projet uzazi bora -...
TRANSCRIPT
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Projet Uzazi Bora
Les Progrès Realisés
pour Améliorer la Santé de la
Reproduction Maniema
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Introduction
But est de contribuer à la réduction de la mortalité maternelle et néonatale dans la Zone de Santé de Kasongo en RDC
Projet de santé de la reproduction compréhensive pour
l’amélioration de la qualité des services Partenariat avec le Ministère de la Santé et
RAISE/Université de Columbia-Marie Stopes International
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Zone de Sante de Kasongo
•1 Hôpital Général de Référence •2 Centres de Santé de Référence •19 Centres de Santé Population: 192.674 Habitants
Zone de Santé de Kasongo
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Les Volets du Projet
- La Planification Familiale
- Les Soins Obstétricaux et Néonatals d’Urgence (SONU)
- La Prévention et Prise en Charge des IST, VIH/SIDA incluant la PTME
- La Prise en Charge Médicale des Survivants des Violences Sexuelles
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La Planification Familiale
• Projet disponibilise toute la gamme des méthodes contraceptives
• Introduction des implants en RDC
• Introduction des méthodes permanentes
• Formation des prestataires sur les méthodes à long terme et les méthodes à court terme
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Les Soins Obstétricaux et Néonatals d’Urgence (SONU)
• Formation des prestataires et des formateurs, et suivis pour la validation de compétences cliniques
• Réhabilitation et dotation en matériels nécessaire pour les SONU
• SONU (SAA) était une opportunité pour l’introduction de FP aux accouchées et clientes de SAA
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Stratégies
1. Le Partenariat:
• Le Ministère de la Santé - niveau Local, Provincial et National
• Synergie avec les partenaires: GTZ/PARSS, STIC, Heal Africa, ABA, et autres ONGs et OBC locales
2. La Formation, Supervision Facilitante, Recyclage:
• Validation des compétences cliniques sur modèles anatomiques
• Le Counseling basé sur BERCER pour la PF
• Supervision intégrée assurée par BCZS et CARE
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La Formation Basée sur la Compétence
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Stratégies (Continue)
3. La Communication pour le Changement de Comportement (CCC)
• Développement des messages clés
• Groupe folklorique, sketch, Radio communautaire
• Relais communitaires (RECO)
• Causeries éducatives: • Mitonge • Misadi • Consultation Pré Natale (CPN) • Persuadeur dans la communauté
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Une Misadi de Mulangabala
Misadi de Mulangabala fait un Causerie avec des membres de Communautés a Maviringo
La mère, nouveau né, animateur du BCZS de Kasongo et la matrone
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Strategies (Continue)
4. La Mobilisation Communautaire: • Formation et Accompagnement de CODESA • Réalisation de l’étude de faisabilité de la mutuelle de
santé 5. Le Plaidoyer à tous les niveaux:
• Allocation de plus des fonds pour la santé maternelle et infantile
• Utilisation des indicateurs de processus des Nations Unies pour les SONU
• Intégration de module de formation sur les Soins Après Avortement
• Amélioration de la sécurité des médicaments et contraceptifs
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-100
100
300
500
700
900
1100
1300
Jan-Jun 08 Jul-Dec 08 Jan-Jun 09 Jul-Dec 09 Jan-Jun 10 Jul-Dec 10
DIU
Implant
Ligature tubaire
Vasectomie
Pilule
Injectable
CU
1086
1210
1109
1010
743
905
Nombre de clients qui acceptent une méthode de PF dans la Zone de Santé de Kasongo 2008-2010
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0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Jan-Jun 2008 Jul-Dec 2008 Jan-Jun 2009 Jul-Dec 2009 Jan-Jun 2010 Jul-Dec 2010
Besoins satisfaits en SONU CARE RDC, Jan 08-Mar 11
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Enquête de la Population
Méthodologie
• Entretiens individuels avec des femmes (âgés 15-49) dans toute la zone de rayonnement des formations sanitaires appuyées par CARE sous le projet RAISE
• Echantillonnage – 25 grappes ont été sélectionnées
– Sélection aléatoire des ménages dans chaque grappe
– Sélection aléatoire d’une femme dans chaque ménage
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Prévalence Contraceptive (CPR)
2.8%
5.9%
0%
1%
2%
3%
4%
5%
6%
7%
Baseline 2008 Midterm 2010
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Utilisation de méthode à long-terme ou de méthode permanente, parmi les clientes utilisant une méthode
moderne
0%
27%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Baseline 2008 Midterm 2010
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Barrières à l'utilisation de planification familiale
55.3%
37.4%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Baseline 2008 Midterm 2010
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Besoin non-satisfait en planification familiale
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Femmes ayant accouché devant un personnel qualifié au centre de santé
39.8%
78.2%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Baseline 2008 Midterm 2010
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Conclusion et Recommandations
• Assurer la qualité de service
• Augmenter la masse critique des prestataires formés
• Mettre à l’échelle ce paquet d’activités
• Assurer une stratégie pour mobiliser la communauté pour créer la demande et pour répondre aux barrières de services
• Assurer la sécurisation des produits contraceptifs
• Profitez des opportunités d’intégration comme clinique post-natale, clinique prénatale pour augmenter utilisation des services comme la planification familiale
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Merci Beaucoup!
