The Faces Behind the Success: Oyo state PPFN Team
By Augustina Armstrong-Ogbonna
As the wife of a clergyman, how comfortable will you be educating people about sexual and reproductive health?
That was one question that forty-eight years old Mrs. Abimbola Adedoyin said she would remember for a very long time when she was interviewed for the position of Program Officer Service Delivery Southwest Region with the Planned Parenthood Federation of Nigeria PPFN in 2011.
Five years later, she was the Coordinator of the Bill and Melinda Gates funded Expanding Sexual and Reproductive Health project under the Cluster Plus Model which was a nine-month pilot in Ibadan the capital city of Oyo state in Southwest Nigeria.
She has gathered experience as a nurse for about three decades and mother of two children aged 20 and 16. Abimbola can best be described as a grassroots strategist with a passion for changing lives through effective health delivery.
As she went down memory lane explaining how the strategy for the cluster plus model was designed and executed, her front gap teeth were always on display.
“We started the cluster plus model in January 2015, after selecting ten health facilities within a 20km radius from each other in the five local government of the Ibadan municipal. Some of the facilities were already working with us in the cluster model but the plus model, we added new ones. The health services comprises of private, government-owned and faith based organisation. The local government area the project was targeted at are Ibadan Southwest, Ibadan Northeast, Ibadan East, Ibadan North and Egbeda”.
Abimbola said before the cluster plus model; she was working on core sexual and reproductive health issues with PPFN partner clinics. But the group plus design was an opportunity to display that family uptake was possible. According to her, a strategy was put in place to increase contraceptive prevalence rate CPR to 36% by the end of 2015.
Outreach: Time to display
“The cluster plus model was designed as a one-stop shop with integrated services during our outreaches. Before now, our outreaches were focused on a particular issue at a time. For example, we can have outreaches for breast cancer or cervical cancer or family planning. But with the cluster plus model during a single outreach, we do have screening for breast and cervical cancer, counseling and administration of all family planning methods. Also if a woman is detected with early stage of cervical cancer, we carry out a curative operation called cryotherapy. We had two instances of successful bilateral tubal ligation operations done during our outreach. A man also benefitted with the successful operation during our outreach”.
The outreaches rotated among the PPFN health facilities under the cluster plus model and with the help of community role model agent the people in each community was made aware. Abimbola said before an outreach is done, there is usually a pre-outreach meeting and planning with the involvement of the community representatives.
“The success level of our outreaches was due to the bottom-top model we used. When we wanted to start the cluster plus model, we asked the communities under our target area to nominate the Community Health Extension Workers CHEW the have been working with. This is because the CHEW are the foot soldiers who go into the community to counsel the people on health issues. This gave the communities a sense of ownership and resulted in their total participation during the period of the outreach”.
“We hold meetings with the Community Development Association, Landlords Association, Village Head Teachers, traditional and religious leaders in the particular community we intend holding the outreach. These leaders go into the community to inform their people.
Abimbola said the CHEWS were exposed to different type of training and taught about the different family methods.
“Before now some of them have only heard about these methods, but we also trained them on how to administer them to patients. As a result of our training on early detection of cervical and breast cancer. During outreaches, our CHEWs can detect these among the women attending”.
The Community Leaders are selected among the different Community Development Association popularly called CDA in the Local Government where the project are targeted. These group of people is called Role Model Agent.
This strategy has contributed to the high turnout we witnessed during our outreaches. We attend to between 800-1,000 people during a single outreach that usually lasts three days, she added”.
Abimbola said the plus model was not only about outreaches but other components which she listed as; Direct Data Information Capturing DDIC, Usage of vouchers, integrated outreaches, community involvement and capacity building through on the job training.
“Staff at our cluster facilities were trained on different sexual and reproductive health issues, detection of breast and cervical cancer, management of sexually transmitted infection, a curative method of early detection of cervical cancer like the cryotherapy operation, management information system, commodity documentation and book keeping, amongst others. Also, our CHEW was trained on wholistic counseling on the different family planning methods”.
