Jhpiego Burkina Faso, Ouagadougou, Burkina Faso.
Jhpiego, Baltimore, MD, USA.
BMC Womens Health. 2024 May 20;24(1):301. doi: 10.1186/s12905-024-03121-z.
Successful efforts to encourage uptake of subdermal contraceptive implants, with a lifespan of three to five years, necessitate planning to ensure that quality removal services are available when desired. In Burkina Faso, implant use has tripled over the past 8 years and now comprises almost half of the contraceptive method mix. Population Monitoring for Action (PMA) surveys identified barriers to obtaining quality removal when desired, particularly when the implant is not palpable, or providers lack needed skills or supplies. The Expanding Family Planning Choices (EFPC) project supported ministries of health in four countries with evaluation and strengthening of implant removal services.
An implant removal landscape assessment was conducted at 24 health facilities in three regions of Burkina Faso with high implant use that included provider observations of implant removal, interviews with providers and health facility managers, and facility readiness surveys. The project used landscape data to mobilize stakeholders through a series of participatory workshops to develop a collaborative roadmap and commit to actions supporting quality implant removals.
Landscape findings revealed key gaps in provision of quality removal services, including high levels of provider confidence for implant insertion and removal (82% and 71%, respectively), low competence performing simple and difficult removals (19.2% and 11.1%, respectively), inadequate supplies and equipment (no facilities had all necessary materials for removal), lack of difficult removal management systems, and a lack of standard data collection tools for removal. Exposure to the data convinced stakeholders to focus on removals rather than expanding insertion services. While not all roadmap commitments were achieved, the process led to critical investments in quality implant removals.
Landscape data revealed that facilities lack needed supplies and equipment, and providers lack skills needed to perform quality implant removals, limiting client reproductive choice. Disseminating this data enabled stakeholders to identify and commit to evidence-based priority actions. Stakeholders have since capitalized on program learnings and the roadmap, including following MOH guidance for implant removal supplies and health provider training. Our experience in Burkina Faso offers a replicable model of how data can direct collective action to improve quality of contraceptive implant removals.
为了鼓励使用具有三至五年寿命的皮下避孕植入物，需要进行规划，以确保在需要时能够提供高质量的取出服务。在布基纳法索，过去 8 年来，植入物的使用量增加了两倍，现在占避孕方法组合的近一半。人口监测行动（PMA）调查发现，在需要时获得高质量取出服务存在障碍，特别是当植入物不可触及，或者提供者缺乏所需的技能或用品时。扩大计划生育选择（EFPC）项目支持了四个国家的卫生部对植入物取出服务进行评估和加强。
在布基纳法索三个植入物使用率较高的地区的 24 个卫生设施进行了植入物取出景观评估，包括提供者对植入物取出的观察、对提供者和卫生设施管理人员的访谈以及设施准备情况调查。该项目利用景观数据通过一系列参与式研讨会动员利益攸关方，制定合作路线图并承诺采取行动支持高质量的植入物取出。
景观调查结果显示，在提供高质量取出服务方面存在一些关键差距，包括提供者对植入物插入和取出的高度信心（分别为 82%和 71%）、进行简单和困难取出的能力较低（分别为 19.2%和 11.1%）、供应品和设备不足（没有一个设施具备取出所需的所有材料）、缺乏困难取出管理制度，以及缺乏取出的标准数据收集工具。接触这些数据使利益攸关方将重点放在取出上，而不是扩大插入服务。虽然并非所有路线图承诺都得到了履行，但这一过程为高质量的植入物取出投资提供了关键支持。
景观数据显示，设施缺乏所需的供应品和设备，提供者缺乏进行高质量植入物取出所需的技能，这限制了客户的生殖选择。传播这些数据使利益攸关方能够确定并承诺采取基于证据的优先行动。利益攸关方此后利用项目的学习成果和路线图，包括按照卫生部关于植入物取出供应品和卫生提供者培训的指导意见。我们在布基纳法索的经验提供了一个可复制的模式，说明数据如何能够引导集体行动，以提高避孕植入物取出的质量。
