africa is different: FP in uganda
i attended an all-day workshop today hosted by the ministry of health and family health international (FHI) re: community reproductive health worker (CReHW) provision of family planning methods in uganda. in 2004, FHI partnered with the ministry and save the children to conduct research on a pilot program in nakasongola district that trained CReHWs in community-based distribution (CBD) of depo-provera. what does this mean? it means that women and men who lived in the community and who didn't necessarily have any medical background were recruited by save the children to work as CReHWs, and as such underwent a 21-day training on STDs, HIV/AIDS, reproductive health, and family planning. once trained the CReHWs worked within the community educating men and women on the above topics, providing basic family planning methods (pills, condoms), and referring clients to local health facilities for reproductive health services. (sound familiar? yes, it is very similar to MIHV's family planning community health worker program described in this post.)
the idea of CReHWs isn't novel (community health workers are used all over in public health, both stateside and overseas). what is novel is the addition of another, separate 21-day training exclusively on community-based distribution of depo-provera. if you don't know what depo-provera (aka DMPA or NET-EN) is, it's an injectable contraceptive containing progestin, which is one of the hormones found in combined oral contraceptives (the pill), and prevents pregnancy using pretty much the same mechanism as the pill. in a nutshell, a CBD program for depo means that we are training non-medical providers to provide an injection. i highly doubt that would fly in the U.S. as far as i know, there is a very strict regiment in the U.S. that regulates who in the medical hierarchy can give injections. but, here it's different. there has been CBD of depo in bangladesh since the 1970s, it's been available in parts of latin america since the 1990s, and it's been in africa (specifically uganda) since 2004.
why is africa different?
at first glance, one might question the medical wherewithal of allowing a non-medically trained individual to give injections. but, as research shows, these paraprofessionals actually achieve comparable outcomes to the medical professionals in numbers of satisfied clients, percentages of clients who experience side effects associated with the DMPA, and percentages of clients who suffer from injection site problems (e.g. abscess, infection). to be honest, when it comes down to it, you have to be creative in the delivery of care and services when you live in a country whose health infrastructure is at times non-existant. no, i cannot imagine my neighbor walking into my house in the U.S. and giving me an injection, but i also cannot imagine having to walk 25 km to get to the nearest clinic or doctor or nurse.
in my earlier post i talked about "why family planning," but i didn't put family planning specifically into the context of uganda. so, what's the picture in uganda?
- the infant mortality rate (IMR) in uganda is 97. IMR is conventionally defined as the number of deaths <1 year of age in a defined time period per 1,000 live-births during the same time period. as reference, the IMR in the U.S. is about 6 (i say "about" because the IMR fluctuates based on region, race, ethnicity, socioeconomic status, etc).
- the maternal mortality rate (MMR) is 506, which means that 506 women die due to complications of pregnancy and/or delivery for every 100,000 live-births. again, as reference, the MMR in the U.S. is 9.8 (it drops to 7.5 for white women and spikes to 22 for black women...but, that's a topic for another time).
101paige 101africa 101iph
- the total fertility rate (TFR) in uganda is 6.9. in other words, the average ugandan woman gives birth to 7 children in her lifetime. at today's workshop a man from nakasongola district shared that he and his wife opted for family planning because they'd had trouble spacing their children...they had 5 children in 6 years.
the idea of CReHWs isn't novel (community health workers are used all over in public health, both stateside and overseas). what is novel is the addition of another, separate 21-day training exclusively on community-based distribution of depo-provera. if you don't know what depo-provera (aka DMPA or NET-EN) is, it's an injectable contraceptive containing progestin, which is one of the hormones found in combined oral contraceptives (the pill), and prevents pregnancy using pretty much the same mechanism as the pill. in a nutshell, a CBD program for depo means that we are training non-medical providers to provide an injection. i highly doubt that would fly in the U.S. as far as i know, there is a very strict regiment in the U.S. that regulates who in the medical hierarchy can give injections. but, here it's different. there has been CBD of depo in bangladesh since the 1970s, it's been available in parts of latin america since the 1990s, and it's been in africa (specifically uganda) since 2004.
why is africa different?
at first glance, one might question the medical wherewithal of allowing a non-medically trained individual to give injections. but, as research shows, these paraprofessionals actually achieve comparable outcomes to the medical professionals in numbers of satisfied clients, percentages of clients who experience side effects associated with the DMPA, and percentages of clients who suffer from injection site problems (e.g. abscess, infection). to be honest, when it comes down to it, you have to be creative in the delivery of care and services when you live in a country whose health infrastructure is at times non-existant. no, i cannot imagine my neighbor walking into my house in the U.S. and giving me an injection, but i also cannot imagine having to walk 25 km to get to the nearest clinic or doctor or nurse.
in my earlier post i talked about "why family planning," but i didn't put family planning specifically into the context of uganda. so, what's the picture in uganda?
- the infant mortality rate (IMR) in uganda is 97. IMR is conventionally defined as the number of deaths <1 year of age in a defined time period per 1,000 live-births during the same time period. as reference, the IMR in the U.S. is about 6 (i say "about" because the IMR fluctuates based on region, race, ethnicity, socioeconomic status, etc).
- the maternal mortality rate (MMR) is 506, which means that 506 women die due to complications of pregnancy and/or delivery for every 100,000 live-births. again, as reference, the MMR in the U.S. is 9.8 (it drops to 7.5 for white women and spikes to 22 for black women...but, that's a topic for another time).
101paige 101africa 101iph
- the total fertility rate (TFR) in uganda is 6.9. in other words, the average ugandan woman gives birth to 7 children in her lifetime. at today's workshop a man from nakasongola district shared that he and his wife opted for family planning because they'd had trouble spacing their children...they had 5 children in 6 years.
Labels: global-health, paige, uganda
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