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The IBP initiative, a WHO-based partnership of NGOs, civil society organizations, governments, academic institutions, and other implementing partners, promotes evidence-based global guidelines, tools, and other interventions for local application, and incorporates implementation experience and learning back into the global discourse.

Abou Coulibaly,1 Tieba Millogo,2 Adama Baguiya,1 Nguyen Toan Tran,3 Blandine Thieba,4 Armando Seuc,5 Asa Cuzin-Kihl,5 Sihem Landoulsi,5 James Kiarie,5 Rachel Yodi,6 Désiré Mashinda,6 Séni Kouanda1 1Institut de Recherche en Sciences de la Santé (IRSS), Département Biomédical et Santé Publique, Ouagadougou, Burkina Faso; 2Institut Africain de Santé Publique, Ouagadougou, Burkina Faso; 3University of Technology, Faculty of Health, Australian Centre for Public and Population Health Research, Sydney, Australia; 4Université Joseph KI-ZERBO, Unité de Formation et de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso; 5World Health Organization, Department of Reproductive Health Research, Geneva, Switzerland; 6Université de Kinshasa, Ecole de Santé Publique, Kinshasa, République Démocratique du CongoCorrespondence: Abou CoulibalyInstitut de Recherche en Sciences de la Santé (IRSS), 03 B.P. 7047, Ouagadougou, 03, Burkina FasoTel +226 71 40 77 89Email samsoncoul@gmail.comPurpose: An earlier adoption of contraceptive methods during the postpartum period could help women to extend the inter-pregnancy interval. This article aimed to determine and compare the timing of long-acting reversible contraceptives (LARC) use (ie, intrauterine device and implant) in Burkina Faso (BF) and DR Congo (DRC) between the intervention and control groups.Patients and Methods: A total of 1120 postpartum women were enrolled and followed up to 12 months postpartum. We used Yam-Daabo trial data which was a multi-intervention, single-blinded, cluster-randomised controlled trial done in primary health-care centres (clusters) in both countries. Centres were randomly allocated to receive the six-component intervention or standard antenatal and postnatal care in matched pairs (1:1). We did a secondary analysis using Royston-Parmar’s semi-parametric model to estimate the effect of the interventions on the median time of LARC uptake.Results: Our analysis included 567 postpartum women in BF (284 in the intervention group and 283 in the control group) and 553 in the DRC (274 in the intervention group and 279 in the control group). After showing an increase in family planning use in these two African countries, Yam Daabo’s interventions showed a reduction of the median time of LARCs adoption in the intervention group compared to the control group in both countries (difference of 39 days in Burkina Faso; difference of 86 days in the DR Congo).Conclusion: The Yam Daabo intervention package resulted in increased and earlier adoption of LARC in rural settings in Burkina Faso and urban settings in DR Congo. Such an intervention could be relevant in similar contexts in Sub-Saharan Africa with very high fertility rates and high unmet needs for contraception.Keywords: family planning, postpartum, long-acting reversible contraceptives, sub-Saharan Africa

IntroductionWomen who use contraceptive methods sometimes stop early, use methods intermittently, or switched contraceptive methods. All these events (discontinuations and switching) contribute to the occurrence of unwanted and close pregnancies. This study aimed to explore contraceptive discontinuation and switching during the Yam-Daabo project to measure the effect of interventions on the continuation of contraceptive methods use.MethodsWe conducted a secondary analysis of the Yam-Daabo trial data. We choose the discontinuation and switching of a modern contraceptive method as outcome measures. We performed a survival analysis using the Stata software package to estimate the effect of the interventions on contraceptive discontinuation. We also studied the main reasons for discontinuation and switching.ResultsIn total, 637 out of the 1120 women used at least one contraceptive method (of any type), with 267 women in the control and 370 in the intervention group. One hundred seventy-nine women of the control group used modern methods compared to 279 women of the intervention group with 24 and 32 who discontinued, respectively. We observed no statistically significant association between interventions and modern methods discontinuation and switching. However, modern methods' discontinuation was higher in pills and injectables users than implants and IUDs users. The pooled data comparison showed that, in reference to the women who had not switched while using a modern method, the likelihood of switching to a less or equal effectiveness method among the women of the control group was 3.8(95% CI: 1.8-8.0) times the likelihood of switching to a less or equal effectiveness method among the women of the intervention group. And this excess was statistically significant (p ConclusionThe results of this study show no statistically significant association between interventions and modern methods discontinuation. Discontinuation is more related to the methods themselves than to any other factor. It is also essential to set up specific actions targeting women's partners and influential people in the community to counter inhibiting beliefs.Trial registrationPan African Clinical Trials Registry (PACTR201609001784334, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=1784 ).

