Provider-Initiated Family Planning Within HIV Services in Malawi: Did Policy Make It Into Practice?

Erin K. McGinn; Laili Irani

doi:10.9745/GHSP-D-19-00192

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FIGURE 1.
Availability of Family Planning Methods in 41 Facilities in 9 Districts in Malawi, April–May 2015
Abbreviations: ART, antiretroviral therapy; FP, family planning; IUD, intrauterine device.
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FIGURE 2.
Percentage of Providers in 9 Districts in Malawi Who Reported Receiving Family Planning Training on Specific Contraceptive Methods, by Method and Facility Type, April–May 2015 (N=96)
Abbreviations: CHAM, Christian Health Association of Malawi; IUD, intrauterine device.

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TABLE 1.
Types of Facilities From Which Data Were Collected Across 9 Districts in Malawi, by Facility Type, April–May 2015
Type of Facility No.
Health post/center/clinic 19
Public hospital 9
Christian Health Association of Malawi hospital/health center 7
Integrated health center 6
Total number of facilities 41

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TABLE 2.

Description of Organization of Antiretroviral Therapy and Family Planning Services, According to the Health Service Provider Within Selected Facilities, by Facility Type, Malawi

	Health Centers/Posts No. (%)	Public Hospitals No. (%)	CHAM Missions No. (%)	Integrated Health Centers No. (%)	Total No. (%)
Total number of providers	54 (44.3%)	32 (26.2%)	21 (17.2%)	15 (12.3%)	122 (100%)
Have ART services been reorganized to accommodate FP services?
Yes	43 (79.6%)	26 (81.3%)	17 (80.9%)	15 (100%)	101 (82.8%)
No	11 (20.4%)	6 (18.8%)	4 (19.0%)	0	21 (17.2%)
How have ART services been reorganized to accommodate provision of FP services?^a
Created more space	8 (18.6%)	4 (15.4%)	3 (17.7%)	4 (26.7%)	19 (18.8%)
Revised ART on-site protocols to accommodate FP services	12 (27.9%)	17 (65.4%)	5 (29.4%)	8 (53.3%)	42 (41.6%)
Trained ART providers in different FP methods	21 (48.8%)	11 (42.3%)	4 (23.5%)	12 (80.0%)	48 (47.5%)
Created informal referral agreements within facility	26 (60.5%)	14 (53.8%)	6 (35.3%)	5 (33.3%)	51 (50.5%)
Developed facility referral agreements across facilities	14 (32.6%)	10 (38.5%)	5 (29.4%)	2 (13.3%)	31 (30.7%)
Revised ART client registers to accommodate FP services	4 (9.3%)	4 (15.4%)	1 (5.9%)	2 (13.3%)	11 (10.9%)
Adjusted operating time for ART services	7 (16.3%)	2 (7.7%)	2 (11.8%)	4 (26.7%)	15 (14.9%)
Provided ART/FP on same day	3 (6.9%)	3 (11.5%)	1 (5.9%)	0	7 (6.9%)
Do you have time/opportunity to counsel ART clients on FP methods?
Yes	51 (94.4%)	29 (90.6%)	20 (95.5%)	14 (93.3%)	144 (93.4%)
No	2 (3.7%)	2 (6.3%)	1 (4.8%)	1 (6.7%)	6 (4.9%)
Not sure	1 (1.9%)	1 (3.1%)	0	0	2 (1.6%)
What FP methods do you counsel ART clients on?^a^,^b
Fertility awareness methods	51 (100%)	29 (100%)	20 (100%)	14 (100%)	144 (100%)
Pills	44 (86.3%)	21 (72.4%)	18 (90.0%)	12 (85.7%)	95 (83.3%)
Male condoms	51 (100%)	26 (89.7%)	20 (100%)	14 (100%)	111 (97.4%)
Female condoms	45 (88.2%)	25 (86.2%)	19 (95.0%)	13 (92.9%)	102 (89.5%)
Injectables	47 (92.2%)	26 (89.7%)	20 (100.0%)	14 (100%)	107 (93.9%)
IUD	28 (54.9%)	18 (62.1%)	12 (60.0%)	5 (35.7%)	63 (55.3%)
Implants	43 (84.3%)	19 (65.5%)	16 (80.0%)	10 (71.4%)	88 (77.2%)
Female sterilization	34 (66.7%)	20 (69.0%)	11 (55.0%)	7 (50.0%)	72 (63.2%)
Male sterilization	25 (49.0%)	13 (44.8%)	7 (35.0%)	5 (35.7%)	50 (43.9%)
Emergency contraception	19 (37.3%)	17 (58.6%)	10 (50.0%)	5 (35.7%)	51 (44.7%)
Are clients referred out for services?
Yes	48 (88.9%)	15 (46.9%)	16 (76.2%)	12 (80.0%)	91 (74.6%)
No	6 (11.1%)	17 (53.1%)	5 (23.8%)	3 (20.0%)	31 (25.4%)
What prior knowledge do you have of facilities to which you are referring clients for FP services?^a^,^c
Services provided	32 (66.7%)	10 (66.7%)	12 (75.0%)	9 (75.0%)	63 (69.2%)
Weekdays on which services are provided	34 (70.8%)	11 (73.3%)	6 (37.5%)	7 (58.3%)	58 (63.7%)
Times when services are provided	25 (52.1%)	5 (33.3%)	5 (31.3%)	5 (41.7%)	40 (44.0%)
Transport costs to reach the referral site	14 (29.2%)	3 (20.0%)	5 (31.3%)	4 (33.3%)	26 (28.6%)
No prior knowledge	5 (10.4%)	5 (33.3%)	1 (6.3%)	2 (16.7%)	13 (14.3%)

↵a Categories are not mutually exclusive.
↵b Of the 114 providers who counsel ART clients on FP.
↵c Of the 91 providers who refer clients for services.
Abbreviations: ART, antiretroviral therapy; CHAM, Christian Health Association of Malawi; FP, family planning.

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Supplemental material

Supplement 1 -
Key Indicators from the 2010 and 2015/2016 Malawi Demographic and Health Surveys

Supplement 2 -
Select Interview Questions Posed to Providers and Clients in 9 Districts in Malawi, April-May 2015