PSI/Tanzania Presentation
Private sector role in Family Planning
By Dr. Nguke Mwakatundu,RH Director
Some Abbreviations
•
•
•
•
•
•
•
•
•
CPR: Contraceptive Prevalence Rate
CYP: Couple Years of Protection
FP: Family Planning
IPC: Interpersonal Communication
IUCD: Intrauterine Contraceptive Device
LTM: Long Term Method
MWRA: Married Women of Reproductive Age
OC: Oral Contraceptive
PA: Public Announcement
National Coverage
National Reach
Zonal Offices
Regional Offices
Background and Geographical
Coverage-RH Program
• Familia RH program was initiated in 2007,and started
services provision in January 2009
• Sales of RH products cover the whole of Tanzania
with exception of IUCDs and Implants which cover 13
regions in Tanzania.
• PSI/Tanzania distributes six FP products and offers
service delivery in 17 regions of mainland Tanzania
(Network facilities in 13 regions and outreach
activities in 12 regions).
• Distributes one safe motherhood product and will
start limited distribution of another one in Q2 2013
RH Program Objectives
• Family Planning
 To contribute towards increase of national CPR target
(target 60% use among MWRA by 2015) and reducing total
fertility rate from 5.4 to 3.1 by 2015
 To promote usage of FP methods especially long-term
methods (Implants and IUCD’s).
• Maternal mortality
 To contribute towards reducing maternal mortality to
193/100,000 live births by 2015(Currently at 454/100,000)
 To reduce maternal deaths due to post partum
haemorrhage (PPH) and incomplete abortions using
misoprostol.
 To increase access to safer delivery -Clean delivery pack
Program Components
• Product procurement, packing and distribution
• Social marketing of 6 FP products,1 safe motherhood product,
and another safe motherhood product from Q2 2013
• Distribution at national and regional level in all authorized
outlets.
• Increased access to services (esp LTM)
• Comprehensive partnership with private sector facilities
• Service provision through outreach teams
• Behaviour Change Communication
•
•
•
•
Inter Personal Communication in communities
Medical detailing to health facilities and pharmacies
Community events
Public Announcements
Program Components
• Supportive environment
• Curriculum revision
• TOT’s
• Working with universities, professional associations (e.g.
AGOTA)
• Working with the Ministry of Health at national and local level to
improve the environment for better access to FP and safe
motherhood services
• Integration
• FP / HIV : Counselling, referral for testing and free condom
distribution
• Treatment of Incomplete abortion / FP
• Postpartum FP
Familia Products Range
•
Family Planning Products:






IUCD’s
Implants
Condoms(male and female)
Injectables
Oral Contraceptives
Emergency contraceptives(supplier brand)
• Safe Motherhood Products


Misoprostol (supplier brand)
Clean Delivery Pack
PSI/Tanzania Current distribution model
District/Rural
Centers
wholesaling
outlets
Urban
retailer
Urban
wholesaling
outlets
Health
facilities
MDCs
Institutions,
NGOs, CBOs
etc
Target Groups
Pharmaceutical
Regional
Distributor
Rural
retailer
Clinics, VCT,
HBC, CHWs,
Peer
educators
page 10
Behavioural Change Communication
Activities
• IPC activities: Household
Visits, Neighbourhood
Meetings, Clinic meetings
• Women groups meetings :
Markets places, Saloon s
visits, kitchen parties
• IEC materials: posters,
brochures
• Public Announcements (PA)
• Mass media: radio spots,
newspapers
page 11
Private Sector Partnership
Service Delivery
Approach
•
•
•
•
•
•
•
•
•
Social franchising model
Selection of health facilities based on specific criteria
Signature of MOU
Comprehensive training in clinical skills for LTM
Equipment for LTM provision
Access to products, expendables and job aids
Monthly event days post-training for capacity building
On going coaching and mentoring for quality
Branding and local promotion of services through
posters, wall paintings, PAs
• Referral system to facility using IPC agents
Branding of Facilities
Wall Paintings
Public Sector Approach
• 10 outreach teams supporting the public sector in 12
regions.
• Each team is of 2 nurse midwives partnering with
public sector providers trained in LTM
• Selection of location / health facilities driven by
district authorities
• Demand creation prior to the event using posters;
public announcements; local leaders; facility
providers
• Equipment, supplies and IP material brought by PSI
team
• All FP clients are screened for HIV and referred for
testing if they are at risk
• Free condoms offered to all clients in need
Major Achievements in 2012
• More than doubling in provision of LTM’s(102,778
insertions in 2012 Vs 48,518 in 2011)
• Increased provision of LTM’s in private sector by 92%(58327
combined IUCD’s and Implants Vs 30446 in 2011)
• Increased provision of LTM’s in the public sector by
145%(44451 combined IUCD‘s and Implants Vs 18072 in
2011)
• Over 317 providers in the private sector network as of
Dec 2012 from 255 at end of 2011, 24% increase in
number of providers in the private sector network.
• 250 IPC workers supporting the private sector network
as of Dec 2012
• Over 300,000 women reached through IPC in 2012
Major Achievements cont.
• Increase in number of outreach teams from 5 to10
teams supporting the public sector in 12 regions.
• Increase in number of women counselled for HIV
during FP counselling by 55% (82,891 in 2012 from
53,593 in 2011)
• Increase in number of women referred for testing for
HIV by 66%(16,849 in 2012 from 10,134 in 2011)
• Increase in number of free condoms distributed by
98%(486,315 in 2012 from 245,541 in 2011)
LTM’s Insertions-Private Sector
45000
40741
40000
35000
30000
25000
21833
IUCD insertions
20000
15000
17586
14700
12578
8613
10000
5000
3677
3650
0
2009
2010
2011
2012
Implant insertions
LTM’s Insertions-Outreach
30000
28459
25000
20000
15992
IUCD insertions
15000
12911
Implant insertions
10000
5161
5000
994
239
0
2010
2011
2012
IUCD’s and Implants Distribution
30000
27155
25000
21370
20000
15418
IUCD's distributed
15000
Implants distributed
10235
10000
4400
5000
2060
400
0
0
2009
2010
2011
2012
OC’s distribution
OC's Sales
1600000
1428336
1400000
1200000
1000000
800000
600000
718092
OC's Sales
663552
525072
400000
200000
0
2009
2010
2011
2012
Injectables distribution
Injectables sales
180,000
170,650
160,000
140,000
120,000
100,000
Injectables sales
80,000
60,000
40,000
18,090
20,000
4,100
0
2010
2011
2012
Familia condoms distribution
Familia condoms distribution
25,000,000
20,088,720
20,000,000
15,000,000
10,929,600
10,000,000
6,785,032
4,262,400
5,000,000
0
2009
2010
2011
2012
Familia condoms distribution
Misoprostol distribution
Misoprostol distributed
350000
310,408
300000
250000
200000
191710
172080
177960
Misoprostol distributed
150000
100000
50000
0
2009
2010
2011
2012
CYP’s growth
1,400,000
1,200,000
1,000,000
800,000
CYP's other FP methods
CYP's condoms
600,000
400,000
200,000
0
2009
2010
2011
2012
National CYP Contribution, Jan-Dec 2011 by
organisation
T-MARC
7%
PSI
24%
MoHSW
69%
2013 Priorities
• Integrating other services to be delivered in the
Familia social franchise
• Increasing productivity of private network providers
and IPC workers
• Increasing sales of FP products
• Introducing Clean Delivery Pack
THANK YOU