Contributors: Obasesam Edet, Ikechukwu Opara and Oluwatobi Alawode
With TCI’s coaching support, Abia state government is implementing a number of high-impact proven service delivery, demand generation and advocacy solutions. In terms of service delivery, the focus has been on facility-based in-reaches, establishing and strengthening the capacity of facility quality improvement teams (QITs) and demonstrating the 72-hour clinic makeover in a selection of high-volume sites.
These efforts, coupled with social mobilization and activities fostering an enabling environment, have contributed to a 108% increase in annual family planning client volume, comparing the 12 months leading up to June 2020 with the 12 months leading up to July 2018 (when TCI began implementation). This accounts for an additional 8,448 family planning clients. For long-acting reversible contraceptives (LARCs), there was a 213% increase over the same period, translating to 5,698 additional LARC clients.
Learn more about how these results have come to be.
To strengthen and expand the number of LARC providers, TCI coaches trained nurses on using in-reaches as a form of “modified on-the-job training." They invited LARC providers from nearby facilities to the in-reaches to provide supportive supervision. Mrs. Ifendu Ndiya is a senior nursing officer who was coached by TCI on LARC provision and in-reaches who shared the following:
We were used to doing outreaches where we spend so much time on mobilization and few people receive FP services. But with the in-reaches, more women and men are now aware of family planning and we spend less on mobilization since this happens right here in our facility. Now, in the whole of Aba south LGA, there is no facility that cannot provide LARC services. This has increased new acceptors in the LGA and we are grateful to TCI for providing us with the necessary ... capacity building, coaching, mentorship and demonstration of best approaches that can help increase our State mCPR.
Facility-Based In-reaches Drive Increase in Service Uptake
With support from TCI, a QIT was established at the Osusu 1 Primary Health Care Center (PHC) in Aba North LGA. The QIT identified client user fees as a major hindrance to uptake of family planning services. As a result, Ward Development Committee (WDC) Chairman and QIT member John Nwachukwu asked how the community can help ensure free family planning services. He suggested the facility give the WDC a costed list of needed consumables that the facilities often charge family planning clients. Below is the response from the Officer-in-charge, Mrs. Chioma.
The community now provides these consumables with funds from influential members in the community. This led to the abolishing of user fees in the facility and people now take up the service. This initiative has been shared with other facilities, which we hope can help for now till when the government procures consumables.
Strengthening Community Involvement in the Health System
I can remember vividly when I was posted to this place; it was a mess. But, fortunately, TCI came last year and did a 72-hour makeover, which changed things ... starting with FP services. Before, we used to have about 3 to 4 new acceptors in a month. But after the makeover, we had 32 new acceptors and the number has been more than 25 new acceptors monthly. In other services, the impact is not quantifiable. Let’s take immunizations. In a week, we used to have about 10 to 18 clients, but now we have about 35 clients. Antenatal services were also affected. We used to have about 4 to 5 patients, but, now in a month, we have about 20-30 patients. Lastly, our deliveries were also affected. Unlike before when we normally have about 2 clients, because mothers believed that coming in here to deliver means they are coming in contact with infection, today our health center is more like a mini-hospital, neat and easy to clean.
Additional Benefits of the 72-Hour Makeover
Working hand-in-hand with state government and facility staff, TCI helps implement the homegrown high-impact approach, 72-hour clinic makeover. Mrs. Oleka Uchechi is the Officer-in-Charge of World Bank PHC, which benefited from a TCI-funded 72-hour clinic makeover in 2019. Reflecting on this experience, she describes the changes that she witnessed across all service areas: