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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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Introducing Medical Abortion: Thinking Strategically

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  1. 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 05_XXX_MM1

  2. 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". 05_XXX_MM2

  3. Begin with the End in Mind ICMA's mandate Promoting access to medical abortion in the context of safe abortion worldwide 05_XXX_MM3

  4. 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 05_XXX_MM4

  5. 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 05_XXX_MM5

  6. 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 05_XXX_MM6

  7. 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 05_XXX_MM7

  8. 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. 05_XXX_MM8

  9. Sustainable Scaling Up scale up Sustainable Vertical Scaling Up Institutionalization Horizontal Scaling Up Expansion 05_XXX_MM9

  10. 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 05_XXX_MM10

  11. Strengthening Capacity for Scaling Up Health Service Innovations www.ExpandNet.net 05_XXX_MM11

  12. Overview of the Strategic Approach http://www.who.int/reproductive-health/publications/ 05_XXX_MM12

  13. 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 05_XXX_MM13

  14. 05_XXX_MM14

  15. 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 05_XXX_MM15

  16. 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 05_XXX_MM16

  17. Scaling Up Policies and Programmes Related to Safe Abortion Equity-Choice-Collaboration-Rights Based-Client Centred 05_XXX_MM17

  18. Ensuring Sustainability of Policies and Programmes Related to Safe Abortion Strong Stakeholder Collaboration 05_XXX_MM18

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