2022-09-24-世界卫生组织-Scaling_up_evidence-based_interventions_to_strengthen_postpartum_family_planning_services_in_the_Democratic_Republic_of_Congo_6页_754kb

报告摘要

Summary of Scaling up Evidence-Based Interventions to Strengthen Postpartum Family Planning Services in the DRC

Core Content

The Yam Daboo study (2015–2018) tested a low-cost package of interventions to increase the uptake of postpartum family planning (PPFP) in Burkina Faso and the Democratic Republic of the Congo (DRC). The study demonstrated that integrating family planning training and the use of a PPFP counselling tool could effectively improve PPFP uptake. Building on this success, the intervention was scaled up in 2019 under the FP Accelerator project in three provinces of the Kasai region in the DRC: Kasai, Kasai Central, and Kasai Oriental.

Main Interventions and Components

The scaling-up process involved four key components:

Training of Trainers: A series of sessions were conducted to train health professionals on the use of the PPFP counselling tool and family planning integration into the curriculum.
Adaptation of the PPFP Counselling Tool: The tool was updated and contextualized for use in the DRC.
Pilot Testing of Pedagogical Notes: These notes were developed for final-year midwifery students and tested across the three provinces.
Integration into Midwifery Curriculum: The PPFP counselling tool was incorporated into the basic curriculum of midwifery training programs at the Instituts Supérieurs des Techniques Médicales (ISTM).

Following the training, the family planning content in the midwifery curriculum was reviewed and strengthened, with a focus on counselling techniques and the Medical Eligibility Criteria (MEC) wheel.

Key Results

In Kasai and Kasai Central, the number of new PPFP acceptors increased significantly:
- From 62,529 to 77,200 in Kasai (2019–2021)
- From 44,584 to 46,540 in Kasai Central (2019–2021)
In Kasai Oriental, the number of new PPFP acceptors declined from 6,987 to 3,788 over the same period. The reasons for this decline are not yet clear and will be further investigated.

Main Findings and Views

The integration of family planning training into midwifery education, along with the use of a PPFP counselling tool, significantly improved the uptake of postpartum family planning.
The approach was successful in replicating results in two of the three provinces, indicating its scalability and adaptability.
Communication skills of midwives were identified as a critical factor in increasing PPFP uptake.
The sustainability of the approach is being monitored, and there is a plan to expand training to more healthcare centres and include nurses and doctors in the training process to ensure broader coverage and long-term impact.

Next Steps

A full assessment of the intervention is planned at the end of 2022, including a focus on Kasai Oriental, where the decline in PPFP acceptors was observed.
There is a need to extend training to nursing staff in areas with a shortage of trained midwives.
The project aims to scale up the approach to more training centres to meet the unmet need for family planning in the DRC.

Key Information

The Yam Daboo study was a multi-intervention, cluster-randomized controlled trial that showed the effectiveness of integrating PPFP into primary health services.
The PPFP counselling tool was updated in January 2020 to better suit the DRC context.
The medical eligibility criteria wheel is an essential tool for midwives to assess contraceptive suitability.
The Project National de Santé de la Reproduction (PNSR), in collaboration with the World Health Organization (WHO), led the scaling-up process.
The sustainability of the program depends on the continuity of trained personnel and the integration of PPFP into the education system.

References

World Health Organization. Medical eligibility criteria wheel for contraceptive use. Geneva 2015. https://www.who.int/publications/i/item/9789241549257
Tran, NT. et al. Effectiveness of a package of postpartum family planning interventions on the uptake of contraceptive methods until twelve months postpartum in Burkina Faso and the Democratic Republic of Congo: the YAM DAABO study protocol. BMC Health Serv Res 18, 439 (2018). https://doi.org/10.1186/s12913-018-3199-2
Tran NT et al. Participatory action research to identify a package of interventions to promote postpartum family planning in Burkina Faso and the Democratic Republic of Congo. BMC Womens Health. 2018;18(1):122. https://doi.org/10.1186/s12905-018-0573-5
Tran NT et al. Post-partum family planning in Burkina Faso (Yam Daabo): a two group, multi-intervention, single-blinded, cluster-randomised controlled trial. Lancet Glob Health 2019; 7: e1109-17 https://doi.org/10.1016/S2214-109X(19)30202-5
More on WHO's work on contraception: https://www.who.int/health-topics/contraception