Aksanti sana!
Tuasakidila wa bunyi!
Thank you very much!
Matondo mingi! Melesi mingi!
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1. CONTEXTE DE LA RDC
2. JUSTIFICATION DE LA MISE EN OEUVRE DU PROGRAMME DE PF
3. EXPERIENCE DE LA RDC
4. RESULTATS
5. DEFIS
6. LECONS APPRISES
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Niger Chad
Sudan
Algeria
Mali
Libya Egypt
Mauritania
Morocco
Western Sahara
Nigeria
Benin
Togo
Burkina
Ghana
Ivory Coast
Guinea
Senegal
Liberia
Sierra Leone
Gambia
Guinea Bissau
Ethiopia
Djibouti
Eritrea
Uganda Somalia
Kenya
Cameroon
Central African Republic
Congo Gabon
Equatorial Guinea
Democratic Rep. of Congo
Tanzania
Zambia Angola
Mozambique Madagascar
Zimbabwe
Botswana Namibia
Swaziland
Lesotho South Africa
Malawi
Burundi Rwanda
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Contexte de crise politique (1990) et de guerre civile ( 1996)
Destruction des infrastructures Déplacement de la population Manque de prestataires qualifies dans les
zones rurales ( conditions difficiles) Reformes du système sanitaire récent
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850
1289
1837
547
670
0
200
400
600
800
1000
1200
1400
1600
1800
2000
ENSELF(1985) MMSCS2 (1990) ELSS (1998) EDS (2007) EDS (2008)
Evolution de la mortalité maternelle en DRC
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La prévalence contraceptive: 15% en 1991 et 6% à ce jour causes: Services non disponibles (Contexte de guerre)
▪ Manque de personnel qualifié en la matière
▪ Non disponibilité des produits contraceptifs
▪ Manque d’information de la population sur la PF
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90% DES DECES DUS A DES COMPLICATIONS DES AVORTEMENTS ET
30% DES DECES MATERNELS
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Améliorer la capacité des hôpitaux du Minisanté et de leur personnel de fournir les services SR clés et de former les autres dans ces compétences Créer un cadre des formateurs qualifiés qui va
donner la formation à base des compétences et la supervision Créer un centre de formation dans chaque
province En collaboration avec le PNSR
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P. Orientale
Sud Kivu
Nord Kivu
Kasaï Occidental
P. de Kinshasa
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AU NIVEAU DU SYSTEME
AU NIVEAU DE L’OFFRE DES SERVICES
AU NIVEAU DE LA COMMUNAUTE
UTILISATION DES SERVICES
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Construction/ réhabilitation de 4 salles de formation dans les différentes provinces Salles de formation équipées en matériels
didactiques et en modèles anatomiques Approvisionnement des structures en intrants et
équipements nécessaires Formation de formateurs Formation des prestataires
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PROVINCES RAISE 1 2007-2011
FP- PACE 2011-2012
Services fournis Population cible
Sud Kivu 2 HGR & 4 CS 4 HGR& 9 CS
pillules, injectables, implants, DIU ainsi que LT pour les HGR 9 4763
Province Orientale 1 HGR & 2 CS 3 HGR & 6 CS
pillules, injectables, implants, DIU ainsi que LT pour les HGR 64 178
Kasai occidental 2 HGR & 4 CS 3 HGR & 9 CS
pillules, injectables, implants, DIU ainsi que LT pour les HGR 131 839
Nord Kivu 1 HGR & 6 CS
pillules, injectables, implants, DIU ainsi que LT pour les HGR 47 026
Kinshasa 3 HGR & 3 CS 0
pillules, injectables, implants, DIU ainsi que LT pour les
HGR+DBC 365 117
TOTAL 8 HGR & 13 CS 11 HGR & 30 CS 702 923
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23 formateurs en PF
48 formateurs en SONU
100 Superviseurs en Supervision facilitante
26 Formateurs en Soins médicaux aux SVS
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225 prestataires en PF
226 prestataires en SONU
154 prestataires en SAA
68 Prestataires en Soins médicaux aux SVS
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47 41
336
810
1818
2180
0
500
1000
1500
2000
2500
Jan-Jun 2008 Jul-Dec 2008 Jan-Jun 2009 Jul-Dec 2009 Jan-Jun 2010 Jul-Dec 2010
Nouvelles acceptantes PF, toutes les methodes IRC DRC, 2008 - 2010
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0
500
1000
1500
2000
2500
3000
3500
4000
4500
2008 2009 2010
Nouvelles acceptantes PF par an IRC DRC, 2008 - 2010
Implant
DIU
Ligature des trompes
Injectable
COC
88
1145
3998
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Au niveau de l’offre des services ▪ Déperdition des personnels ▪ Disponibilité des Intrants et équipements
Au niveau communautaire ▪ Manque d’informations et les rumeurs
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Impact de la mise en œuvre du projet sur les politiques
Intrants et équipements doivent être disponibles en permanence
La formation doit être axée sur l’acquisition des compétences Les compétences doivent être mises en œuvre
immédiatement Une stratégie efficace de sensibilisation doit être mise en
œuvre
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Merci pour votre attention
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INTERNATIONAL CONFERENCE ON FAMILY PLANNING SLIDE 1