Introduction : Women who use contraceptive methods sometimes stop early, use methods intermittently or switched contraceptive methods. All these events (discontinuations and switching) contribute to the occurrence of unwanted and close pregnancies. This study aimed to explore contraceptive discontinuation and switching during the Yam-Daabo project to measure the effect of interventions on the continuation of contraceptive methods use.Methods: We conducted a secondary analysis of the Yam-Daabo trial data. We choose the discontinuation and switching of a modern contraceptive method as outcome measures. We performed a survival analysis by using the Stata software package to estimate the effect of the interventions on contraceptive discontinuation. We also studied the main reasons for discontinuation and switching.Results: In total, 637 out of the 1,120 women used at least one contraceptive method (of any type), with 267 women in the control and 370 in the intervention group. Modern methods were used by 179 women of control group compared to 279 women of intervention group with 24 and 32 who discontinued, respectively. We observed no statistically significant association between interventions and modern methods discontinuation and switching. However, the discontinuation of modern methods was higher in pills and injectables users than implants and IUDs users. The pooled data comparison showed that, in reference to the women who had not switched while using a modern method, the likelihood of switching to a less or equal effectiveness method among the women of the control group was 3.8(95% CI: 1.8-8.0) times the likelihood of switching to a less or equal effectiveness method among the women of the intervention group. And this excess was statistically significant (pConclusion: The results of this study show no statistically significant association between interventions and modern methods discontinuation. Discontinuation is more related to the methods themselves than to any other factor. It is also important to set up specific actions targeting women's partners and influential people in the community to counter inhibiting beliefs.Trial registration: Pan African Clinical Trials Registry (PACTR201609001784334, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=1784).

IntroductionWomen who use contraceptive methods sometimes stop early, use methods intermittently, or switched contraceptive methods. All these events (discontinuations and switching) contribute to the occurrence of unwanted and close pregnancies. This study aimed to explore contraceptive discontinuation and switching during the Yam-Daabo project to measure the effect of interventions on the continuation of contraceptive methods use.MethodsWe conducted a secondary analysis of the Yam-Daabo trial data. We choose the discontinuation and switching of a modern contraceptive method as outcome measures. We performed a survival analysis using the Stata software package to estimate the effect of the interventions on contraceptive discontinuation. We also studied the main reasons for discontinuation and switching.ResultsIn total, 637 out of the 1120 women used at least one contraceptive method (of any type), with 267 women in the control and 370 in the intervention group. One hundred seventy-nine women of the control group used modern methods compared to 279 women of the intervention group with 24 and 32 who discontinued, respectively. We observed no statistically significant association between interventions and modern methods discontinuation and switching. However, modern methods’ discontinuation was higher in pills and injectables users than implants and IUDs users. The pooled data comparison showed that, in reference to the women who had not switched while using a modern method, the likelihood of switching to a less or equal effectiveness method among the women of the control group was 3.8(95% CI: 1.8–8.0) times the likelihood of switching to a less or equal effectiveness method among the women of the intervention group. And this excess was statistically significant (p ConclusionThe results of this study show no statistically significant association between interventions and modern methods discontinuation. Discontinuation is more related to the methods themselves than to any other factor. It is also essential to set up specific actions targeting women’s partners and influential people in the community to counter inhibiting beliefs.Trial registrationPan African Clinical Trials Registry (PACTR201609001784334,https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=1784).

