News Archive 2008

E&R Study # 13 Evaluation of a Family Planning and Antiretroviral Therapy Integration Pilot in Mbale, Uganda
In Uganda, there is an urgent need for quality, voluntary family planning (FP) services to help people living with HIV (PLHIV) achieve their fertility intentions and to reduce HIV incidence. The AIDS Support Organization (TASO), one of the leading local nongovernmental organizations (NGOs) in Uganda providing HIV counseling, prevention, care, treatment, and support services to PLHIV, provides services in 11 centers and 15 minicenters. TASO Mbale (TASO/M)-located in the Mbale District in eastern Uganda-is one of the 11 centers and began providing antiretroviral therapy (ART) services in September 2004.

TASO clinicians and administrators struggle to meet the FP needs of PLHIV who arrive at their clinics with unplanned pregnancies and/or incomplete abortions. Although TASO/M has provided limited FP services to ART clients on an ad hoc basis since 2004, it lacked a comprehensive FP program. With this in mind, the ACQUIRE Project-in collaboration with TASO/M and the Ugandan Ministry of Health (MOH) and with funding from the U.S. Agency for International Development (USAID)-implemented an FP-ART integration pilot from March 2006 to April 2007 with the launching of FP services in September 2006. This report details the results of a retrospective evaluation conducted by ACQUIRE in November 2007, using a case study methodology to assess its FP-ART integration pilot, including its effect on the program processes and FP method mix and uptake at TASO/M.
Read more>>> (PDF, 334KB)

E&R Study # 12 Mobilizing Married Youth in Nepal to Improve Reproductive Health: The Reproductive Health for Married Adolescent Couples Project, Nepal 2005-2007
The ACQUIRE Project, in association with CARE Nepal, implemented a two-year pilot project in 2005-the Reproductive Health for Married Adolescent Couples Project (RHMACP)-within the Parsa and Dhanusha districts of Nepal. The project utilized an ecological model to improve health outcomes for married adolescents in target districts. In close collaboration with District Public Health Offices, the RHMACP established a peer education network to disseminate RH information to married couples; supported local health facilities to provide youth friendly-services; and fostered an enabling environment among parents, in-laws, and influential community members to increase married adolescents' access to, and use of, health services. Read more>>> (PDF, 848KB)

E&R Study #11 Engaging Communities as Partners in Postabortion Care: A Desk Review of the Community Postabortion Care Project in Nakuru, Kenya
This desk review documents the ACQUIRE Project-s efforts in community engagement and mobilization for PAC in Kenya. The Kenya COMMPAC Project was a replication of the Bolivia PAC Community Mobilization Program (C-PAC), which was implemented by CATALYST and Socios para el Desarrollo/PROSALUD (2004-2007). Both the Bolivia and Kenya projects are important efforts funded by USAID to put the community PAC component into practice, and empower the community to mobilize itself to reduce maternal morbidity and mortality due to complications resulting from miscarriage and incomplete abortion. Read more>>> (PDF, 379KB)

ACQUIRE Publishes Working Paper on Active Community Engagement
The ACQUIRE Project is pleased to announce the publication of a working paper titled the Active Community Engagement Continuum. This document presents a framework for analyzing community engagement in RH/FP and the role the community plays in institutionalizing lasting behavior and social change. It was developed based on a review of documents, best practices, and the lessons learned through the ACQUIRE experience.

This conceptual framework is meant to be used by other donors, governments, and agencies whose focus is on improving RH/FP systems and services. The continuum can also help with the strategic integration of community engagement into service-delivery projects. Finally, it provides a basis for discussion related to indicators, time frames, and definitions of terms and is a tool that global RH/FP projects can use to build a shared understanding of community engagement when designing, implementing, and documenting programs. Read more >>> (PDF, 1.1MB)

ACQUIRE Publishes Increasing Awareness and Use of Long-Acting and Permanent Contraceptive Methods in Guinea: Case Study of a Pilot IUD Intervention
In 2004, the ACQUIRE Project in Guinea, in partnership with the country-s Ministry of Health (MOH), implemented a three-phase project to increase access to and awareness of long-acting and permanent methods of family planning (LAPMs) particularly the intrauterine device (IUD), and to increase the MOH-s capacity to provide these services.

