Dora Ward Curry | October 2015
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Presentation at the Global Maternal Newborn Health Conference, October 19, 2015

Background: The Supporting Access to Family Planning and Post-Abortion Care (SAFPAC) initiative, led by CARE, supports local governments to provide high-quality post-abortion care and family planning to crisis-affected women and adolescent girls in Chad, the Democratic Republic of the Congo (DRC), Djibouti, Mali, and Pakistan. In addition to competency-based training and supply chain support, SAFPAC delivered clinical oversight, support for program improvement through data use by intensified, systematic supervision.

Methodology: These results represent routine supervision and service delivery data from health centers and referral hospitals that are subject to rigorous quality verification during monthly supervision and data review meetings. Findings cover supervision checklist scores measuring basic infection prevention measures (such as availability of gloves, proper handwashing procedure and waste disposal) and facility-based records of service delivery.

Results: These efforts contributed to reaching 98,658 new family planning users with contraception between July 2011 and December 2014, 57% of whom chose long-acting or permanent methods. The initiative provided post-abortion care to 5,949 women, of whom 58% chose long-acting or permanent methods. Average infection prevention scores (on a 1 – 10 scale) improved from below 8 to above 9.5, data quality errors were virtually eliminated and stock-outs reduced significantly in all countries. DR Congo experienced no stock-outs in all of 2014. The project achieved these results in spite of insecurity, inadequate staff capacity in data use, and weak supervision and compensation systems. Key in achieving these results were regular monthly visits, data analysis with health workers and communities together and on-site assessment and coaching after clinical trainings.

Conclusion: These results demonstrate the potential impact of high-quality supervision on MNCH activities even in fragile states and conflict-affected settings. Basic principles (regular visits, community involvement in quality improvement and data-driven front-line management) are key to service quality and are possible in extremely challenging settings.