“I noticed the CHEW were underutilized as their job function is meant to be 60:40 ratio of community work and health facility work. I decided to incorporate them into the cluster plus model. They were able to take the family planning methods to women, families, and communities who needed them the most. With the training we gave the CHEW, they were able to help clients make informed choices on family planning method they wanted”.
Abimbola sad though the job was tasking it was result oriented. “We saw changes, growth, barriers broken, myths and beliefs removed. The staff working with us from the local government were exposed to training that helped detect breast and cervical cancer, management of sexually transmitted infection, management of information system, the curative operation for early detection of cervical cancer like cryotherapy, amongst others”.
Success and the way forward
She outlined the success of the project with so much delight.
“We made impact because many private facilities now want to be among our cluster facilities. They believe it is an opportunity to leverage and train their staff. In the communities we worked, women have become empowered to make informed choices on the sexual and reproductive health. They can plan for their families, the rate of teenage and unwanted pregnancies has reduced, maternal and abortion mortality has also reduced. With this project, we were able to take family planning to the door steps of the women in our rural communities that needed family planning but couldn’t afford it.
My joy will be to see this cluster plus model replicated in all our cluster states across the country, she smiled. Though she once forfeited her studies abroad to raise her two children in Nigeria. She said, ” I am glad, I am helping and empowering women in our rural communities make informed choices on their sexual and reproductive health needs.”
Abimbola said her work with PPFN had made her a sexual and reproductive advocate even in the church were her husband oversea.
“When my husband is counseling soon to be the couple, I also counsel them on sexual and reproductive health issues. Also in the church, I mount the pulpit to discuss family planning. This is to help break the silence surrounding sexual and reproductive discuss, which some perceive as a taboo not to be discussed in public fora like the church”.
Commodity Security through DDIC
One man responsible for ensuring commodity security by working with all the cluster facilities, so they don’t run out of any commodity for the different family planning method was Babatunde Saheed Benson. The 32-year-old joined PPFN as an intern in March 2014, but after over two years, he can describe himself as a monitoring and evaluation officer. Though he worked as the supply chain officer during the cluster plus project.
“My job entails the use of a mobile app built for direct data information capturing DDIC. I created an account for each of the ten facilities that were under the cluster plus model. Before I stock up there store, I take and inventory which serves as stock before supply. This data I input into the mobile app. I then supply and also input the data of what I supplied the facility. The supply is done once in two months. Before the next supply, the app forecast what a particular facility will need base on their consumption rate”.
Saheed said the facility also send in their monthly report through the mobile app.
“After I was trained on the usage of the DDIC app, I also conducted training for the store keepers of the facilities we worked with. All through the nine months of the cluster plus project, no facility ever ran out of stock. This made the family planning method commodity always available to those that need them”.
With a background in banking before joining PPFN, Saheed said he now knows about family planning and the diverse methods available to women of different age groups. He pointed out that implanol and the IUCD method was more used by women during the 9 months of the cluster plus project. Though he appealed for an increase in the allowances of the CHEW, if the project is to be scaled up to other parts of the country. “These CHEW worked hard in ensuring the success of this project”, he concluded.
How do women in poor communities access family planning during the cluster plus project?
About two years ago, after her master degree program, 28 years old Tawa Agungbiade had no job. She got an internship placement with the PPFN office at Ibadan. But now, she was responsible for ensuring 63 women in poor communities in the five local government areas of the cluster plus project had to access to family planning. Slim and with eyes filled with compassion, she highlighted how through the voucher system women were able to access family planning methods.
“During our cluster system, we realized finance was a huge challenge affecting women from accessing family planning. When the cluster plus model was designed, the voucher system was included. With our eligibility criteria questions, we were able to single out women that really couldn’t afford family planning. The affordability was not the money they paid for services in some instance, but also not even having money to paying for their transport fare. They were cases of people saying they couldn’t feed properly, let alone transport themselves to access family planning methods. But the voucher system was able to solve that.”
Tawa said her experience with PPFN had changed her earlier plans of either working in the banking system. “I am no longer interested in that aspect of finance; I will like to further my studies in health finance. That is an important aspect to me. I feel fulfilled helping those women access family planning through the voucher system”, she added.