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Implementation and evaluation of a large-scale postpartum family planning program in Rwanda

卢旺达大规模产后计划生育方案的实施和评估

基本信息

批准号：
10437814
负责人：
Kristin Marie Wall
金额：
$ 54.22万
依托单位：
EMORY UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-07-01 至 2026-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10437814
关键词：
Academic advising Address Adoption Africa Area Birth Intervals Breast Feeding Capital Chicago Child Cities Client Client satisfaction Clinic Communities Community Health Aides Consolidated Framework for Implementation Research Contraceptive Usage Contraceptive methods Cost Savings Cost utility Counseling Country Couples Data Decision Making Diffusion Effectiveness Evaluation Family Planning Family Planning Programs Goals Government Health Health care facility Implant Intervention Interview Intrauterine Devices Maintenance Maternal Health Maternal Mortality Measures Methods Modeling Morbidity - disease rate National Institute of Child Health and Human Development Neonatal Mortality Newborn Infant Nurses Outcome Patients Play Postpartum Period Postpartum Women Pregnancy Pregnant Women Prevention Professional counselor Provider Randomized Research Rwanda Savings Services Testing Woman Women&apos s Health Work World Health Organization Zambia abortion acceptability and feasibility base comparison intervention cost cost effective cost effectiveness cost estimate design effectiveness evaluation effectiveness implementation study experience implementation cost implementation framework implementation process improved incremental cost-effectiveness innovation low and middle-income countries mortality neonatal health novel organizational readiness pilot test programs promoter randomized trial reversible contraceptive side effect social standard of care theories tool unintended pregnancy uptake

项目摘要

PROJECT SUMMARY In 2017-2018, we worked closely with the Rwanda Ministry of Health (MOH) to develop and pilot test a theory- based, multi-level intervention targeting postpartum family planning (PPFP) supply and demand in 5 government health facilities in Kigali, the capital. This innovative PPFP intervention is known as `C4' because it is informed by Clients, Clinic providers, Champions, and Community Health Workers. Long-acting reversible contraceptives (LARC), the intrauterine device (PPIUD) and implant, are fundamental to PPFP programs. LARCs are highly effective and are the only reversible methods that may be safely used in early postpartum period by breastfeeding women. During our pilot, LARC uptake among postpartum women increased significantly (172% for PP implant, 2,687% for PPIUD), PPFP feasibility and acceptability were high among providers and clients, and side-effects were rare. We now propose to use an implementation science framework to evaluate the effectiveness of different PPFP demand creation strategies and test the hypothesis that C4 is adaptable to large-scale implementation, cost-effective, and sustainable. In a Type 2 effectiveness- implementation hybrid study, we will evaluate facility organizational readiness prior to implementing C4 in a clinic randomized trial in 12 high-volume health facilities in Kigali, Rwanda (Aim 1). Adaptability and sustainability within government facilities is a critical aspect of our proposal, and the MOH and other local stakeholders will be engaged from the outset. We expect to deliver C4 PPFP counseling to over 21,000 women/couples during the project period. We will then evaluate C4 effectiveness and implementation processes using RE-AIM (Aim 2). We hypothesize that C4 will significantly increase the number of stakeholders engaged, PPFP providers and promoters, couples/clients receiving information about PPFP (reach), and LARC uptake (effectiveness) comparing intervention versus standard of care. We expect PPFP client satisfaction will be high and side-effects will be rare. The independent effectiveness of each demand creation strategy on LARC uptake will be estimated. We assess measures of C4 adoption, implementation, and maintenance at the patient-, provider- and stakeholder-level to assess C4 sustainability. Finally, we will evaluate C4 cost-effectiveness and develop a national costed implementation plan to guide Rwandan MOH decision-making for nationwide roll-out of PPFP services (Aim 3). We hypothesize that C4 will be cost-saving relative to standard of care. C4 represents an important contribution to the Rwanda Family Planning 2020 goals and the MOH are enthusiastic to see our successful pilot efforts expanded to a larger number of facilities for greater and sustained impact. Our PPFP implementation model is designed to be replicable and expandable to other countries in the region which similarly have high unmet need for PPFP.

项目总结