This case study illustrates the effectiveness of a synergistic -supply and demand- strategy that includes the engagement of religious and district MOH officials to increase awareness and knowledge of long-acting family planning methods in a low-resource setting in West Africa. This communications campaign was implemented with minimal monetary investment, in a context with clinical supply challenges, little local marketing capacity, a limited range of media, and a relatively conservative religious culture. Despite these challenges, the campaign succeeded in reaching the intended audience with relevant information that translated into a considerable number of women seeking IUD services and making an informed choice to use the IUD within a period of a few months time. Read more>>> (PDF, 1.6MB)

IUD Use and Discontinuation in Bangladesh

IUD discontinuation rates for the IUD are lower than for other modern methods at 35.4% (BDHS, 2004), but still higher than global rates. The majority of Bangladeshi IUD users (63.7%) indicate side effects and health concerns as the main reasons for discontinuing use of the IUD (NIPORT, Mitra and Associates, and ORC Macro, 2005). To better understand client perspectives towards IUD discontinuation, ACQUIRE conducted a study consisting of close-ended interviews with IUD acceptors, in-depth interviews with IUD discontinuers and provider interviews.

The study of 330 acceptors in six predominantly rural districts found a 12-month discontinuation of 47.3%, which is higher than the rate from the latest BDHS. Findings further revealed that women experienced side effects differently. Many side effects had a physiological basis (e.g. extra menstrual flow), but community, societal, religious and spousal factors also played a role that caused women to see physiological changes as -problems.- Women with bleeding problems discontinued quickly. Prolonged and increased menstruation proved a fundamental problem for IUD users and their spouses because menstruation is seen as taboo. The health sector did not appear to strongly influence continuation or discontinuation, except that those reporting receiving more information (such as when to return for a check up) were more likely to remove the IUD than those who reported not getting this information. Recommendations pointed to the need for more community interventions, greater education on menstrual issues and routine prophylaxis for bleeding.
Read more>>> (PDF, 706KB)

The ACQUIRE Project will be sharing its expertise at the following events.
We invite you to join us.

Fistula Survivors Share Their Stories
The ACQUIRE Project announces the release of a collection of videos of Ugandan fistula survivors, Learn From My Story: Women Confront Fistula in Rural Uganda. Produced in partnership with the Center for Digital Storytelling and St. Joseph-s Hospital in Kitovu, Uganda these moving stories were captured at a workshop for women with fistula, where they recounted the hardships they endured and as well as their search for safety, acceptance, and dignity.
The stories can be viewed at http://www.engenderhealth.org/our-work/maternal/digital-stories-uganda-fistula.php.

ACQUIRE Announces Ten Guiding Principles for LAPM Service Programs
Family planning is at a crossroads-after rising to prominence in many parts of the developing world, many programs appear to have lost momentum. In Sub-Saharan Africa, for example, unmet need for family planning is the highest in the world-48.8 million women, nearly half the married women of reproductive age-want to space or limit the number of children they have. However, less than half (21 million women) are currently using a contraceptive method and less than one in seven married women of reproductive age are using a modern method of contraception.

Long-acting and permanent methods (LAPMs), including IUD, implants, and female and male sterilization can address a full range of women-s and couples- needs. Yet in Sub-Saharan Africa, only 2.7 million women are currently using these methods-fewer than one in eight contraceptive users. LAPMs are recognized as the most clinically effective and cost effective methods of contraception. The expansion of access to LAPMs in national health systems is a pressing need that must be addressed to sustain advances in health and to support economic and social development goals now and into the future.

