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Introducing Medical Abortion: Introducing Medical Abortion: Thinking StrategicallyThinking Strategically

Peter Fajans MD MPH and Ronnie Johnson PhD

UNDP/UNFPA/WHO World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP)

Department of Reproductive Health and ResearchWorld Health Organization

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What do we mean by "Introduction"?What do we mean by "Introduction"?

Product introduction refers to "the integrated set of activities to prepare health systems to accept and manage the provision of new, improved, or underutilized technologies".

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Begin with the End in Mind

ICMA's mandate

Promoting access to medical abortion

in the context of safe abortion worldwide

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Build Support for Introduction of MA in Build Support for Introduction of MA in the Context of Safe Abortion Carethe Context of Safe Abortion Care

Involve broad range of key stakeholders

Inform, listen to concerns, build support

Develop information materials for different target audiences

Advocacy with gatekeepers and other stakeholders

Conduct clinical or introductory trials to familiarize health professionals and prepare for regulatory approval

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Assess Needs and Priorities for Assess Needs and Priorities for IntroductionIntroduction

Review available in-country literature

Conduct a field-based assessment of current abortion and related SRH services– Participatory process to provide multiple perspectives

and build ownership and consensus– In-depth interviews with managers, providers, women

seeking services, community members including youth

– Observations of facilities and services as appropriate

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Social, Cultural, Legal, Political and Resource

Contexts

PEOPLE

SERVICES TECHNOLOGYAvailability,

CharacteristicsPolicies,

Programmes, Access, Availability,

Quality of Care

Women's Needs and Perspectives,

Gender Issues

The Strategic Approach: Conceptual FrameworkThe Strategic Approach: Conceptual Framework

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Examples of Follow-Up Actions from Examples of Follow-Up Actions from Strategic AssessmentsStrategic Assessments

Policy directives to increase access to contraception and safe abortion for at-risk groups

Development/revision of national standards and guidelines and training curricula for CAC, including MA

Introduction of MVA and MA for 1st trimester abortion

Introduction of MA and D&E for 2nd trimester abortion to replace less safe methods

Development of IEC/communication strategies for women and communities

New models of service delivery

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Importance of Local Evidence Importance of Local Evidence for Scaling Upfor Scaling Up

Is the innovation feasible and effective in the local context?Learn what works before investing in wide-scale implementationRefine and improve the package of interventionsBuild ownership by involving stakeholders in design and implementationOpportunity for decision-makers to observe new services, to build supportProvide input to development or revision of national standards and guidelines, training curricula, IEC materials, etc.

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Sustainable Scaling UpSustainable Scaling UpSustainable Scaling UpSustainable Scaling Up

Horizontal Scaling UpHorizontal Scaling Up ExpansionExpansion

Vertical Vertical Scaling UpScaling Up

InstitutionalizationInstitutionalization

scale up

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The InnovationUser

Organization(s)Resource

Team

TYPES OF TYPES OF SCALING UPSCALING UP

DISSEMINATIONDISSEMINATIONAND ADVOCACYAND ADVOCACY

ORGANIZATIONALORGANIZATIONALCHOICESCHOICES

COSTS/RESOURCECOSTS/RESOURCEMOBILIZATIONMOBILIZATION

MONITORINGMONITORINGANDAND

EVALUATIONEVALUATION

Scaling up Strategy

A Framework for Scaling Up

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1

Strengthening Capacity for Scaling Strengthening Capacity for Scaling Up Health Service InnovationsUp Health Service Innovations

www.ExpandNet.net

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2

Overview of the Strategic ApproachOverview of the Strategic Approach

http://www.who.int/reproductive-health/publications/

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3

Making Decisionsabout ContraceptiveIntroduction: A Guidefor conductingassessments tobroaden contraceptivechoice and improvequality of care

A practical guide for

implementing Strategic

Assessments

http://www.who.int/reproductive-health/publications/rhr_02_11_contraceptive_introduction/ci-guide.pdf

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4

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5

Strateg

ic Ass

essmen

t Policy & Programme Strengthening

Developing

and Testing

Programme

Innovations

Scaling-Up

Successful

Interventions

STAGE I

ReproductiveHealth

Challenges

Improved ReproductiveHealth Status

and Programmes

STAGE II STAGE III

The Strategic Approach The Strategic Approach Implementation ProcessImplementation Process

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Strategic assessments on issues Strategic assessments on issues related to abortionrelated to abortion

Viet Nam (1997)*Romania (2001)Bangladesh (2002)*Mongolia (2003)*Ghana (2005)*Moldova (2005)*Macedonia (2007)

Ukraine (2008)*Zambia (2008)Malawi (2009)Russia (2009)Guinea (2009)

Collaborating partners: EngenderHealth, Ipas, Pop Council, RH Alliance, WHO

* Follow up includes introduction of MA

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Organizational Process environmental analysis; MoH leadership;

strategic assessment; continuity and coordination; appropriate decisions on pace; scope

Evidence-Based Approachonly scale up a tested innovation

Monitoring & Evaluationbaseline data; achievement indicators;

feedback to strengthen access and quality of care

Resource Mobilizationunderstanding costs;

generating and sustaining funding

Dissemination & Advocacytraining; equipping;

generating political commitment and user knowledge; marketing

Systems Perspectivebroad focus on the innovation;providers; users; health system

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8

Product effective; registered; competitively

priced; good availability; sustainable supply; widely known

Users/Communitiesgood knowledge/well-informed; good access; sufficient demand

Health Systemevidence-based standards and norms;strong capacity; good quality of care;

outpatient and client focus

Political Commitmenthigh-level; multisectoral; good depth; continuously

rededicated

Providersmultiple cadres; well-informed;

well-trained; well-equipped; good incentives