Introduction

The Regional PAC Initiative offers technical assistance in ESA to:

• advocate for better programming in PAC;

• conduct situation analyses and design appropriate activities;

• share lessons learned;

• strengthen the PAC network, which includes USAID missions, other donors, NGOs, cooperating and implementing agencies and host country collaborators;

• facilitate links between program initiators and technical assistance providers; and

• forge partnerships and mobilize resources. 

Using field examples from the Postabortion Care Initiative, this paper will illustrate how Regional Health Networks fosters collaboration and improves PAC.

Regional Health Networks

The basic principles that contribute to the success of Health Networks include joint planning and programming with an emphasis on partnerships, African leadership and ownership, and capacity building.

Over the years, REDSO has learned three key lessons from implementing health networking activities. First, network initiatives must have a clear focus on a regional issue to generate results that are well utilized and will genuinely contribute to regional improvements. The focus must be clearly delineated and be of common concern to multiple partners.

Second, we have learned that African ownership of the initiative is critical for its success. The concept of ownership by all partners is an essential factor in the success of all of our networking initiatives. We’ve used a process whereby all partners were involved in the identification of the initiative topic; the development and adaptation of relevant approaches, interventions and models; the implementation of joint workplans; and the utilization and dissemination of results. We also have learned that no matter how well a lesson about an intervention or process that has a proven positive track record has been shared, ownership will not be achieved without local adaptation. The concept of "adding your own egg" is critical if ownership is to be transferred.

Third, we learned that the capacity for following up activities must be in place for the initiative to achieve its objectives. Activities are strategic, and steps are progressive, one step building on the step before it. A meeting simply to share information, with the end result being just that, would not fit into a strategic process. Networking activities are part of a larger process leading to improved utilization of critical information in the region.

REDSO/ESA staff play a facilitative and catalytic role in fostering activity within each of the focus areas. The most common networking mechanisms for implementing activities include study tours, workshops and meetings, pilot studies, information collection and dissemination, south-to-south consultations and technical assistance.

The activities described below demonstrate the successful use of networking mechanisms to improve PAC in the region.

Development of Advocacy Materials

To date, more than 5,000 copies have been distributed throughout the region to ministries of health, technical assistance and multilateral agencies, nongovernmental organizations, medical and nursing schools, training hospitals, FP associations and participants at conferences and workshops. The materials are available for all stakeholders to use. For example, Dr. Florence Mirembe of Mulago Hospital in Kampala adapted the electronic presentation for her address to the African Association of Obstetrics and Gynecology in 1997. These materials have proved to be important tools for defining the magnitude of the problem, describing a range of interventions and clarifying USAID policy, which has had tremendous impact on government and NGO decisions to address unsafe abortion. Stakeholders are now taking action to explore ways to initiate or expand PAC activities within their RH programs, and funding for PAC programs is increasing.

Country Assessments

Each assessment contributes to a growing regional perspective and knowledge base that is helping to inform the design and implementation of PAC programs throughout ESA. To date, the Regional PAC Initiative has conducted country level assessments in Kenya, Malawi, Uganda and Zambia. Although the assessment objectives have varied slightly from country to country, the primary objectives were to:

• Identify key stakeholders and partners in the strengthening of PAC services.

• Assess the situation of unsafe abortion and the need for PAC services including:

• a description of the policy environment and current status of PAC services;

• identification of constraints and opportunities for expanding and improving PAC services; and

• an assessment of government and donor interest in strengthening PAC policies, programs and services.

• Recommend actions to strengthen PAC, including specific activities that could be undertaken by the USAID Mission or host country government based on its comparative advantage and strategic objectives in population and health.

Secondary objectives were to direct the attention of key decision-makers to the importance of PAC and to encourage support for PAC programs.

The assessments have been a collaborative effort between USAID/ REDSO and respective country missions, the POLICY Project, local counterparts (usually representing the teaching hospital, the MOH and the nurses’ council/association) and, in both Zambia and Malawi, JHPIEGO joined in as well. The assessment teams are very strategic. Each team member brings a different perspective and area of expertise, providing a more comprehensive look at the situation of unsafe abortion in these countries. Local counterparts are carefully selected in hopes the assessment exercise will develop their capacity to be champions for PAC, and there has been tremendous value added through the collaboration of JHPIEGO and POLICY Project.

Final reports were jointly written for all assessments and disseminated widely, not only in the respective countries, but also throughout the region. Most assessments were followed by dissemination meetings with key stakeholders participating and, in all four countries, new activities are taking place (or are about to). This follow through is the most essential component to networking.

For example, an assessment was conducted in Uganda. Many interviewees stated a need for increasing access to quality PAC services, particularly in rural areas, and there was consensus that nurse midwives, if trained, could play a larger role. There was tremendous confusion, however, regarding nurse midwife policies and the specific procedures they were allowed to perform. Upon review it was determined that none of the current policies explicitly restrict nurse midwives from practicing MVA, but a majority of those interviewed expressed the importance of having supportive policies in place prior to launching a national effort. A dissemination meeting was held to share these findings. The MOH became interested in the University’s developing a pilot study to look at the safety and efficacy of nurse midwives providing MVA services in selected districts in Uganda. Currently PRIME, as a partner in the DISH (Delivery of Improved Services for Health) Project, is piloting a PAC training program for public sector nurse midwives.

During the design phase of this project, it was realized that similar work was being done in Ghana and there were lessons to be learned. This resulted in the development of a study tour so that the Ghanaian experience could be shared across borders.