Background: an earlier adoption of contraceptive methods during the postpartum period could help women to extend the inter-pregnancy interval. This article aimed to determine and compare the timing and dynamics of long-acting and reversible contraceptives (LARC) use (i.e., intra-uterine device and implant) in Burkina Faso (BF) and the DR Congo (DRC).Methods: Study participants were followed up to 12 months postpartum. We used Royston-Parmar's semi-parametric model to estimate the effect of the interventions. All multivariate results were adjusted for covariates found to be imbalanced between the intervention and control groups. We used a Mantel-Haenszel-type method to compare adjusted hazard ratios (aHR) between the two countries. We computed the median time of contraceptive adoption in each group by country.Results: Our analysis included 567 postpartum women in BF (284 in the intervention group and 283 in the control group) and 553 in the DRC (274 in the intervention group and 279 in the control group). Interventions had an effect in LARC use in BF (aHR 1.85; p=0.001) as well as DRC (aHR 2.78; pConclusion: The Yam Daabo intervention package resulted in an increased and earlier adoption of LARC in both rural settings in Burkina Faso and urban settings in DR Congo. Such an intervention could be relevant in similar contexts in Sub-Saharan Africa.Plain English summary: Many studies showed that postpartum family planning use is low and unmet need for contraception following pregnancy is high in low- and middle-income countries. The Yam Daabo cluster-randomised controlled trial showed that a package of six low-technology interventions, designed in a participatory manner and aimed at strengthening routine antenatal and postnatal services in primary health clinics, doubled the proportion of women using short-acting and long-acting reversible modern contraceptives up to 12 months post partum when compared with women using routine care. This paper, which is a secondary analysis of the Yam Daabo trial, focuses on long-acting and reversible contraceptive (LARC) because of their multiples advantages and few disadvantages by reporting the dynamics of LARCs adoption during the first year postpartum. Such an analysis is very relevant because an earlier adoption of LARC in poor countries such as Burkina Faso and the DR Congo, with a high fertility rate, is effective in spacing pregnancies.Yam Daabo’s interventions showed a reduction of the median time of LARCs adoption in the intervention group compared to the control group in both countries (just under 2 months for the median time for LARC adoption in intervention group, difference of 39 days in Burkina Faso; 75 days postpartum for the median time for LARC adoption in intervention group, difference of 86 days in the DR Congo). This is an important point for the decision makers. According to our results, if the women are checked in the six postpartum weeks, as recommended by the WHO about postnatal care in 2013, and exposed to Yam Daabo’s interventions, this might increase an earlier PPFP use and specifically LARC use. Considering the high effectiveness of LARC, this may contribute to prevent unintended pregnancies and extend the inter-pregnancy interval. This is all the more important since most of these countries have very high fertility rates with high unmet needs for contraception. These results have important programmatic implications for countries with similar context.

Objectives Postpartum family planning (PPFP) is essential for maternal and newborn health but is often not systematically addressed before or after childbirth. This article describes the development and field-testing of a PPFP counseling tool to support providers and women. Methods Participatory action research involving women, men, providers, policymakers, researchers, and contraceptive experts from Burkina Faso and the Democratic Republic of Congo. Results The tool consists of an A4-size flipchart with illustrations on the client side and clinical information and counseling tips on the provider side, and can be used during visits of the antenatal-delivery-postnatal care continuum. Qualitative results suggest that the tool is easily understandable, user-friendly, relevant, and useful with regard to providing PPFP information to clients, and respectful of clients’ rights and choices. It may have a positive influence on clients’ attitudes towards PPFP and their decision to use contraception. Conclusions The tool holds promise in guiding a systematic discussion on birth spacing options among providers and clients. Its impact on contraceptive uptake requires further research. Practice implications If proven effective, the tool could be disseminated to Ministries of Health and local, regional, and global partners to strengthen national family planning and maternal and child health strategies in low-resource countries.

