Francophone Africa Guidelines Survey
Background
In March 2002, Francophone MAQ Subcommittee members met in Dakar after the Francophone Regional Postabortion Care Conference. - Photo by Chris Davis, JHPIEGO The development and implementation of national guidelines for family planning and reproductive health (FP/RH) have been important components of USAID’s Maximizing Access and Quality (MAQ) Initiative in Francophone West Africa. FP/RH guidelines have been developed in the following nine Francophone West African countries: Benin, Burkina Faso, Cameroon, Guinea, Ivory Coast, Mali, Niger, Senegal and Togo. At the 1999 regional MAQ conference in Dakar, Senegal, a team from each of these countries reported where they were in terms of guidelines development and produced action plans for next steps in the guidelines implementation process. Since the launch of the Francophone MAQ Subcommittee in July 2000, the Francophone MAQ initiative has built upon guidelines development and implementation and is now focusing on finding the most effective ways to integrate sexually transmitted infection (STI)/HIV/AIDS prevention into FP/RH programs.
Francophone MAQ Subcommittee members Judith Collins and Lucas Mbofung with Nicole Buono, USAID, at the Dual Protection Workshop held in Yamoussoukro, Ivory Coast, August 2002. Photo contributed by Lucas Mbofung, Ministry of Public Health, Cameroon It should be noted that in West Africa, national FP/RH guidelines are referred to as policies, norms and protocols (PNP). Policies (also called norms or standards) specify the minimum levels of acceptable performance for each component of FP/RH services offered. Policies/norms/standards apply to systems (e.g., a standard range of services expected to be found at various levels, by type of provider; or standard equipment) or to providers (e.g., the type of basic or inservice training/qualifications needed to provide specific services). Protocols (also called procedures) give step-by-step instructions for performing each FP/RH job to attain a minimum level of acceptable service provision.
Desk Review
In October and November 2001, four USAID cooperating agencies (Family Health International, Intrah/PRIME, JHPIEGO and the Population Council) conducted desk reviews that examined the integration of STI/HIV/AIDS services in the PNP in four West African countries (countries W, X, Y and Z). Findings from the desk reviews were shared with the respective national Ministries of Health.
Findings
Although the PNP documents in all 4 countries (WXYZ) contain STI/HIV/AIDS information, opportunities to include some additional important information on this subject were missed. (See Table 1.)
Provider Followup Interviews
In 2002, members of the Francophone MAQ Subcommittee developed a questionnaire for use in conducting in-depth interviews with providers at healthcare facilities. The draft questionnaire was pretested in two West African countries. Based on results of the pretest, the questionnaire was adapted to the local country context. In June 2002, the questionnaire was reviewed and approved by the Western Institutional Review Board (WIRB). Following WIRB approval, local consultants began using the finalized questionnaire to conduct interviews with doctors, nurses and midwives in the same four West African countries that were included in the desk review.
Findings from these interviews will help us determine whether the protocols are accessible and useful to providers. (For example, is a copy of the protocols available at the facility? Are the protocols easy or hard to use?) The interview questions will also help us to determine whether STI/HIV/AIDS services are successfully integrated in the protocols. (For example, do providers use the protocols in their daily work to provide STI/HIV/AIDS services? How do providers use the protocols to provide these services?)
Information provided by healthcare providers during these interviews will be shared in each country with the Ministry of Health. It is hoped that the findings from these interviews can be used to improve future FP/RH protocols. Findings from this study may guide us in developing new ways to make the protocols more accessible to providers at all levels of the healthcare system. For example, we may be able to articulate some best practices for disseminating guidelines and orienting/training providers in the use of the guidelines. We may be able to create new job aids that will make the protocols easier to understand and use on the job. If we are able to make the protocols more accessible to providers, we will be better able to ensure that high quality healthcare services reach the clients who need them.
Table 1. STI/HIV/AIDS Content in the PNP of Four Francophone West Africa Countries
Content Country W X Y Z Information concerning client-focused prevention Counseling about risk assessment X X X X Counseling for prevention (addressed to all clients) X X X X Focusing on women X X X X Focusing on adolescents X X X Focusing on men X Male condoms listed as a method that should be regularly available at the clinic X X X X Demonstration of the use of the male condom recommended X X X X Female condoms listed as a method that should be regularly available at the clinic X Demonstration of the use of the female condom recommended X Dual protection (addressed to all clients) X X X Inform clients that contraceptives other than condoms do not provide protection against STIs and HIV/AIDS X X X X Information, education and communication (IEC) materials about prevention (addressed to all clients) should be available at the clinic X X X Prevention focusing on service providers Use of gloves during pelvic examinations X X X X Use of gloves for drawing blood X X X Disinfection of equipment (specula, gloves) X X X Information on ways to protect service providers from needle sticks X X X Information on the prevention of STI/HIV/AIDS transmission during labor and childbirth X Voluntary counseling and testing Offer counseling, tests and/or referral for voluntary testing as part of FP/RH services X X X X Offer counseling, testing and treatment of STIs for partners X X X X Provide guidance to staff on the client-centered approach to counseling X X X X Mother-to-Child Transmission Counseling, during FP/RH visits, on breastfeeding options Counseling, during FP/RH visits, on mother-to child transmission of STIs/HIV/AIDS
