Scaling up PPIUD services across India while ensuring quality of services Bulbul Sood, Jhpiego/India

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Huge unmet need (73% in first 3

months)

Birth-to-birth interval (57.6 % of

births had birth interval of less than

36 months) Source: SRS 2011

High vulnerability to unintended

pregnancy (Due to low awareness)

JSY was bringing women to

facilities - are more receptive to

accept FP methods

Why Postpartum Family Planning is Crucial for Family Planning?

JSY Beneficiaries: 2005 to 2014

Source: HMIS, MOHFW, GoI

~ 450,000 PPIUCDs inserted

States >20

Training Sites 75

Service Providers

Doctors 3121

Nurses 6161

Service Delivery Sites

Medical Colleges 44

District Hospitals 300

Sub District Facilities 673

LAD

LAD

* till March-2015

Rapid Expansion of PPFP/PPIUCD Services: Impact at Scale

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Phased Expansion of PPFP/PPIUCD Services

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PPIUCD Experience in India

146568

99389

68974

35672 31135

25252 21205

14863 12929 9318 9017

3806 2633 2091 1405 1104 870 825 717

0

20000

40000

60000

80000

100000

120000

140000

160000

Total Reported PPIUCD Insertions Feb-10 to Apr-15

N = 487,773

Data as on 01/06/2015 Data as on 01/06/2015

Data as on 01/06/2015 Source: PPIUCD Monthly reports

Post- placental (within 10 min)

57%

Post-partum (within 48 hrs)

22%

Intra- cesarean

21%

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Trend of Number of Facilities Reporting PPIUCD Insertion Services: Impact at Scale

21 75

200

395

717 728

0

50,000

100,000

150,000

200,000

250,000

0

100

200

300

400

500

600

700

800

2010 2011 2012 2013 2014 2015*Year

Nu

mb

er

of

PP

IUC

D In

sert

ion

s

Nu

mb

er

of

Faci

litie

s

*April - 2015

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Proportion of PPIUCD Acceptors Among Institutional Deliveries (Jan-11 to Apr-15)

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

Jan Mar May Jul Sep Nov Jan Mar May Jul Sep Nov Jan Mar May Jul Sep Nov Jan Mar May Jul Sep Nov Jan Mar

2011 2012 2013 2014 2015

PP

IUC

D A

cce

pto

rs

Month

Total deliverie

s: 51,52,47

9

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0%

5%

10%

15%

20%

25%

30%

35%

40%

Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15

% P

PIU

CD

acc

ep

tors

Month

Bihar Chhattisgarh Jharkhand Madhya Pradesh Rajasthan UP

Data as on 01/06/2015 Total deliveries=10,08,689

Trend of PPIUCD Acceptors among Institutional Deliveries 6-HFS (Nov 14 to Apr 15)

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3.1%

2.1%

5.8%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

10.0%

Expulsion Infection Removal

Data as on 01/06/2015 Data as on 01/06/2015

Data as on 01/06/2015

Follow-up Findings (Based on Jan 11 – Apr 15 Data)

N=262,866

Data as on 01/06/2015 Data as on 01/06/2015

Data as on 01/06/2015 Source: PPIUCD Monthly reports

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Strategies for Successful Scale-up

System Based

Approach

Implementation through the

system

Using NRHM Funds

Policy shifts

FP as MNCH intervention

Focus on spacing

Contextualization of program strategies

Task shifting

Insertion: Drs to SNs

Dedicated counsellors

Standardization of processes

(SOPs) for each program

component

Decentralizing institutional

training capacity

Aggressive, continued and

inclusive advocacy

Government led initiative

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Investing in Quality during Scale-up

Focus on PPFP

Competency based training

Use of customized clinical standards

Emphasis on counselling - hiring of dedicated counsellors

Strong follow-up systems, including robust data collection systems

Generation of local evidence through studies

Structured supportive supervision visits

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Annual Explosion Rates

4.41%

2.22% 1.99%

3.35% 3.23% 3.32%

2010(n=521)

2011(n=10,056)

2012(n=25,564)

2013(n=46,184)

2014(n=1,28,916)

2015(n=52,146)

* Till Apr-15

Expulsion rates have remained at acceptable level even after rapid scale-up and withdrawal of external TA from all but 6 states of India

-

5

10

15

20

25

10-11 ($3,370,360) 11-12 ($4,428,112) 12-13 ($8,134,230) 13-14 ($11,711,962) 14-15 ($19,326, 771)

Mill

ion

s $

USAID BMGF Norway Packard Foundation Govt of India BMGF TSU LAD

**GOI funding converted from INR to US $ as per current exchange rate i:e INR 61.43 per US $.

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“Buy-in” of All Stakeholders for Successful Scale-up and Sustainability (PPFP)

THANK YOU