BACKGROUND:In rural Burkina Faso, a package of six low-technology, post-partum contraceptive interventions (ie, refresher training for providers, a counselling tool, supportive supervision, daily availability of contraceptive services, client appointment cards, and invitation letters to attend appointments for partners), aimed at strengthening existing primary health-care services and enhancing demand for them, doubled the use of modern contraceptives at 12 months post partum (ie, 55% uptake in intervention recipients vs 29% in routine-care users). This study assessed the effect of a similar package but in urban settings of Kinshasa province, Democratic Republic of the Congo, in an effort to reduce the unmet need for post-partum family planning. METHODS:Yam Daabo was a multi-intervention, single-blinded, cluster-randomised controlled trial done in six primary health-care centres (clusters) in Kinshasa. Centres were randomly allocated to receive the six-component intervention or standard antenatal and postnatal care in matched pairs (1:1) on the basis of number of monthly births, the ratio of health workers per population in the health zone, and the urban and suburban settings. Only data analysts could be masked to cluster allocation. Health-care facilities were eligible if they provided a continuum of antenatal, delivery, and postnatal care, were well stocked with contraceptives, and were situated close to the main study centre. All pregnant women presenting to the six centres were eligible if they were in their third pregnancy trimester and had no counterindications to deliver in the facility. The main outcome was prevalence of use of modern contraceptives at 12 months after delivery. Analysis was by modified intention-to-treat using generalised linear mixed models or Fisher's exact test for small groups. Prevalence ratios were adjusted for cluster effects and baseline characteristics. This study was registered with the Pan-African Clinical Trials Registry (PACTR201609001784334). FINDINGS:From July 1, 2016, to Feb 2, 2017, eight of 52 clinics assessed for eligibility met the criteria and were randomised. Of 690 women approached, 576 (83%) women were enrolled: 286 in the four intervention clusters and 290 in the four control clusters. Of them, 519 (90%) completed the 12-month study exit interview (252 in the intervention group and 267 in the control group) and were included in the intention-to-treat analysis. At 12 months, 115 (46%) of 252 women in the intervention group and 94 (35%) of 267 in the control group were using modern contraceptives (adjusted prevalence ratio [PR] 1·58, 95% CI 0·74-3·38), with significant differences in the use of contraceptive implants (22% vs 6%; adjusted PR 4·36, 95% CI 1·96-9·70), but without difference in the use of short-acting contraceptives (23% vs 28%; 0·92, 0·29-2·98) and non-modern or inappropriate methods (7% vs 18%; 0·45, 0·13-1·54). There were no serious adverse events or maternal deaths related to the study. INTERPRETATION:The Yam Daabo intervention package did not have a significant effect on the overall use of effective modern contraceptives but significantly increased implant use in women post partum who live in urban settings in Kinshasa up to a year after childbirth. However, interferences from external family planning initiatives in the control group might have diminished differences between the services received. Such an intervention could be potentially relevant in similar contexts in DR Congo and other countries. FUNDING:Government of France; UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction.

Summary Background In rural Burkina Faso, a package of six low-technology, post-partum contraceptive interventions (ie, refresher training for providers, a counselling tool, supportive supervision, daily availability of contraceptive services, client appointment cards, and invitation letters to attend appointments for partners), aimed at strengthening existing primary health-care services and enhancing demand for them, doubled the use of modern contraceptives at 12 months post partum (ie, 55% uptake in intervention recipients vs 29% in routine-care users). This study assessed the effect of a similar package but in urban settings of Kinshasa province, Democratic Republic of the Congo, in an effort to reduce the unmet need for post-partum family planning. Methods Yam Daabo was a multi-intervention, single-blinded, cluster-randomised controlled trial done in six primary health-care centres (clusters) in Kinshasa. Centres were randomly allocated to receive the six-component intervention or standard antenatal and postnatal care in matched pairs (1:1) on the basis of number of monthly births, the ratio of health workers per population in the health zone, and the urban and suburban settings. Only data analysts could be masked to cluster allocation. Health-care facilities were eligible if they provided a continuum of antenatal, delivery, and postnatal care, were well stocked with contraceptives, and were situated close to the main study centre. All pregnant women presenting to the six centres were eligible if they were in their third pregnancy trimester and had no counterindications to deliver in the facility. The main outcome was prevalence of use of modern contraceptives at 12 months after delivery. Analysis was by modified intention-to-treat using generalised linear mixed models or Fisher's exact test for small groups. Prevalence ratios were adjusted for cluster effects and baseline characteristics. This study was registered with the Pan-African Clinical Trials Registry (PACTR201609001784334). Findings From July 1, 2016, to Feb 2, 2017, eight of 52 clinics assessed for eligibility met the criteria and were randomised. Of 690 women approached, 576 (83%) women were enrolled: 286 in the four intervention clusters and 290 in the four control clusters. Of them, 519 (90%) completed the 12-month study exit interview (252 in the intervention group and 267 in the control group) and were included in the intention-to-treat analysis. At 12 months, 115 (46%) of 252 women in the intervention group and 94 (35%) of 267 in the control group were using modern contraceptives (adjusted prevalence ratio [PR] 1·58, 95% CI 0·74–3·38), with significant differences in the use of contraceptive implants (22% vs 6%; adjusted PR 4·36, 95% CI 1·96–9·70), but without difference in the use of short-acting contraceptives (23% vs 28%; 0·92, 0·29–2·98) and non-modern or inappropriate methods (7% vs 18%; 0·45, 0·13–1·54). There were no serious adverse events or maternal deaths related to the study. Interpretation The Yam Daabo intervention package did not have a significant effect on the overall use of effective modern contraceptives but significantly increased implant use in women post partum who live in urban settings in Kinshasa up to a year after childbirth. However, interferences from external family planning initiatives in the control group might have diminished differences between the services received. Such an intervention could be potentially relevant in similar contexts in DR Congo and other countries. Funding Government of France; UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction.

