Підсумкова конференція проекту Разом до здоров я 2005 -2011

Підсумкова конференція проекту “Разом до здоров’я” 2005 -2011 рр. Successful strategies, public health impact, lessons learned and remaining challenges Laurentiu Stan JSI Research and Training Institute, Inc. 1

The Together for Health (Tf. H) Project Background www. tfh. jsi. com 2

Together for Health (Tf. H) • Six-year project (Oct. 2005 – Nov. 2011) – $12. 3 million • Implemented by JSI Research & Training Institute Inc. in collaboration with: – The Academy for Educational Development – Harvard School of Public Health • Goal: Abortions , unintended pregnancies Sexually transmitted infections • …by improved provision & access to quality FP/RH services, in public and private sectors www. tfh. jsi. com 3

FP/RH Service Provision in Ukraine at baseline • Numerous health professionals (> 12, 200 Ob. Gyn’s) and health facilities • FP/RH service provision: mainly by Ob-Gyn’s through a vertical network of FP centers and WCC • GOU concerned of needs for health reforms: – Emerging primary health care – Decentralization towards regional level and below • Over-reliance on traditional methods & abortions • Providers & population perpetuated misconceptions about contraception, especially hormonals • Low access to modern contraceptives (no donations, reduced GOU procurements) & geographic inequalities www. tfh. jsi. com 4

Suboptimal access to information on FP/RH in the health sector for its clients Source: UDHS, 2007 www. tfh. jsi. com 5

Tf. H Objectives & Intended Results 1. Increase health providers’ knowledge & skills (clinical and counseling) training 2. Improve clients’ knowledge and attitudes regarding FP/RH services & supplies IEC/BCC interventions 3. Improve availability, accessibility & affordability of contraceptives commodities 4. Strengthen capacity of public & private sectors to support policies & systems for improved RH policy www. tfh. jsi. com 6

Tf. H Coverage by 2011 (15 out of 27 regions - 65% of Ukrainian population ) www. tfh. jsi. com 7

Tf. H Implementation Strategies (1) Working under the Umbrella of…. …. State Program Reproductive Health of the Nation (SPRHN) To support its FP/RH objectives and activities, at the national and oblast levels. www. tfh. jsi. com 8

Tf. H Implementation Strategies (2) Comprehensive approach, branding of the FP program/interventions Change Behavior of Population/ Clients “Have you asked the doctor about FP methods? ” “Ask the doctor about FP methods” Capacity Building of Health Providers Contraceptive Availability in Pharmacies and Public Sector www. tfh. jsi. com 9

The Together for Health (Tf. H) Public Health Impact www. tfh. jsi. com 10

Building capacity for quality service provision in Primary Health Care • over 9, 000 health professionals trained since 2006 • ~ 2/3 were PHC providers (FDs and non-Ob-Gyns’) Source: Tf. H, 2011 www. tfh. jsi. com 11

Improved availability of FP services and supplies at the community level Increased availability of free contraceptives at health facilities Source: Tf. H, 2011 www. tfh. jsi. com 12

Percent reduction of abortion rates in project-assisted regions, 2005 -2010 Source: Ukraine MOH, 2005 -2010 www. tfh. jsi. com 13

Average annual reduction of abortion rates in project assisted regions Regions Years in the Baseline Tf. H-exposed Year cohort Lviv 2006 4 years Kharkiv 2006 4 years Vinnitsa 2006 4 years Volyn 2006 4 years Dnipropetrovsk 2006 4 years Poltava 2006 4 years Odessa 2007 3 years Donetsk 2007 3 years Zaporizhzhya 2007 3 years Rivne 2007 3 years Khmelnytsk 2007 3 years Ivano-Frankivsk 2008 2 years Cherkassy 2008 2 years AR Crimea 2009 1 year Sevastopol 2009 1 year www. tfh. jsi. com 14

Contraception, steadily replacing abortion Abortion rate (per 1, 000 WRA) 24 22 2005 20 2006 2007 18 2008 16 2009 14 2010 12 10 0. 4 0. 5 0. 6 0. 7 0. 8 0. 9 CYPs - Total active users in private sector (mils. ) Development, 2005 – 2011 Source: Support for Market Ukraine MOH, 2005 – 2010 www. tfh. jsi. com 15

Contraception, steadily replacing abortion with positive demographic changes (Ab. decrease; contraceptive increase; birth rates increase) Khmelnytsky - 16% Ab. Rate decline + 7% Birth Rate increase Dnipropetrovsk - 25% Ab. Rate decline + 8% Birth Rate increase www. tfh. jsi. com 16 Source: Ukraine MOH, 2005 -2010

Decline of incidence of child abandonment (ICA) higher in the Tf. H-assisted regions Source: Ukraine MOH, 2005 -2010 www. tfh. jsi. com 17

