TABLE 1.

Evolution of the Postabortion Care Program in Guinea, 1998–2014

Phase and Years of ImplementationCumulative No. of Health FacilitiesProgram DescriptionDonorTypes and Specific Names of Health Facilities
Introduction
1998–2001
12Pilot in 2 national hospitals (1998 and 1999), followed by 10 additional sites in 2001, in Conakry and Upper Guinea. Activities included advocacy to stakeholders; development of PAC policies, standards, and protocols; site needs assessments; training in infection prevention, counseling skills, and family planning, and in abortion complication management using MVA; provision of initial stocks of equipment and supplies; transfer of learning visits to support organization of services, placement of contraceptives in PAC procedure room, and linkage to other reproductive health services and supportive supervision; site-level all-staff orientations about PAC, which often included engaging local officials and radios to inform them of the services.
Policy: The MOPH first recognized the need for PAC, then led the development and finalization of the PAC policy, standards, and protocols. Subsequently, MOPH adopted the PAC implementation approach used in the first 12 health facilities as the standard for PAC introduction to be used in scale-up. All subsequent implementing partners were asked to follow the same approach.
USAID
  • National hospitals: Donka and Ignace Deen

  • Regional hospitals: Faranah, Kankan

  • Prefectural hospitals/municipal medical centers: Dabola, Dinguiraye, Mandiana, Siguiri, Kissidougou, Kouroussa, Kerouane

  • Urban health center: Banan Koro

Early expansion
2002–2005
22Activities included training of trainers, who then supported implementation of the same activities as above in order to integrate PAC in 10 new sites; community engagement meetings linked with initiation of PAC services at new sites.USAID, UNFPA, unknown for selected health facility
  • Prefectural hospitals/municipal medical centers: Matam, Ratoma, Flamboyant, Minière, Forecariah, Pita, Boke, Boffa, Fria, Dubreka

Expansion
2006–2009
38Policy: When the MOPH revised national reproductive health policies, standards, and protocols, PAC standards and protocols were incorporated into that document, which was finalized in 2006.
Activities included those listed above in 16 new sites as well as supervision and refresher training for the 22 sites previously integrated. A 2008 regional PAC meeting in Saly, Senegal, and hosted by CEFOREP was the catalyst for additional PAC program consolidation, including:
  • Fostering Change Virtual Leadership Program targeting 4 West African countries, including Guinea (2009–2010)

  • Advocacy, tool development, and initial implementation in 5 Conakry health facilities of a quality improvement methodology of SBM-R22

  • Commercial vendor established and approved by MOPH to resupply MVA equipment

UNFPA and USAID
  • Regional hospitals: N’zérékoré, Kindia, Mamou, Labe

  • Prefectural hospitals/municipal medical centers: Télimélé, Lelouma, Coleah, Beyla, Sinko, Gueckedou, Macenta, Lola, Yomou, Coyah

  • Urban health center: Télimélé, Lelouma/Leysare

Support to existing sites
2010–2014
38Activities included follow-up and supportive supervision of PAC activities in health facilities in Conakry and Upper and Forest Guinea, training of PAC service providers in LARCs, and rollout of SBM-R at 28 sites. Revision of community health worker educational materials regarding bleeding during pregnancy and postabortion family planning. 2013 regional meeting in Saly, Senegal, hosted by E2A, and evaluation visits of Fostering Change Program Countries.23USAID and UNFPA
Post-assessment 2014-present48Ebola virus epidemic-related disruptions to the health system. In recovery and reconstruction phase, training of providers and support to additional 10 sites, including 6 in prefectures not previously covered and in 4 urban health centers.USAID
  • Prefectural hospitals/municipal medical centers: Dalaba, Tougué, Mali, Koubia, Gaoual, Koundara

  • Urban health center: Dabola, Dubreka, Manquepas, Boffa

  • Abbreviations: CEFOREP, Centre Régional de Formation, de Recherche et de Plaidoyer en Santé de la Reproduction; E2A, Evidence to Action; LARCs, long-acting reversible contraceptives; MOPH, Ministry of Public Health; MVA, manual vacuum aspiration; PAC, postabortion care; SBM-R, Standards-Based Management and Recognition; UNFPA, United Nations Population Fund; USAID, United States Agency for International Development.

  • Notes: Guinea is geographically divided into 8 regions, 38 prefectures or municipalities (equivalent to a district), and 410 sub-prefectures. Each sub-prefecture has a health center (urban or rural). Prefectural hospitals have an average catchment population of 304,804, and regional hospitals cover 1,447,819 population. Users pay fixed amounts defined by the Ministry of Health for each type of service and facility, thus PAC service costs are fixed at 6000 francs (US$0.82) in health centers, 10,000 francs ($1.37) in prefectural or regional hospitals, and 15,000 francs ($2.05) in teaching hospitals. This price does not include contraceptive services, which incur a small additional fee. Donors supply the great majority of contraceptives offered through government health facilities in Guinea.