In Burkina Faso, the coverage of services for family planning is low due to shortage of qualified health staff and limited access to services.Following the launch of the Ouagadougou Partnership, an alliance to catalyse the expansion of family planning services, the health ministry created a consortium of family planning stakeholders in 2011. The consortium adopted a collaborative framework to implement a pilot project for task sharing in family planning at community and primary health-care centre levels in two rural districts. Stakeholders were responsible for their areas of expertise. These areas included advocacy; monitoring and evaluation; and capacity development of community health workers (CHWs) to offer oral and injectable contraceptives to new users and of auxiliary nurses and auxiliary midwives to provide implants and intrauterine devices. The health ministry implemented supportive supervision cascades involving relevant planning and service levels.In Burkina Faso, only 15% (2563/17 087) of married women used modern contraceptives in 2010.Adoption of new policies and clinical care standards expanded task sharing roles in family planning. The consortium trained a total of 79 CHWs and 124 auxiliary nurses and midwives. Between January 2017 and December 2018, CHWs provided injectables to 3698 new users, and auxiliary nurses or midwives provided 726 intrauterine devices and 2574 implants to new users. No safety issues were reported.The pilot project was feasible and safe, however, financial constraints are hindering scale-up efforts. Supportive supervision cascades were critical in ensuring success.Au Burkina Faso, la couverture des services de planification familiale est faible, en raison de la pénurie de personnel de santé qualifié et de l'accès limité à ces services.Suite au lancement du Partenariat de Ouagadougou, alliance destinée à accélérer l'expansion des services de planification familiale, le ministère de la Santé a créé en 2011 un consortium d'acteurs de la planification familiale. Ce consortium a adopté un cadre collaboratif pour mettre en œuvre un projet pilote visant à partager les tâches de planification familiale, aux niveaux de la communauté et des centres de soins primaires, dans deux districts ruraux. Les différents acteurs étaient responsables de leurs domaines d'expertise, parmi lesquels la sensibilisation, le suivi et l'évaluation, ainsi que le renforcement des compétences des agents de santé communautaires, afin de proposer des contraceptifs oraux et injectables à de nouvelles utilisatrices, et des aides-soignants et sages-femmes auxiliaires, dans le but de poser des implants et des dispositifs intra-utérins. Le ministère de la Santé a mis en place des structures d'encadrement faisant intervenir les niveaux concernés de planification et de services.Au Burkina Faso, seules 15% (2563/17 087) des femmes mariées utilisaient des contraceptifs modernes en 2010.L'adoption de nouvelles politiques et de nouveaux standards de soins a élargi les rôles de partage des tâches en matière de planification familiale. Le consortium a formé un total de 79 agents de santé communautaires et de 124 aides-soignants et sages-femmes auxiliaires. Entre janvier 2017 et décembre 2018, les agents de santé communautaires ont délivré des contraceptifs injectables à 3698 nouvelles utilisatrices, et les aides-soignants et sages-femmes auxiliaires ont posé 726 dispositifs intra-utérins et 2574 implants à de nouvelles utilisatrices. Aucun problème de sécurité n'a été signalé.Ce projet pilote était réalisable et sûr; cependant, des contraintes financières entravent les efforts d'évolution. Les structures d'encadrement ont été essentielles à la réussite de ce projet.En Burkina Faso, la cobertura de los servicios de planificación familiar es baja debido a la escasez de personal sanitario cualificado y al acceso limitado a los servicios.Tras la puesta en marcha de Ouagadougou Partnership (la Asociación de Uagadugú), una