Figures & Tables
Figures
- Figure 1.
Integrated EPI-Family Planning Service Delivery Model in Liberia
Abbreviations: EPI, Expanded Programme on Immunization; FP, family planning.
- Figure 2.
Client Flow for Integrated EPI-Family Planning Services
Abbreviation: EPI, Expanded Programme on Immunization.
- Figure 3.
Contraceptive Method Mix Among Same-Day Referral Acceptors in Pilot Facilities, Lofa and Bong Counties, March–November 2012
Abbreviations: COCs, combined oral contraceptive pills; LAM, lactational amenorrhea method; POPs, progestin-only pills.
Mothers bringing their children for vaccination review a family planning brochure provided by the vaccinator.
Tables
- Table 1. Time Frame and Key Activities for the Integrated EPI-Family Planning Pilot Initiative in Liberia
Time Frame Activity Remarks Feb 2011 Initial discussions with the MOHSW; stakeholder meeting with national EPI and family planning officials, county health teams, partners Decision to work in Bong and Lofa; consensus to work only on facility-based integration for routine immunization Apr–May 2011 Formative research to inform details of integration model Sensitivity and stigma regarding postpartum women's use of family planning services revealed Jun–Sep 2011 Design, pretesting, and production of training materials Addresses perceptions regarding use of contraceptives by postpartum women noted during formative assessment Feb 2012 Training of staff at 5 facilities each in Bong and Lofa 3-day training for vaccinators and family planning providers, including field practice; 1-day orientation for county supervisors and officers in charge Mar–Nov 2012 Pilot of integrated EPI-family planning service delivery, including monthly supervision visits to participating facilities Supervision by MCHIP staff accompanied by representatives from Family Health Division, EPI, and county health teams Jul–Aug 2012 Refresher training and midterm assessment using quantitative and qualitative methods Based on facility staff feedback, introduced privacy screens in vaccination area to enhance confidentiality of the mother's family planning decision Dec 2012 Final assessment using quantitative and qualitative methods Included focus group discussions with referral acceptors and non-acceptors, interviews with service providers and facility officers in charge, and interviews with partner agency representatives and supervisors Mar 2013 Final stakeholder meeting Presentation of approach and key findings to the MOHSW, partners, and county health teams from 6 counties Abbreviations: EPI, Expanded Programme on Immunization; MCHIP, Maternal and Child Health Integrated Program; MOHSW, Ministry of Health and Social Welfare.
Description of Participants No. of Participants Key Informant Interviews 42 Vaccinators 10 Family planning providers 10 Officers in charge 9 Program managers, partner agency representatives, supervisors 13 Focus Group Discussions (FGDs)a 56 4 FGDs with family planning referral acceptors 31 4 FGDs with non-acceptors 25 ↵a Health facility staff were not present during FGDs to minimize their potential influence on client responses.
- Table 3. Family Planning (FP) Referrals and Use at Pilot Sites During Intervention Period (March–November 2012), by County
Facility Average Monthly % of Mothers Accepting FP Referrals From Vaccinators Total No. of Mothers Accepting FP Referrals No. (%) of Referral Acceptors Who Went to the FP Provider No. (%) of Referral Acceptors Who Went to the FP Provider and Accepted a Method That Day Bong County 1,064 934 (88%) 892 (96%) Fenutoli Clinic 26.0% 99 85 (86%) 80 (94%) Garmu Clinic 45.2% 361 342 (95%) 328 (96%) Zoweinta Clinic 15.7% 159 138 (87%) 126 (91%) Salala Clinic 9.9% 241 191 (79%) 186 (97%) Phebe Hospital 12.5% 204 178 (87%) 172 (97%) Lofa County 426 357 (84%) 332 (93%) Borkeza Clinic 12.4% 51 43 (84%) 40 (93%) Ganglota Clinic 34.1% 86 54 (63%) 53 (98%) Gbonyea Clinic 32.4% 80 72 (90%) 71 (99%) Kpaiyea Clinic 24.3% 65 54 (83%) 52 (96%) Curran Hospital 14.4% 144 134 (93%) 116 (87%) - Table 4. Factors Enhancing Implementation of the Integrated EPI-Family Planning Model: Results of In-Depth Interviews and Focus Group Discussionsa
Category Factor Infrastructure • Proximity of family planning and immunization services to each other and clarity of pathways between service sites • Privacy for clients (at immunization stations in particular) Management, staffing, and coordination • Availability of vaccinators and family planning providers on the same day • Frequent communication between vaccinators and family planning providers Training and supportive supervision • Regular supportive supervision • On-the-job training for new staff Supplies • Reliable commodity supply (vaccines and contraceptives) Behavior change communication • Job aids or reminder materials to reinforce key steps of the referral process • Good-quality counseling Abbreviation: EPI, Expanded Programme on Immunization.
↵a With clients, service providers, supervisors, and partner organizations.
- Table 5. Number of Penta 1 and Penta 3 Doses Administered at Pilot and Non-Pilot Facilities by County, Pre-Intervention Period (March–November 2011) vs. Intervention Period (March–November 2012)
Lofa County Bong County Pilot Facilities (N = 5) All Other Facilities (N = 48) Pilot Facilities (N = 5) All Other Facilities (N = 31) Before During % Change Before During % Change Before During % Change Before During % Change Penta 1 doses 533 721 +35% 8,095 7,244 −11% 2,303 2,508 +9% 8,673 9,583 +10% Penta 3 doses 458 553 +21% 7,456 7,012 −6% 2,175 2,280 +5% 8,063 8,926 +11% Penta 1 to Penta 3 dropout rate 14% 25% 8% 3% 6% 9% 7% 7%
GHSP-D-14-00156 Supplementary Material
Cooper et al. doi: 10.9745/GHSP-D-14-00156
Files in this Data Supplement:
- Supplementary Material - Cooper et al. doi: 10.9745/GHSP-D-14-00156
- Supplementary Material - Cooper et al. doi: 10.9745/GHSP-D-14-00156
- Supplementary Material - Cooper et al. doi: 10.9745/GHSP-D-14-00156
- Supplementary Material - Cooper et al. doi: 10.9745/GHSP-D-14-00156
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