With a smile that exposes a tiny coveted tooth gap characteristic of East African women, 30-year-old Mariam Omari finds it difficult to hide her joy: She is excited to become a mother, once again. It has been 11 years since her last pregnancy, and Mariam and her husband, John, 36, now want a third child. The couple has two children—a daughter, 13, and son, 11.

"Waiting to have another child gave me time to keep focused on my business of selling rice to help support my family," Mariam said.

Fortunately for Miriam, she was able to choose from among a full range of contraceptive methods and services at her local health clinic in Tanzania. Not all women are so lucky; many living in rural areas across Tanzania routinely encounter contraceptive stockouts and irregular supplies.

To address this problem, EngenderHealth’s RESPOND Project collaborated with Tanzania’s Ministry of Health and Social Welfare (MOHSW) and its local partners to implement COPE® for Contraceptive Security.[1]They aimed to determine if the COPE for Contraceptive Security approach improved a health care facility’s capacity to ensure that family planning (FP) commodities are on hand on a daily basis. As a new tool, the project developed and tested COPE for Contraceptive Security’s effectiveness in increasing access to all FP methods. The RESPOND Project used self-assessment guides and facility checklists to help staff think through all of the necessary elements to support contraceptive security, which exists when people are able to choose, obtain and use the contraceptive methods and services they desire from among a full range of methods (short-acting, long-acting, and permanent).

The RESPOND Project found COPE® for Contraceptive Security to be a highly effective, low-resource intervention to mobilize facility staff to identify and resolve challenges to stockouts and irregular supplies. After implementation, health care providers reported an overall increase in teamwork and shared responsibility. Respondents described their success in adhering to inventory management standards, improved infection prevention procedures, enhancements made to infrastructure that directly benefited clients and decreased stockouts. Providers also reported that improved method availability led to increases in the number of FP clients at the facility. Both clients and health care providers interviewed stated that there was renewed confidence and respect between the communities and the facilities.

The approach was successful in increasing and sustaining the availability of contraceptives at participating facilities, and just as important, in boosting providers’ and clients’ confidence that FP methods would be available.

After seeing the positive results, the MOHSW committed to scale up the approach by asking EngenderHealth’s RESPOND Tanzania Project (RTP) to integrate COPE® for Contraceptive Security into technical assistance activities for the public sector’s routine supervision of MOHSW facilities.

In addition, COPE® for Contraceptive Security was tested at 18 health care facilities in two districts (Mangochi and Salima) in Malawi in 2014. To facilitate South-to-South capacity building, master trainers from Tanzania traveled to Malawi to orient and train national decision makers on the approach. This opened a door of opportunity for cultivating contraceptive security in Malawi, as the government implements new national- and district-level action plans for family planning. In 2015–2016, EngenderHealth and the MOH in Malawi are scaling up COPE for Contraceptive Security at 60 facilities in 10 districts throughout the country. This work is funded by the Reproductive Health Supplies Coalition’s Innovation Fund. Learning from the scale-up work will inform future replication and scale-up internationally.

[1] This was using an adaptation of EngenderHealth’s COPE® (which stands for “client-oriented, provider-efficient” services)—a quality improvement process and set of tools that enable staff from all levels of a health facility to identify challenges in implementing their daily tasks, create and implement an action plan to address them, resolve problems using locally available resources and track their progress and achievements.

For more information, visit: EngenderHealth-Factsheet-Family-Planning-English

PHOTO: Fanny Schertzer (Own work) [CC BY 2.5], via Wikimedia Commons