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ORIGINAL ARTICLE
Open Access

Improving Contraceptive Access, Use, and Method Mix by Task Sharing Implanon Insertion to Frontline Health Workers: The Experience of the Integrated Family Health Program in Ethiopia

Yewondwossen Tilahun, Candace Lew, Bekele Belayihun, Kidest Lulu Hagos and Mengistu Asnake
Global Health: Science and Practice December 2017, 5(4):592-602; https://doi.org/10.9745/GHSP-D-17-00215
Yewondwossen Tilahun
aPathfinder International Ethiopia, Addis Ababa, Ethiopia.
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Candace Lew
bPathfinder International, Washington, DC, USA.
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  • For correspondence: clew@pathfinder.org
Bekele Belayihun
aPathfinder International Ethiopia, Addis Ababa, Ethiopia.
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Kidest Lulu Hagos
aPathfinder International Ethiopia, Addis Ababa, Ethiopia.
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Mengistu Asnake
aPathfinder International Ethiopia, Addis Ababa, Ethiopia.
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    FIGURE

    Implanon Scale-Up Program Components and Implementation

    Abbreviations: FMOH, Federal Ministry of Health; HEWs, Health Extension Workers.

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    Health Extension Workers learn about Implanon during a theoretical training session. © Pathfinder International Ethiopia.

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    An instructor simulates Implanon insertion on an arm model to Health Extension Workers during a training session. © Pathfinder International Ethiopia.

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    Under the supervision of an instructor, a Health Extension Worker inserts an Implanon implant in a client during training, as other trainees watch the procedure. © Pathfinder International Ethiopia.

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    TABLE 1.

    Number of HEWs Trained on Implanon Insertion and Number of Health Posts With Trained HEWs,a by Region, July 2009 to December 2015

    Name of RegionHEWsHealth Posts
    Total No. of HEWsNo. of Trained HEWs% of HEWs TrainedTotal No. of Health PostsNo. of Health Posts With Trained HEWs% of Health Posts With Trained HEWs
    Amhara3,8852,20456.71,8911,891100.0
    Oromia3,8612,99777.62,5532,50198.0
    SNNPR2,9342,53686.41,4671,31089.3
    Tigray79669987.839837794.7
    Total11,4768,43673.56,3096,07996.4
    • Abbreviations: HEW, health extension worker; SNNPR, Southern Nations, Nationalities, and People's Region.

    • ↵a Includes health posts with at least 1 HEW trained on Implanon insertion.

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    TABLE 2.

    Contraceptive Services Provided to Clients by HEWs During and After Training, and by Nurses and Doctors through Back-Up and Outreach Servicesa

    No. (%) of Service Visits Served by HEWsNo. (%) of Service Visits Served by Other Health Care ProvidersTotal No. (%) of Service Visits
    During Training SessionsbWith Post-Training Supplies Provided to HEWscWith Gap-Filling Supply Support to Health Posts After Post-Training Supplies ExhaustedcDuring Back-Up ServicesdDuring Implant Removal Service Support at Health CenterseDuring Outreach Implant Removal Service Supportf
    Jul 2009 to Dec 2015Jul 2009 to Dec 2015Sep 2011 to Dec 2015Sep 2011 to Dec 2015Sep 2011 to Aug 2012Sep 2011 to Aug 2012Jul 2009 to Dec 2015
    Total service visits82,702 (100.0)446,010735,00089,177 (100.0)20,498 (100.0)8,931 (100.0)1,382,318 (100.0)
    LARC insertions67,662 (81.8)446,010735,00035,414 (39.7)1284086 (92.9)
    Implanon insertions63,989 (77.4)446,010735,00028,991 (32.5)1,273,990 (92.2)
    Jadelle insertions3,590 (4.3)4,321 (4.8)7,911 (0.6)
    IUD insertions83 (0.1)2,102 (2.4)2,185 (0.2)
    Short-acting methods12,320 (14.9)32,716 (36.7)45036 (3.3)
    Depo-Provera injectables10,214 (12.4)25,231 (28.3)35,445 (2.6)
    Oral contraceptive pillsg2,106 (2.5)4,950 (5.6)7,056 (0.5)
    Condoms2,535 (2.8)2,535 (0.2)
    LARC removals2,720 (3.3)21,047 (23.6)20,498 (100.0)8,931 (100.0)53,196 (3.8)
    Implanon removals1,163 (1.4)17,302 (19.4)14,389 (70.2)4,321 (48.4)37,175 (2.7)
    Jadelle removals191 (0.2)1,461 (1.6)2,637 (12.9)686 (7.7)4,975 (0.4)
    IUD removals23 (0.03)75 (0.1)98 (0.01)
    Norplant removals1,343 (1.6)2,209 (2.5)3,472 (16.9)3,924 (43.9)10,948 (0.8)
    • Abbreviations: HEW, Health Extension Worker; IFHP, Integrated Family Health Program; IUD, intrauterine device; LARC, long-acting reversible contraceptive; TOT, training of trainers.