alianza para promover la expansión de los servicios de planificación familiar, el Ministerio de Salud creó en 2011 un consorcio de interesados en la planificación familiar. El consorcio adoptó un marco de colaboración para ejecutar un proyecto piloto de distribución de tareas en materia de planificación familiar a nivel comunitario y de centros de atención primaria de la salud en dos distritos rurales. Las partes interesadas eran responsables de sus áreas de especialización. Estas áreas incluían la promoción, la vigilancia y la evaluación, y el desarrollo de la capacidad de los trabajadores sanitarios de la comunidad (community health workers, CHW) para ofrecer anticonceptivos orales e inyectables a los nuevos usuarios, así como de los enfermeros auxiliares y las parteras auxiliares para proporcionar implantes y dispositivos intrauterinos. El Ministerio de Salud implementó cascadas de supervisión de apoyo que involucran niveles relevantes de planificación y servicio.En Burkina Faso, solamente el 15 % (2 563/17 087) de las mujeres casadas utilizaron anticonceptivos modernos en 2010.La adopción de nuevas políticas y estándares de atención clínica expandió la distribución de tareas en la planificación familiar. El consorcio capacitó a un total de 79 CHW y 124 enfermeros y parteras auxiliares. Entre enero de 2017 y diciembre de 2018, los CHW administraron inyectables a 3 698 nuevas usuarias, y los enfermeros auxiliares o parteras suministraron 726 dispositivos intrauterinos y 2 574 implantes a las nuevas usuarias. No se informó de ningún problema de seguridad.El proyecto piloto era viable y seguro; sin embargo, las limitaciones financieras están obstaculizando los esfuerzos de ampliación. Las cascadas de supervisión de apoyo fueron fundamentales para garantizar el éxito.انخفاض تغطية خدمات تنظيم الأسرة بسبب نقص العاملين الصحيين المؤهلين ومحدودية الوصول إلى الخدمات.عقب إطلاق شراكة واغادوغو وهو تحالف لتحفيز توسع خدمات تنظيم الأسرة، شكلت وزارة الصحة ائتلافًا من أصحاب المصلحة في تنظيم الأسرة في عام 2011. اعتمد الائتلاف إطارًا تعاونيًا لتنفيذ مشروع تجريبي خاص بمشاركة المهام المتعلقة بتنظيم الأسرة على مستوى مراكز الرعاية الصحية الأولية والمجتمع في منطقتين ريفيتين. وكان أصحاب المصلحة مسؤولين عن مجالات خبراتهم. وشملت هذه المجالات: التأييد؛ والمراقبة والتقييم؛ وتطوير قدرات العاملين في مجال الصحة المجتمعية (CHW) لتقديم موانع الحمل التي يتم تعاطيها عن طريق الفم، والقابلة للحقن إلى مستخدمين جدد؛ بالإضافة إلى تطوير قدرات الممرضات المساعدات والقابلات المساعدات لتوفير أدوات زرع داخل الرحم وأجهزة رحمية لمنع الحمل. نفذت وزارة الصحة سلاسل إشراف داعمة تتضمن مستويات التخطيط والخدمات ذات الصلة.استخدمت 15% فقط (2563/17087) من النساء المتزوجات في بوركينا فاسو وسائل منع حمل حديثة في عام 2010.أدى اعتماد سياسات جديدة ومعايير الرعاية السريرية إلى توسيع أدوار مشاركة المهام المتعلقة بتنظيم الأسرة. ودرب الائتلاف إجمالي 79 عاملاً في مجال الصحة المجتمعية (CHW)، و124 ممرضة مساعدة وقابلة مساعدة. في الفترة ما بين يناير/كانون ثاني 2017 وديسمبر/كانون أول 2018، قدم العاملون في مجال الصحة المجتمعية (CHW) وسائلَا قابلة للحقن إلى 3698 مستخدمًا جديدًا، وقدمت الممرضات المساعدات والقابلات المساعدات 726 جهازًا رحمياً و2574 أداة للزرع داخل الرحم للمستخدمين الجدد. ولم يتم الإبلاغ عن أي مشاكل متعلقة بالسلامة.كان المشروع التجريبي عمليًا وآمنًا، ومع ذلك، كانت القيود المالية تعيق جهود التوسع. كانت سلاسل الإشراف الداعمة حاسمة في ضمان النجاح.在布吉纳法索，由于缺乏合格的医务人员以及获得服务的途径有限，计划生育服务的覆盖率很低。.在瓦加杜古伙伴关系（旨在促进推广计划生育服务的联盟）启动之后，卫生部于 2011 年成立了一个计划生育利益相关者联盟。该联盟采用协作架构以实施试点项目，从而在两个农村地区的社区和初级医疗保健中心实现计划生育任务分担。利益相关者对其专业领域负责。这些领域包括加大宣传、监测与评估，培养社区卫生工作者 (CHW) 向新用户提供口服型和注射型避孕药的能力，以及由助理护士和助理助产士提供植入型避孕措施和宫内节育器的能力。卫生部实施了支持性联动监督，涉及相关的计划和服务层面。.2010 年，布吉纳法索仅有 15% （即 2563/17087）的已婚妇女使用现代避孕措施。.新的政策和临床护理标准的采用扩大了任务分担在计划生育中的作用。联盟共培训了 79 名社区卫生工作者以及 124 名助理护士和助产士。2017 年 1 月至 2018 年 12 月间，社区卫生工作者向 3698 名新用户提供了注射型避孕药物，助理护士或助产士向新用户提供了 726 个宫内节育器和 2574 个植入型避孕措施。目前尚未出现任何安全问题报告。.试点项目可行且安全，但是，财政拮据影响了其规模的进一步扩大。支持性联动监督是成功的关键。.