The ACQUIRE Project has identified guiding principles for LAPM service programs that when applied in an integrated model of supply, demand and advocacy will result in increased access to, quality of, and use of LAPM services. These guiding principles are part of ACQUIRE-s forthcoming comprehensive programming resource package for long-acting and permanent methods (LAPMs) of contraception. Reflecting almost four decades of family planning field experience and accumulated evidence related to the critical role that LAPMs play in health and development, the package contains a set of practical informational resources and tools to help national and local policy makers, health managers, and international donor representatives introduce or reinvigorate LAPM programs in resource-poor settings and ultimately to get commitment from national health systems to fully support their advancement. Read the document >>> (PDF, 668KB)

Going the Extra Mile to Provide and Sustain Family Planning Services in Remote Madagascar
ACQUIRE Partner, CARE, is pleased to share its most recent publication: Going the Extra Mile to Provide and Sustain Family Planning Services in Remote Madagascar. This case study highlights the Extra Mile Initiative (EMI); the EMI is a program that delivered education and services in family planning to six remote communes bordering conservation zones where ecological resources were threatened as a result of growing populations. This case study explores how the EMI was embedded in the local health system, communities and local government of the six communes it served providing a network of technical training and support as well as supervision and logistical support.
Read more>>> (PDF, 519KB) or visit the CARE USA website at www.care.org/reprohealth.

ACQUIRE Publishes Report on Community Postabortion Care Project (COMMPAC) in Nakuru District, Kenya
Education, mobilization, and promotion to prevent unplanned pregnancies and inform the community about delays in seeking care are critical to reducing complications related to miscarriage and unsafe abortion. Community empowerment through community awareness and mobilization is a core component of the U.S. Agency for International Development-s (USAID-s) postabortion care (PAC) model. As a focus country of the USAID/Washington Postabortion Care Working Group, Kenya was provided funding to replicate the PAC community mobilization model that has been implemented in Bolivia since 2004. Through the Catalyst Project in Bolivia, 50 community groups were trained in PAC and participated in facilitated trainings and meetings to improve community access to PAC services. Read more>>>

Men: Telling It Like It Is, Volume 1
EngenderHealth/Men As Partners- is proud to introduce a new educational tool that focuses on -redefining masculinity- in this era of gender-based violence, HIV, and AIDS. In this 10-minute video, the first in the series, Men: Telling It Like It Is, EngenderHealth/Men As Partners highlights three characters who take the audience through their experiences with HIV and being a man in a democratic South Africa. The characters highlight key HIV prevention messages of getting tested for HIV, choosing abstinence, and confronting sexual harassment. The video challenges traditional and unhealthy male gender norms linked to masculinity. Read more and watch the video>>>

ACQUIRE Publishes Vasectomy: The Unfinished Agenda
Although the need for family planning remains widespread and its health and economic rationales remain valid, family planning has been neglected in the face of competing health and development priorities. Given the need to -reposition family planning- (i.e., to raise the priority of and resources for family planning), vasectomy services in particular need more attention and support. Vasectomy, the only highly effective male method of contraception, is safe, simple to perform, and economical-yet in most countries it is the family planning method that is the least known, understood, or used.

We have learned many lessons about how to program effectively for vasectomy, but a great many barriers to vasectomy-s widespread use remain, at multiple levels-client, community, provider, facility, program and policy. A better understanding of what causes these barriers and how they can be removed, and of how to program effectively for vasectomy services, coupled with sustained commitment of attention and resources can result in greater use of vasectomy.

This paper is meant to inform programming for no-scalpel vasectomy (NSV) as well as to advocate for greater attention to vasectomy services within family planning programs. ACQUIRE considers the status of vasectomy today and situates vasectomy within the context of the need to -reposition family planning.- It offers important lessons learned over the past several decades about effective vasectomy services, as well as what causes the widespread barriers to vasectomy-s greater availability and use and how best they can be removed. A better understanding of these barriers and lessons learned, coupled with sustained commitment of attention and resources can result in greater use of vasectomy. Read more >>> (PDF, 730KB)

Kenya Family Planning Program Internationally Recognized as "Story of the Year"
The Implementing Best Practices (IBP) Initiative, an international initiative dedicated to improving access and quality of reproductive services, has recognized Kenya's family planning revitalization program as the 2006 -Story of the Year-. The Kenya IBP team, led by the Division of Reproductive Health of the Ministry of Health, in collaboration with partners, including the U.S. Agency for International Development (USAID) and the ACQUIRE Project strategically implemented supply, demand, and advocacy best practices which resulted in remarkable family planning achievements. Many of these achievements resulted from previous FP programming efforts under the EngenderHealth led AMKENI Project.