    • ↵a Data for the different program activities in the table were collected at different points during the program period; this table does not include insertions performed by doctors and nurses at the health center level.

    • ↵b Includes both TOT and rollout training sessions.

    • ↵c Post-training supplies were provided to HEWs to allow them to provide immediate services and gap-filling supply support was provided to health posts after post-training supplies were exhausted. HEWs also provided other contraceptive services to clients post-training, but these data are not included in this table.

    • ↵d IFHP supported regular back-up services, whereby doctors and nurses from health centers traveled to health posts to offer removal services for LARC clients.

    • ↵e In addition to doctors and nurses traveling from the health centers to health posts to offer removal services, the doctors and nurses also provided removal services at the health centers.

    • ↵f IFHP mobile teams traveled to woredas outside the project catchment area to serve women in need of implant removals.

    • g Includes both combined oral contraceptive pills and progestin-only pills.

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    TABLE 3.

    Sociodemographic Characteristics of Implant Clients, December 2009 to June 2010 (N=7,254)a

    CharacteristicsFrequencyPercentage
    Age, years
    <24158221.9
    25–29225431.2
    30–34185025.6
    35–39109715.2
    ≥404486.2
    Place of residence
    Urban5317.3
    Rural672092.7
    Educational status
    Illiterate644288.8
    Literate81211.2
    Parity
    171210.2
    299914.4
    3–6410859
    ≥7113816.4
    Previous use of family planning
    New user (no previous method)183725.3
    Oral contraceptive pills4546.3
    Depo-Provera injectables461663.6
    Other method3444.8
    Current method
    Implanon implants622186.4
    Jadelle implants91612.7
    Other method610.9
    Length of use, years
    <1295957.5
    1–3166832.4
    4–53897.6
    ≥61332.6
    Source of information about implant
    Health Extension Worker478671.1
    Health worker4576.8
    Volunteer community health worker88413.1
    Other6099.1
    • ↵a Totals for each variable do not always equal 7,254 because some respondents did not answer all questions. Percentages are calculated based on the total number of respondents for each individual question.

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Global Health: Science and Practice: 5 (4)
Global Health: Science and Practice
Vol. 5, No. 4
December 28, 2017
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Improving Contraceptive Access, Use, and Method Mix by Task Sharing Implanon Insertion to Frontline Health Workers: The Experience of the Integrated Family Health Program in Ethiopia
Yewondwossen Tilahun, Candace Lew, Bekele Belayihun, Kidest Lulu Hagos, Mengistu Asnake
Global Health: Science and Practice Dec 2017, 5 (4) 592-602; DOI: 10.9745/GHSP-D-17-00215

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Improving Contraceptive Access, Use, and Method Mix by Task Sharing Implanon Insertion to Frontline Health Workers: The Experience of the Integrated Family Health Program in Ethiopia
Yewondwossen Tilahun, Candace Lew, Bekele Belayihun, Kidest Lulu Hagos, Mengistu Asnake
Global Health: Science and Practice Dec 2017, 5 (4) 592-602; DOI: 10.9745/GHSP-D-17-00215
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