not a one-time investment. 4. Supplying health facilities with appropriate materials, equipment, and commodi- ties, supported by effective management helps meet patient needs. 5. Empowering community members to understand their options and demand appropriate services can effect change in the system when needed.