The Together for Health (Tf. H) Key Lessons Learned www. tfh. jsi. com 18

Importance of FP/RH in the Gov’t health agenda dictates allocations at national & regional levels Proportion of expenditures vs. alloted (FP Objective) Central budget; Tf. H vs. non-Tf. H Regions (Local budgets) Cumulative data 2008 -2010 Source: MOH/Tf. H, 2011 Source: Tf. H, 2011 www. tfh. jsi. com 19

Partnership and coordination with various stakeholders • National level institutions - to foster nationwide dissemination and programs’ sustainability • Local level counterparts (governmental & NGOs) - to coordinate efforts and maximize results (e. g. best reach the most vulnerable groups) • Private sector partners - to ensure coordinated messages, dissemination to non-project areas, and for leveraging additional resources • Higher educational institutions - to ensure institutionalization of FP/RH education for doctors and nurses. THREE EXAMPLES SELECTED FURTHER www. tfh. jsi. com 20

USAID’s Tf. H Partnership with national level institutions and authorities Professor Nina Goyda, Pro-Rector • Sustainable policy development: programs, protocols, guidelines (SPRHN approval and implementation) • Nationwide dissemination—reaching additional beneficiaries from ALL regions • Facilitation of communication between providers – regional authorities – national level health authorities • Institutionalization of project-developed approaches: service provision systems, curricula, M&E tools, etc. • Ensure coordination of messages when reaching various types of professionals: university professors, doctors, health managers and administrators www. tfh. jsi. com 21

USAID Tf. H’s Partnership & coordination with Regional level NGOs to reach certain targeted groups/communities Maria Didenko, board member of NGO "Youth center for development", BCC trainer • At local level, NGOs and non-health structures are key partners to reach target population groups • However, NGOs experience with FP/RH and health providers is still in its infancy • NGOs can serve a networking forum with other NGOs active in social areas and on HIV/AIDS prevention • Social services for youth and the Department of education are key partners with experience in reaching certain vulnerable groups/target communities www. tfh. jsi. com 22

USAID’s TFH Partnership & coordination with private sector Bayer Health Care Dr. Vladislav Golovinov Product Manager, Business Unit Women's Healthcare • Development and dissemination of evidence-based information and resources for health professionals • Awareness raising and educational campaigns for youth • Continuous medical education events (CMEs) • Worldwide partnership to assist governments and health ministries to provide access to subsidized contraceptives to vulnerable groups www. tfh. jsi. com 23

Create the momentum and build upon it • Substantial experience accumulated during the Tf. H implementation- basis for further improvements • To achieve change there is a need for a range of actions with continuous investment /TA ~ ”reinvent ourselves” • Providers’ capacity building • Behavior change of population • Policy / SPRHN • Advocacy for adopting new approaches to sustain current public health achievements www. tfh. jsi. com 24

Main challenges ahead in improving FP/RH in Ukraine www. tfh. jsi. com 25

Ukraine, still high abortion-related Maternal Mortality • Ukraine DHS, 2007 : “…almost half of the women undergoing one abortion reported having had 2 -3 during their lifetime” Enhanced focus on behavior change and on standards of abortion procedures Source: Ukraine MOH, 2005 - 2010 www. tfh. jsi. com 26

Need to deeper focus on rural population • Ukraine DHS, 2007: “…women who live in the capital and large cities have lower first abortion rates than those in smaller cities or towns” (Levchuck, 2009) • Ukraine MOH data from 2009: “… percentage of live births to mothers aged 19 years old and younger is almost double in rural areas (12. 8%) than in urban areas (6. 7%)” (Tefft, 2011) www. tfh. jsi. com 27

Population ability to pay for contraceptives is much lower than in 2005 (Source: Support for Market Development and Statistic Committee) Minimum wage could buy: 66 cycles of lowest priced OCs in 2005 44 cycles of lowest priced OCs in 2010 www. tfh. jsi. com 28

Advocacy for improved funding for FP/RH within governmental programs • Need for a renewed call to action for “revival” of the SPRHN and Regional FP/RH programs • Inclusion of FP/RH interventions within the governmental and donors‘ initiatives: – Presidential Initiative “New Life” – Government efforts to reform the health system – UN/WHO lead “Beyond the numbers” initiative www. tfh. jsi. com 29

Building Partnerships HEALTH MANAGERS Academic institutions HEALTH PROFESSIONALS Health professionals POLICY MAKERS COMMUNITIES Policy makers COMMUNITIES HEALTH MANAGERS ACADEMIC INSTITUTIONS www. tfh. jsi. com 30

Підсумкова конференція проекту “Разом до здоров’я” 2005 -2011 рр. ДЯКУЄМО! Ця презентація була розроблена завдяки щедрій підтримці американського народу з допомогою Агентства США з Міжнародного Розвитку. Відповідальність за зміст цієї презентації несе Корпорація Інститут Дослідництва та Тренінгів JSI; інформація, яка відображена в цій презентації не завжди поділяє погляди Агентства США з Міжнародного Розвитку або уряду Сполучених Штатів. 31