Integrating family planning and reproductive health services in primary health care: the Rwandan model
Public health services in Rwanda have demonstrated the capacity to provide high quality post-abortion care (PAC), comprehensive abortion care (CAC), and family planning. The next step was to demonstrate that the integration of these services in Rwanda was feasible, beneficial and replicable, as well as generate evidence on the role of mid-level health workers as providers of safe abortion services and family planning services, including long-acting reversible contraception (LARC). The project employed a client-centered approach to provide high quality, integrated comprehensive abortion and post-abortion family planning services with emphasis on LARC, with the following objectives: 1) Implement integration package, including policies and strategies, provider trainings, job aids, and education/communication materials; 2) Ensure availability of supplies; and 3) establish monitoring and evaluation system. The project was implemented in 32 facilities in two districts in Rwanda: Huye and Musanze.
An estimated 41,730 clients were seen over 6 months of integration. The individual-level integration database showed that between September 2016 and February 2017, 3,504 clients adopted a modern method. This value was 39.9% of the total number of clients who were seen for family planning services according to the monthly data; a considerable increase to the under 5% seen in the pre-integration baseline database. The measures determining successful integration increased over time for functional integration and remained relatively constant for provider and physical integration. This indicates that integration can be sustainably implemented over the course of at least 6 months. Integration factors demonstrated a statistically significant association with uptake of modern and LARC methods. Ultimately, integrating family planning services into other types of sexual and reproductive health care can lead to improved method uptake.
Funding: The David and Lucille Packard Foundation; Erik and Edith Bergstrom Foundation (implementation funds until September 2017)