PSI implements a range of interventions to increase access to high quality Reproductive Health products and services, in support of the Government of Tanzania’s eorts to reduce the Maternal Mortality Rate (MMR) and increase the Contraceptive Prevalence Rate (CPR). Under its portfolio, PSI works in Family Planning and Comprehensive Post Abortion Care (CPAC) oering Women of Reproductive Age (WRA) Reproductive Health solutions throughout the course of their lives. Donors for these interventions are currently the UK Department for International Development (DfID), KfW Development Bank, the Bill & Melinda Gates Foundation (BMGF), Children’s Investment Foundation Fund (CIF) and a private foundation.
PSI primarily employs two models for Reproductive Health services delivery. The first is through a social franchise network of private facilities branded “Familia”. Under the Women’s Health Project (WHP), PSI works through these facilities to expand the availability of long term Family Planning (FP) methods, and access to CPAC. Facility providers are trained and oered supportive supervision and the facilities supported with equipment. Working with over 120 facilities and PRINMAT in 18 regions of Tanzania, the project supported 105 and 188 providers to provide CPAC and FP services respectively. In 2018, these providers were then able to serve 10,312 women with CPAC and over 109,540 women with contraceptive services.
The second service delivery model is Outreach, a channel that increases access to services through mobile teams that targets, youth, rural and peri-urban clients. Outreach teams work closely with the Government’s regional and district Reproductive Health Coordinators in 20 regions to identify priority public health facilities that do not oer long-term FP methods and would benefit from PSI’s support. The specific event days and services oered are publicized, and the surrounding communities mobilized to access free services. In a complementary intervention, a youth brand “Kuwa Mjanja” was developed to increase access to adolescent friendly sexual and reproductive health services using a youth engagement approach. In 2018, integrated FP/HIV services delivered through the Outreach channel reached 162,231 WRA with contraceptive services including 55,849 new users between the ages of 15-19.
Familia Network Services
PSI saw impressive progress in 2018 both in terms of contraceptive uptake and uptake of more effective long acting methods. As seen in Figure 1, Intrauterine Contraceptive Device (IUCD), Implant and Injectable are the leading method of choice in PSI’s Familia clinics while Injectable remains the dominant method followed by implant and pills in general population .
For sustained and good quality contraceptive services, PSI in collaboration with the Ministry of Health, Community Development, Gender, Elderly & Children (MoHCDGEC) trained 60 additional providers from Familia franchised clinics in comprehensive FP clinical skills. In addition, 223 providers were followed up and 188 were certified as competent FP providers.
To increase demand of services delivered through Familia clinics, PSI works with community-based Interpersonal Communication (IPC) agents, who conduct house-to-house mobilization and neighborhood meetings to raise awareness and create demand for FP services. In 2018, IPC Agents referred 80,023 women with 58% (46,703) of those women completing a referral by visiting a Familia franchise facility.
Limited awareness of availability of and stigma associated with CPAC, have been big barrier to CPAC service utilization in both private and public sector. In collaboration with MoHCDGEC Health Promotion department, PSI nationally aired radio spots (Mpe Sikio) to help women recognize signs of incomplete abortion, improve PAC-seeking behaviour and promote community support for women in need of PAC services. The radio spots were also used to reassure service providers about MoHCDGEC support of PAC services.
Adolescent Sexual and Reproductive Health Services (A360)
PSI is implementing a four-year project called Adolescent 360 (A360). This project aims to reach adolescent girls aged between 15-19 with sexual reproductive health information and services through the “Kuwa Mjanja” brand. Activities are implemented through a combination of bespoke facility (“in clinic pop-up events”) and community (“out of clinic pop-up events”) based events.
The “in clinic pop-up” is a clinic-based learning session that offers adolescent girls an opportunity to interact and learn about menarche and body changes as an entry point to a conversation about contraception. These events provide girls with the opportunity to understand the implication of changes that their bodies are undergoing as they grow up. Each girl is also provided with an opt-out private moment with a youth-friendly health care provider to receive correct ASRH information and services.
The “out of clinic pop-up” event is a community-based event that brings together adolescent girls, inspires them to dream, and offers them the opportunity to learn what is possible in achieving their dreams. This event includes entrepreneurship skills training that is the first step in helping many girls achieve their dreams. At the event, girls are also provided with an opportunity to have an opt-out private moment with a youth-friendly health care provider to access relevant ASRH services. Contraception is positioned as one of the tools to help them achieve their goals.
In 2018, PSI scaled up testing of the in-clinic and community-based service delivery approaches in 18 regions to determine acceptability of these models. Between January and November of 2018, this approach yielded 55,849 new users between the ages of 15-19 with a relatively high conversion rate of event attendees to adopters of modern contraceptive methods of 62%. With these results, PSI in collaboration with the MoHCDGEC and PORALG will scale up activities in five priority regions of Rukwa, Katavi, Ruvuma, Mwanza, and Tabora in 2019.
ASRH Conversion Rates (ages 15-19)
PSI’s outreach program aims to strengthen the capacity of public sector providers to meet the demand for modern contraceptives, CPAC and Gender-based Violence (GBV) services for rural and poor women in Tanzania. Events are organized at public health facilities and PSI mobile outreach teams provide mentorship and training support to health providers within communities that lack qualified providers. In 2018, PSI conducted 2,761 event days providing contraception for 106,382 women, CPAC services for 1,598 women, and providing GBV services for 3,928 survivors.
The method mix for outreach events skews towards Long Acting Reversible Contraceptives (LARCs) as the most chosen method since short acting methods are routinely available in the facilities (Figure 3). Many women attending outreach events are coming specifically for LARCs that are not always available routinely due to challenges with availability of skilled staff.
This project has been able to achieve much higher uptake of LARCs among youth than the national LARC use. IUCDs were not found among girls 15-19 in the 2015-2016 Tanzanian DHS, and only 17% of adolescents using modern methods were using implants. By dispelling myths, making contraception relevant to their immediate futures, and offering non-judgmental services, outreach teams were able to help 70% of their youth clients access LARCs. With effective health education and individualized counselling from providers, clients are able to choose a method that suites her reproductive goals and lifestyle. Younger women most commonly choose implants (Figure 4), whereas women over 25 years old most commonly opt for IUDs (Figure 5). Older women are more likely to choose 5-year implants, whereas younger women tend toward 3-year implants. This reflects a finding from PSI’s A360 youth design process that for young women pregnancy is always in the near future, whereas for older women with children a longer duration of protection is desirable for extended spacing or limiting.