Hung Yuen Wai, Riese Sara, Issah Kofi, Diogo Claudette A, Chakraborty Nirali
, 12 W Madison St, Baltimore, MD, 21201, USA.
, 530 Gaither Road, Suite 500, Rockville, MD, 20850, USA.
Reprod Health. 2025 Mar 20;22(1):41. doi: 10.1186/s12978-025-01979-2.
Long-acting reversible contraceptives (LARCs) are highly effective at preventing pregnancy and demonstrate favorable client satisfaction. However, limited knowledge, misconceptions, and concerns about side effects hinder LARC adoption. Marie Stopes International-Ghana collaborated with Ghana Health Service to implement a 5 year multifaceted intervention to transition quality LARC services from an outreach approach to being available in public sector health facilities. This study evaluates if the intervention resulted in immediate or sustained improvements in the provision of quality LARC services in the public sector.
Using a pre-post intervention design, facility structural quality, providers' training, practice, and knowledge on the provision of LARCs, and clients' perceived service quality were assessed in 8 Ghanaian regions. Analyses compared endline and baseline data, categorized into two groups based on the program phase: Recent Intervention facilities and GHS Support facilities. Facility records on a 3 month volume of LARC provision were compared between the last quarters of 2019 and 2022. Multivariate logistic regressions of any increase in the volume of LARC provision were conducted with associated endline facility and provider characteristics summarized at the facility level.
Significant increases were found in the provision of IUD services among Recent Intervention facilities (CHPS facilities: T0 13%, T2 50%, p < 0.001; HC/Hospitals: T0 23%, T2 53%, p < 0.001), while almost all providers offered implant services across facility types and intervention phases. The proportion of providers ever been trained to insert LARCs increased. Immediate and sustained effects were found on knowledge of LARC provision. Although facilities had significant increases in usual IUD availability among those in Recent Intervention (CHPS: T0 13.0%, T2 50.0%, p < 0.001), availability of IUD decreased to pre-intervention level upon transition to GHS Support. Controlling for other factors, facilities which had transitioned to GHS support were far less likely than those in the Recent Intervention phase to have an increase in the volume of LARC provision.
This 5 year collaboration between MSI-Ghana and the Ghana Health Service increased the capacity of providers at 210 GHS facilities to provide high-quality LARC services. Future programs to improve LARC provision in the public sector may also consider including sustainable interventions to strengthen logistical management systems and targeting barriers to LARC access in the community. Increasing access to and use of modern contraception reduces unintended pregnancies and unsafe abortions, thereby decreasing maternal morbidity and mortality. Despite long-acting reversible contraceptives (LARCs) are highly effective at pregnancy prevention and favored by clients, utilization in many low- and middle-income countries has been low. In Ghana, less than half of women who want to delay, space, or limit childbearing use a modern contraceptive method. As the public sector is the predominant source of family planning services, improving the quality and provision of LARC services in the public sector has the most potential to increase women's access to LARCs. Marie Stopes International-Ghana collaborated with Ghana Health Service to implement a 5-year program to transition the provision of quality LARC services from its mobile clinic outreach model to public sector health facilities through a phased approach. We studied the immediate and longer-term effects on the provision and utilization of quality LARC services in the public sector. We collected three rounds of data from intervention facilities, associated providers, and clients. We found increased providers providing IUD services, trained in LARC provision, and increased and sustained knowledge needed for quality LARC services provision. Despite improvement, after the intervention ended, IUD availability at the facility decreased. Facilities that completed the intervention for at least several months were less likely to maintain the increased level of LARC provision than those still in the intervention or recently concluded. These findings underline the need for additional efforts to strengthen logistical management systems to ensure consistent provision of quality LARC services.
长效可逆避孕药（LARC）在预防妊娠方面非常有效，且客户满意度良好。然而，知识有限、误解以及对副作用的担忧阻碍了LARC的采用。国际玛丽斯特普斯组织加纳分部与加纳卫生服务局合作实施了一项为期5年的多方面干预措施，以将优质LARC服务从外展模式转变为在公共部门卫生设施中提供。本研究评估该干预措施是否导致公共部门优质LARC服务的提供立即或持续改善。
采用干预前后设计，在加纳8个地区评估了设施结构质量、提供者关于LARC提供的培训、实践和知识，以及客户感知的服务质量。分析比较了终期和基线数据，根据项目阶段分为两组：近期干预设施和加纳卫生服务局支持设施。比较了2019年最后一个季度和2022年最后一个季度设施关于3个月LARC提供量的记录。对LARC提供量的任何增加进行多变量逻辑回归，并汇总设施层面相关的终期设施和提供者特征。
在近期干预设施中，宫内节育器（IUD）服务的提供显著增加（社区卫生规划服务设施：T0为13%，T2为50%，p<0.001；卫生中心/医院：T0为23%，T2为53%，p<0.001），而几乎所有提供者在不同设施类型和干预阶段都提供植入剂服务。接受过LARC插入培训的提供者比例增加。在LARC提供知识方面发现了即时和持续的效果。尽管近期干预设施中IUD的常规可获得性显著增加（社区卫生规划服务设施：T0为13.0%，T2为50.0%，p<0.001），但在过渡到加纳卫生服务局支持后，IUD的可获得性降至干预前水平。在控制其他因素后，已过渡到加纳卫生服务局支持的设施比近期干预阶段的设施LARC提供量增加的可能性要小得多。
国际玛丽斯特普斯组织加纳分部与加纳卫生服务局之间的这一为期5年的合作提高了210个加纳卫生服务局设施中提供者提供高质量LARC服务的能力。未来改善公共部门LARC提供的项目也可考虑纳入可持续干预措施，以加强后勤管理系统，并针对社区中LARC获取的障碍。增加现代避孕方法的可及性和使用可减少意外怀孕和不安全堕胎，从而降低孕产妇发病率和死亡率。尽管长效可逆避孕药在预防妊娠方面非常有效且受客户青睐，但在许多低收入和中等收入国家的利用率一直很低。在加纳，想要推迟、间隔或限制生育的女性中，使用现代避孕方法的不到一半。由于公共部门是计划生育服务的主要来源，提高公共部门LARC服务的质量和提供量最有可能增加女性获得LARC的机会。国际玛丽斯特普斯组织加纳分部与加纳卫生服务局合作实施了一个为期5年的项目，通过分阶段方法将优质LARC服务的提供从流动诊所外展模式转变为公共部门卫生设施。我们研究了对公共部门优质LARC服务的提供和利用的即时和长期影响。我们从干预设施、相关提供者和客户那里收集了三轮数据。我们发现提供IUD服务的提供者增加，接受了LARC提供方面的培训，以及提供优质LARC服务所需的知识增加且得以持续。尽管有所改善，但干预结束后，设施中IUD的可获得性下降。完成干预至少几个月的设施比仍在干预中或最近结束干预的设施维持LARC提供量增加水平的可能性更小。这些发现强调需要进一步努力加强后勤管理系统，以确保持续提供优质LARC服务。
