In-Reaches Contribute to Significant Results and Diffusion Throughout Abia State, Nigeria

Contributor: Dr. Ikechukwu Opara

Family planning counseling at an Abia in-reach.

TCI’s high-impact interventions in Abia state have changed the state’s family planning landscape. Although TCI coaches at the state level as it relates to its high-impact advocacy and demand generation approaches, the service delivery ones are often demonstrated in selected local government areas (LGAs). In the case of Abia state, this means that TCI is demonstrating service delivery interventions in nine out of 17 LGAs. As a result of TCI’s coaching support and the use of cross-state meeting forums to share the results from the demonstration sites, the service delivery approaches – in particular in-reaches and on-the-job training (OJT) – have been adopted and replicated throughout all of Abia’s 17 LGAs.

Mrs. Joy Okali, a 36-year-old nurse midwife and family planning supervisor of Ukwa East LGA, a non-TCI demonstration LGA, shared how TCI’s coaching enabled her to implement in-reaches and get more service providers trained in the provision of long-acting reversible contraceptives (LARCs) in her LGA. As a result, Ukwa East has experienced great increases in the number of LARC-trained providers and improved access to and uptake of family planning. She explains:

I have been hearing about the impact of in-reaches during our RH coordination meetings from some of the FP supervisors in TCI demonstration LGAs and decided to try to see whether I can leverage on it and achieve similar results as we have been having low client turnout. Most facilities have zero to five new acceptors for LARCs, for example. Following the coaching I received from TCI on in-reaches and how to leverage onto them to conduct OJT, I decided to conduct in-reaches in four facilities in my LGA which have been having low client turnout for FP. Some not even reporting LARC uptake due to lack of trained provider, which is a common challenge in my LGA. I was happy that the in-reach was successful in the four facilities of Ohambele PHC, Obeaku PHC, Azumini PHC and Akwaette PHC. Most of these facilities were not providing LARCs prior to this activity due to lack of trained provider, as mentioned earlier, and had less than five new acceptors on the average monthly but as a result of the in-reach, these facilities reported 73 new acceptors. Of which, 29 took up different LARC options. I also leveraged on the in-reach to conduct OJT for the service providers in the facilities, with the help of an outsourced LARC trained provider from a nearby facility. I can boldly say in-reach is actually a game changer as we call it. It can boost new acceptors in just a day, train service providers during the activity and contribute many more benefits to the facility and community. Thanks to TCI for this intervention; this is indeed ‘Business Unusual’ unlike our normal outreach, which costs more with less results.”

In-reaches had not previously been conducted in Abia state prior to TCI. As a result of TCI’s coaching model, in-reaches have now diffused throughout the state. This experience is significant because it illustrates the cascading effects of coaching as well as the diffusion and the impact of TCI primary best practice in Nigeria. TCI’s high-impact interventions in Abia state have contributed to a 279% increase in LARC uptake (denoted by the purple line in the graph below), which represents 7,456 new LARC users since TCI started implementation in July 2018.

Source: Health Management Information System. To prevent overestimation of short-term methods, the HMIS data was adjusted using standard “couple-years of protection,” (CYP) which is the total estimated protection provided by contraceptives in a one-year period. To account for seasonal variations, the data represents a 12-month average for short-term methods and a 12-month rolling sum for long-term.

During a recent meeting involving all of the FP Supervisors from the 17 LGAs, Lady Confidence Ogboso, shared:

When I heard TCI talk about Business Unusual, I thought it were mere wishful thinking. I thought, how can you achieve this in a usual environment such like ours? But now, the story has changed. From less than 20 LARC providers, we now have more than 100 LARC providers in the state. FP is gradually gaining momentum and being prioritized within the PHC [Primary Health Care] continuum. The sector that was once forgotten is now booming with interventions. Abia State now has other partners, including Marie Stopes, John Snow Incorporated and UNFPA, willing to provide support for FP interventions. Health workers are now lobbying to work in the FP space. Government commitment which hitherto has been almost zero for FP has improved tremendously. Indeed, this TCI catalytic model is working in Abia State.”

These significant changes are being institutionalized within the health system in Abia state as TCI continues to strengthen the capacity of family planning leaders to implement, manage and monitor high-impact family planning interventions. The goal is long-standing impact that continues once Abia state graduates from TCI’s direct support. To find out how to conduct a family planning in-reach, watch the video below: