Introduction
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On 20 and 21 May 1999, JHPIEGO sponsored a workshop to explore issues in
establishing postabortion care (PAC) in low-resource settings. Workshop participants
included United States Agency for International Development (USAID) program staff,
representatives from AVSC International, INTRAH/PRIME, Ipas, JHPIEGO, Johns Hopkins
University Population Communication Services (JHU/PCS), Pathfinder International and
Research Triangle Institute (RTI)/POLICY Project, and other reproductive health (RH)
professionals from 14 developing countries. (See Appendix A for a complete list of
workshop participants and Appendix B for the workshop agenda.) The overall goal of the
workshop was to reach agreement on a strategy for providing PAC services that could be
adopted and implemented by organizations working in the PAC arena. The workshop had three
objectives:
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Organization of the Workshop
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To open the workshop, USAID Technical Advisor Sandra de Castro Buffington
highlighted the Agency’s commitment to PAC and the status of USAID-funded PAC
programs worldwide. Subsequent presentations by other participants on the first day
centered on the need for a PAC strategy, initiatives in East and Southern Africa (ESA),
the role of the community, experience with decentralizing services in Africa, the role of
PAC in averting future abortions, lessons learned from seven countries about improving
access and quality, and the use of misoprostol. The second day of the workshop was
organized around five overarching themes—advocacy, access, institutionalization of
training, sustainability and technical issues. The participants divided into five
corresponding working groups. Each group discussed the role of its theme with respect to
the following areas:
Integration of PAC into existing infrastructure, systems and services
Expansion of the pool of healthcare workers able to provide emergency
services
Incorporation of the community perspective into PAC services
Ongoing provision of supplies and equipment needed for PAC services
Role of misoprostol in PAC services
In the afternoon, each group reported on its discussion and made recommendations for
strengthening the strategy. |
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Recommendations
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A summary of the groups’ recommendations for establishing PAC
services in low-resource settings is presented below. Because the overarching themes are
not mutually exclusive, there were a number of recommendations that were made by more than
one working group. To strengthen access, advocacy, institutionalization of training and
sustainability of PAC services, as well as address a number of unresolved technical
issues, the following actions should be taken: |
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| Advocacy |
Define the purpose of the advocacy process.
Make the advocacy strategy broader than PAC.
Identify the advocacy tools that will be most useful for the specific
situation.
Develop the advocacy strategy by forming a network, identifying key
individuals in the process, facilitating a needs assessment, convening dissemination
events, developing an action plan and tailoring the strategy to the community.
Implement the strategy.
Continually monitor and evaluate to assess impact.
Use findings from evaluations to gain new support.
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| Access |
Involve the woman and her community by providing the community with
information, mobilizing community leaders and building networks.
Focus on service providers by examining practice regulations, supporting
a cadre-neutral approach, strengthening training systems and supervision, and motivating
providers.
Work with the health facility to identify key stakeholders, link family
planning (FP) and other RH, integrate PAC services into existing programs, expand coverage
and consider financial and procurement issues.
Work with government and regulatory bodies to incorporate PAC into all
strategic health planning, encourage policies that support PAC, include PAC in service
delivery guidelines, provide funding and develop necessary support systems for PAC.
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| Institutionalization
of Training |
Integrate PAC into the existing infrastructure, systems and services by
standardizing skills; making competency-based PAC training a part of basic preservice
education and inservice training in maternal health; revising curricula, protocols and
practices; and sensitizing providers to the issues involved in PAC.
Expand the role of the healthcare worker and the pool of providers by
changing laws when necessary, giving sufficient numbers of providers hands-on experience,
training different cadres to work as a team, improving training of trainers, developing
model clinical training sites and addressing issues of quality and skill maintenance.
Know the community and ensure that community perspectives are addressed
in needs assessments and subsequent training.
Ensure ongoing provision of equipment and supplies, including PAC
learning packages and anatomic models, by linking PAC to other maternal health
initiatives, working with the government and networking with other organizations and
donors.
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| Technical Issues |
Address clinical issues such as improving training in pain management,
counseling and diagnostic skills, and emergency preparedness; emphasize the importance of
using recommended infection prevention (IP) practices.
Explore sources of manual vacuum aspiration (MVA) equipment, catalogue
available equipment and develop guidelines for its selection and use.
Conduct research and develop guidelines on the use of oral misoprostol
as a possible medical treatment of incomplete abortion.
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