In close partnership with the MOH, the ACQUIRE Project implemented the family planning revitalization initiative in Kisii District, Nyanza Province in western Kenya. Focusing holistically on supply, demand, and advocacy lead to impressive results including a striking increase in underutilized long-acting and permanent methods such as the IUD and female sterilization.

Supply side initiatives included clinical training, counseling training, strengthening facilitative supervision, and ensuring commodity availability. The creation of a national campaign dispelling myths surrounding the IUD, successfully pilot tested in Kisii District, was a hallmark of demand side activities. Advocacy was the third critical component to Kisii District success; providers became champion advocates for family planning while community volunteers became FP advocates and created a strong link between the community and providers. Men also became actively engaged in a community dialogue on family planning.

For more information on revitalizing family planning in Kisii District, Kenya see
ACQUIRING KNOWLEDGE: Revitalizing the IUD in Kenya (PDF, 140KB)
or

A Guide for Fostering Change to Scale Up Effective Health Services IBP Consortuim, 2007 (PDF, 5.8MB)

For more information on the IBP Initiative and the Story of the Year see IBP In Action.

Announcing a New Curriculum for No-Scalpel Vasectomy (NSV)
The ACQUIRE Project is pleased to announce the publication of the No-Scalpel Vasectomy Curriculum: A Training Course for Vasectomy Providers and Assistants, 2^nd Edition. The curriculum has been revised and updated to reflect the latest research findings on no-scalpel vasectomy (NSV), as well as global expert opinion and field experience from many countries. This clinical training course presents all of the information that both trained vasectomists and their assistants need to be able to provide safe and effective NSV services.

The curriculum-s Trainer-s Manual contains information to guide the trainer during a workshop and to assist him or her in making decisions that will enhance the trainee-s learning experience. The Participant Handbook contains information on all topics that need to be covered in NSV training. It is meant to be used throughout the training course to assist participants in learning the content of the course, and after the course can be used by the trainee as a review guide. The handbook also contains diagrams, charts, and other graphic materials that can be adapted for use with clients.

Both the Trainer-s Manual and the Participant Handbook will shortly become available on a handy compact disk (contact info@acquireproject.org to order copies of the CD) or can be downloaded
Trainer's Manual (PDF, 1.2MB)
Participant Handbook (PDF, 1.1MB)

Note: The No-Scalpel Vasectomy Curriculum should be used in conjunction with No-Scalpel Vasectomy: An Illustrated Guide for Surgeons, 3^rd Edition. This book, which is the basis for the surgical skills training in the course, also serves as a helpful reference after completion of NSV training. Besides being a step-by-step guide to the NSV procedure, the illustrated guide reviews basic medical and surgical practices that are essential to ensuring the safety and effectiveness of any vasectomy procedure. No-Scalpel Vasectomy: An Illustrated Guide for Surgeons, 3^rd Edition is available on CD-ROM or can be downloaded from EngenderHealth-s web site.
Read more>>>

ACQUIRE Publishes French and Spanish Versions of Clinical Update on Pain Management for Female Sterilization by Minilaparotomy
The ACQUIRE Project is pleased to announce the publication of the French (PDF, 74KB) and Spanish (PDF, 77KB) versions of the Clinical Update on Pain Management for Female Sterilization by Minilaparotomy.
The purpose of pain management is to reduce a client's anxiety and her perception and experience of discomfort and pain. Local anesthesia with sedation and analgesia has proven to be the most appropriate anesthetic regimen for female sterilization by minilaparotomy, and is feasible and necessary, even in low-resource settings. Informed by global expert opinion and experience from many countries in the field, this document reaffirms and refines clinical guidance on pain management for female sterilization in EngenderHealth's service delivery programs.

News from 2007

News from 2006

News from 2005