JSI Research & Training Institute, Inc. successfully implemented the Together for Health for the U.S. Agency for International Development from 2005 to 2011. For further information on project activites, visit the TfH page on jsi.com.
Bringing Family Planning Services Closer to the People
July 2010 - Until recently, women and couples in Ukraine interested in family planning and reproductive health (FP/RH) care had to go to obstetrician-gynecologists (ob-gyns)—who usually work in women's health care facilities in towns and cities—making geography a significant barrier for many people. In 2005, the USAID Together for Health (TfH) project set out to change that paradigm, by providing training, evidence-based information, and skills to enable family doctors and midlevel health workers (nurses, midwives, and feldshers [similar to nurse practitioners]) working at the primary health care (PHC) level to provide FP/RH services. Since then, the trainings, conducted in 15 oblasts of Ukraine, have brought family planning services, including contraceptives, closer to the people by expanding the range of health professionals who are able to provide FP/RH care.
When the trainings started in October 2006, less than 600 health facilities provided these services in the project's partner oblasts, but four years later that number has increased four times to 2,475—and it's still growing. This increase is due to the fact that family doctors, internists, midwives, and feldshers working in rural and semi-urban areas are now trained to provide these services, increasing access for everybody, but especially those in rural areas. In Kharkiv Oblast alone, the number of facilities offering FP/RH has skyrocketed from 58 in 2006 to 248 in December 2010, with most of that expansion in underserved areas outside the oblast and rayon centers, as evidenced in the maps below.
Health facilities providing FP/RH services in Kharkiv Oblast in 2006 and 2010, before and after TfH clinical trainings in the region.
The USAID-supported clinical trainings are designed to help health professionals better understand the concepts of client-centered care, family planning counseling and modern contraceptive technology. The conversation surrounding these issues is aided by the variety of practitioners who attend the trainings in mixed groups, including ob-gyns, family doctors, midwives, nurses, and others. The trainings aim to equip each health professional to provide FP/RH services in the manner most appropriate to their field of work and to create a network of health professionals who can offer each other support and information.
For example, while only ob-gyns can provide IUD services or serve clients with health conditions that could complicate the choice of method, family doctors and midlevel staff in rural areas can provide other reversible methods for healthy women (pills, injectables or condoms), and midlevel staff in urban areas can ease busy doctors' workloads by counseling clients.
Nikolai Faida (center) and his clinical team stand next to the TfH family planning poster at his family doctor ambulatory in Komsomolsk. (Photo: R. Criswell)
So far, the trainings have been successful in accomplishing their goal of bringing FP/RH closer to the people. Nikolai Faida, a family doctor working in an ambulatory in the town of Komsomolsk in Poltava Oblast in central Ukraine has included more comprehensive family planning services in his practice since he attended a TfH training. Whereas before, his 1,900 patients had to travel to the rayon hospital for these services, they can now receive up-to-date and evidence-based information and services from him. Particularly useful for Faida—and beneficial to his clients—was the information in the workshop concerning methods of contraception with which he was previously unfamiliar, including emergency contraception, oral contraceptives, and voluntary surgical sterilization. He now takes the initiative to explain all the methods to his patients—adolescents, young couples, older couples, men and women—and he reports an increase in the use of modern contraceptive methods in his area. "I work with some couples who have been using traditional methods for decades," he explains, "and now they have chosen to switch to modern methods. My practice is a perfect place for people to receive information about family planning, because they come to me before they have serious problems. I am now doing all I can to make sure everyone knows about and can use the method that he or she chooses." While Faida still refers his patients to an ob-gyn for more complex services, such as IUD insertion, since the training he has also felt more comfortable providing other FP/RH services, such as STI screening and prescribing contraceptives.
Katerina Svidnyak, another family doctor practicing in a hospital in the town of Zhokva in Lviv Oblast, in western Ukraine, also attended the TfH training. She remarks that the training helped her, especially in her work with adolescents. "I didn't really know how to talk to teenagers about these issues before the training," she explains, "but they are such an important group for family planning and safe sex. After the training I felt like I could better address their needs." The information she received about oral contraceptives was especially helpful for her, since it revealed that many of her fears about hormonal contraception were unfounded, and she now feels well prepared to discuss this option with her clients. She says that she "sees more than ever the crucial preventative role that primary care physicians play in family planning and helping to promote a healthy next generation."
Together for Heath project have already provided about 2,500 PHC professionals (family doctors and midlevel health personnel) with the information necessary to guide their patients through the contraceptive decision making process. With family doctors like Faida and Svidnyak providing FP/RH counseling and services, Ukrainians are getting access to accurate, evidence-based information and services in their community, without having to spend additional resources and time to travel into the closest city. As people continue to gain access to modern contraception from PHC providers, Ukraine is one step closer, as Svidnyak puts it, to "a healthier future."
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