Fistula care. Integrating family planning into fistula services: An evaluation and case study.

This study was designed to: analyze trends shown in routine monitoring data collected on FP counseling and FP acceptors; review experiences with and impressions of the integration process obtained from key informants and clients; analyze relevant and related results from two studies conducted by FC; and conduct observations of patient-provider counseling sessions focus group discussions and self-assessments followed by group discussions to collect additional in-depth data on the integration process and results. The Nigeria integration experience-having been implemented for the longest period is featured as a case study to illustrate the interventions and their results. FP integration activities in all other FC-supported countries are summarized to highlight the interventions undertaken their experience with the integration approach (when it was introduced) the results achieved and challenges encountered. Selected key lessons learned from this review include: 1) The integration of FP into messages delivered during the postoperative and recovery periods was correlated with the strong uptake of FP methods. 2) The five-step integration approach provided a clear process for making system modifications and reorganizing work so that integrated FP-fistula services could function. 3) Integrated FP-fistula services need a well-functioning contraceptive logistics system. 4) It may take more time than expected for providers to become competent and confident in their new knowledge and skills. Selected major findings and recommendations include the following: 1) The number of women counseled and the number of FP users increased in all countries where FC introduced the FP integration approach or where FP was made available at the fistula centers even if not formally integrated with FC project support. 2) The newness of FP as an integrated element of fistula repair services has not yet allowed the health system to incorporate FP-related tasks into the job descriptions of each cadre of personnel (Nigeria). Institutionalizing integrated service delivery tasks will standardize practice support the supervision system to ensure the quality of practices and help shift staff’s attitudes to embrace a woman’s right to actively manage her reproductive intentions. 3) Men play a key role in women’s decision making and their ability to take action. While most women interviewed in Nigeria stated that their partners supported their decision regarding FP nurses said that partners are often a major obstacle to a woman’s decision to use FP. In Uganda the fistula repair facility involves men in FP counseling before and after the surgery and also has created sessions for men to discuss reproductive health.