Introducing Medical Abortion: Thinking Strategically
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Introducing Medical Abortion: Thinking Strategically. Peter Fajans MD MPH and Ronnie Johnson PhD UNDP/UNFPA/WHO World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) Department of Reproductive Health and Research World Health Organization.

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Introducing medical abortion thinking strategically

Introducing Medical Abortion: Thinking Strategically

Peter Fajans MD MPH and Ronnie Johnson PhD

UNDP/UNFPA/WHO World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP)

Department of Reproductive Health and Research

World Health Organization

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What do we mean by introduction

What do we mean by "Introduction"?

Product introduction refers to "the integrated set of activities to prepare health systems to accept and manage the provision of new, improved, or underutilized technologies".

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Begin with the end in mind

Begin with the End in Mind

ICMA's mandate

Promoting access to medical abortion

in the context of safe abortion worldwide

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Build support for introduction of ma in the context of safe abortion care

Build Support for Introduction of MA in the Context of Safe Abortion Care

  • Involve broad range of key stakeholders

  • Inform, listen to concerns, build support

  • Develop information materials for different target audiences

  • Advocacy with gatekeepers and other stakeholders

  • Conduct clinical or introductory trials to familiarize health professionals and prepare for regulatory approval

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Assess needs and priorities for introduction

Assess Needs and Priorities for Introduction

  • Review available in-country literature

  • Conduct a field-based assessment of current abortion and related SRH services

    • Participatory process to provide multiple perspectives and build ownership and consensus

    • In-depth interviews with managers, providers, women seeking services, community members including youth

    • Observations of facilities and services as appropriate

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The strategic approach conceptual framework

The Strategic Approach: Conceptual Framework

Women's Needs and Perspectives, Gender Issues

PEOPLE

SERVICES

TECHNOLOGY

Policies, Programmes, Access, Availability, Quality of Care

Availability, Characteristics

Social, Cultural, Legal, Political and Resource Contexts

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Introducing medical abortion thinking strategically

Examples of Follow-Up Actions from Strategic Assessments

  • Policy directives to increase access to contraception and safe abortion for at-risk groups

  • Development/revision of national standards and guidelines and training curricula for CAC, including MA

  • Introduction of MVA and MA for 1st trimester abortion

  • Introduction of MA and D&E for 2nd trimester abortion to replace less safe methods

  • Development of IEC/communication strategies for women and communities

  • New models of service delivery

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Importance of local evidence for scaling up

Importance of Local Evidence for Scaling Up

  • Is the innovation feasible and effective in the local context?

  • Learn what works before investing in wide-scale implementation

  • Refine and improve the package of interventions

  • Build ownership by involving stakeholders in design and implementation

  • Opportunity for decision-makers to observe new services, to build support

  • Provide input to development or revision of national standards and guidelines, training curricula, IEC materials, etc.

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Introducing medical abortion thinking strategically

Sustainable Scaling Up

scale up

Sustainable

Vertical

Scaling Up

Institutionalization

Horizontal Scaling Up

Expansion

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Introducing medical abortion thinking strategically

A Framework for Scaling Up

Environment

The Innovation

User

Organization(s)

Scaling up Strategy

Resource

Team

DISSEMINATION

AND ADVOCACY

TYPES OF

SCALING UP

ORGANIZATIONAL

CHOICES

COSTS/RESOURCE

MOBILIZATION

MONITORING

AND

EVALUATION

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Strengthening capacity for scaling up health service innovations

Strengthening Capacity for Scaling Up Health Service Innovations

www.ExpandNet.net

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Overview of the strategic approach

Overview of the Strategic Approach

http://www.who.int/reproductive-health/publications/

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Introducing medical abortion thinking strategically

Making Decisions

about Contraceptive

Introduction:A Guide

for conducting

assessments to

broaden contraceptive

choice and improve

quality of care

A practical guide for

implementing Strategic

Assessments

http://www.who.int/reproductive-health/publications/rhr_02_11_contraceptive_introduction/ci-guide.pdf

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Introducing medical abortion thinking strategically

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Introducing medical abortion thinking strategically

The Strategic Approach Implementation Process

STAGE I

STAGE II

STAGE III

Strategic Assessment

Developing and Testing Programme Innovations

Scaling-Up Successful

Interventions

Improved Reproductive

Health Status and Programmes

Reproductive

Health

Challenges

Policy & Programme Strengthening

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Strategic assessments on issues related to abortion

Viet Nam (1997)*

Romania (2001)

Bangladesh (2002)*

Mongolia (2003)*

Ghana (2005)*

Moldova (2005)*

Macedonia (2007)

Ukraine (2008)*

Zambia (2008)

Malawi (2009)

Russia (2009)

Guinea (2009)

Strategic assessments on issues related to abortion

* Follow up includes introduction of MA

Collaborating partners: EngenderHealth, Ipas, Pop Council, RH Alliance, WHO

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Introducing medical abortion thinking strategically

Scaling Up Policies and Programmes Related to Safe Abortion

Equity-Choice-Collaboration-Rights Based-Client Centred

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Introducing medical abortion thinking strategically

Ensuring Sustainability of

Policies and Programmes Related to Safe Abortion

Strong Stakeholder Collaboration

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