Winning the battle to establish evidence on RH service provision in conflict-affected settings: Findings from northern Uganda 2007-2010 Panel: Family Planning on the Frontlines: Implementing Family Planning Programs for Populations affected by War
Presenter: Adrienne Testa1
Authors: Jimmy Odong2, Denis Okwar2, Louise Lee-Jones1, Clare Tanton3, Sara Casey4, Shanon McNab4, Adrienne Testa1
Affiliations: 1 Marie Stopes International 2 Marie Stopes Uganda 3 University College London 4 Heilbrunn Department of Population & Family Health, Columbia University
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INTERNATIONAL CONFERENCE ON FAMILY PLANNING SLIDE 2
Overview
1. Background
2. Methods
3. Results
4. Conclusions
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INTERNATIONAL CONFERENCE ON FAMILY PLANNING SLIDE 3
Background
Northern Uganda was adversely affected by violent civil unrest for over 20 years
Over 1.5 million people displaced during the height of the conflict
Prolonged nature of the conflict had a devastating impact on the Reproductive Health (RH) of women
2006 DHS shows that the contraceptive prevalence rate (CPR) in the north (10.9%) was half that of the national average (23.7%).
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INTERNATIONAL CONFERENCE ON FAMILY PLANNING SLIDE 4
Source: United Nations Office for Humanitarian Affairs. 2007. http://reliefweb.int/sites/reliefweb.int/files/resources/49415 B73CCADA0A2C1257348003EC10Eocha_CE_uga070827.pdf
Map of Uganda Showing Conflict Areas
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INTERNATIONAL CONFERENCE ON FAMILY PLANNING SLIDE 5
Background
In 2007 Marie Stopes Uganda (MSU) began strengthening services to improve provision of RH services to conflict-affected populations in northern Uganda
Comprehensive programme providing EmOC, STI/HIV prevention and addressing GBV
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INTERNATIONAL CONFERENCE ON FAMILY PLANNING SLIDE 6
Background
Support including clinical training and follow-up, commodities, M&E:
– 4 outreach teams from 2007 to end 2008. Support to 2 outreach teams from Jan 2009 to Dec 2010
– 4 Ministry of Health (MOH) health centres, in collaboration with Canadian Physicians for Aid and Relief
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INTERNATIONAL CONFERENCE ON FAMILY PLANNING SLIDE 7
Methods
2007-2010 MSU delivered BCC messages through radio dramas and mass communication to generate demand
Mid level providers trained in provision of long acting and permanent methods (LAPM) of FP
Mobile outreach teams visited remote rural areas where women received counselling and FP method of their choice
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INTERNATIONAL CONFERENCE ON FAMILY PLANNING SLIDE 8
Method
Rural baseline and endline surveys were conducted in 4 MOH health centres catchment areas
Multi-stage cluster sampling design: 45 and 80 clusters in which 25 and 11 households were selected respectively at baseline and endline
1 eligible woman of reproductive age was randomly selected in each household
Survey data were double entered using CSPro software and validated for data entry errors
Data were transferred to STATA for analysis
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INTERNATIONAL CONFERENCE ON FAMILY PLANNING SLIDE 9
Results
A total of 905 respondents at baseline and 873 at endline were included for analysis
Current use of a modern method of contraception increased from 6.9% to 22.9%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
Baseline 2007 Endline 2010
Current Use of Modern Method Contraception
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INTERNATIONAL CONFERENCE ON FAMILY PLANNING SLIDE 10
Results
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
50.0%
Baseline 2007 Endline 2010
Ever Use of Contraception
Ever use of contraception rose from 27.2% at baseline to 47.0% at endline
Injectables was the most common method currently used at baseline at endline: 3.9% and 9.4% respectively
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INTERNATIONAL CONFERENCE ON FAMILY PLANNING SLIDE 11
Results
Women using LAPM increased from 0.6% at baseline to 10.0% at endline:
– Current use of implants increased from 0.4% to 7.1%
– Current use of IUDs rose from 0% to 0.8%.
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INTERNATIONAL CONFERENCE ON FAMILY PLANNING SLIDE 12
Conclusions
MSU in collaboration with RAISE Initiative significantly increased uptake of LAPM of FP by effectively combining
– BCC messaging
– Delivery of high quality services through mobile outreach teams
– Support to rural health centres
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INTERNATIONAL CONFERENCE ON FAMILY PLANNING SLIDE 13
For more information about this study contact [email protected] http://www.mariestopes.org/What_we_do/Refugees_%5E_IDPs/RAISE.aspx
To find out more about how we are addressing unmet need by reaching the most underserved, please visit www.mariestopes.org