В Буркина-Фасо наблюдается низкий уровень охвата услугами по планированию семьи по причине нехватки квалифицированного медицинского персонала и ограниченного доступа к услугам.После запуска программы «Партнерство Уагадугу» (союза, в задачи которого входит ускорение расширения охвата услугами по планированию семьи) Министерство здравоохранения в 2011 году создало консорциум партнеров по данному вопросу. Консорциум определил рамки сотрудничества для осуществления пилотного проекта по разделению функций в оказании услуг по планированию семьи на уровне общин и центров первичного медико-санитарного обслуживания в двух сельских регионах. Каждый из партнеров отвечал за свою область знаний. Эти области знаний включали информационно-разъяснительную работу, мониторинг и оценку, а также обучение общинных медико-санитарных работников (ОМСР) тому, чтобы они могли предлагать пероральные и инъекционные контрацептивы новым пользователям, а также обучение младших медсестер и акушерок процедуре установки имплантатов и внутриматочных устройств. Министерство здравоохранения также внедрило ступенчатую систему надзора и поддержки, в которую вошли соответствующие уровни планирования и оказания услуг.В 2010 году только 15% замужних женщин в Буркина-Фасо (2563 из 17 087) использовали современные контрацептивы.Принятие новых правил и стандартов клинического ухода расширило возможности разделения функций в услугах планирования семьи. Консорциум обучил в общей сложности 79 ОМСР и 124 младшие медсестры и акушерки. В период с января 2017 года по декабрь 2018 года ОМСР выдали инъекционные контрацептивы 3698 новым пользователям, а младшие медсестры и акушерки установили 726 внутриматочных устройств и 2574 имплантата. Проблем с безопасностью при этом не было зарегистрировано.Пилотный проект оказался осуществимым и безопасным, однако финансовые ограничения препятствуют расширению его масштабов. Критическим звеном в обеспечении успешности проекта оказалась ступенчатая система надзора и поддержки.

© 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Background: Post-partum family planning services can prevent maternal and child morbidity and mortality in low-resource settings. We assessed the effect of a family planning intervention package on modern contraceptive use at 12 months post partum in predominantly rural Burkina Faso. Methods: Yam Daabo was a two group, multi-intervention, single-blinded, cluster randomised controlled trial. Primary health-care centres were randomly allocated to intervention or control clusters in a 1:1 ratio with only data analysts masked to the allocation assignment. Interventions comprised refresher training for the provider, a counselling tool, supportive supervision, availability of contraceptive services 7 days a week, client appointment cards, and invitation letters for partners. The primary outcome was modern contraceptive prevalence at 12 months, and secondary outcomes were modern contraceptive prevalence at 6 weeks and 6 months post partum. Analysis was by modified intention to treat. Prevalence ratios were adjusted for cluster effects and baseline characteristics. This study was registered with the Pan-African Clinical Trials Registry (PACTR201609001784334). Findings: From July 27–Oct 17, 2016, eight clinics were randomised and 571 women were enrolled and allocated: 286 to four intervention clusters and 285 to four control clusters. Of these, 523 completed the 12-month study exit interview (260 in the intervention group, 263 in the control group) and 523 were included in the intention-to-treat analysis. At 12 months, modern contraceptive prevalence was 55% among women who received the package and 29% among those who received routine care in control clusters (adjusted prevalence ratio 1·79, 95% CI 1·30–2·47). Significant differences in modern contraceptive prevalence were also seen between intervention and control groups at 6 weeks (42% and 10%, respectively; adjusted prevalence ratio 3·88, 95% CI 1·46–10·35) and 6 months (59% and 24%, respectively; 2·31, 1·44–3·71). Interpretation: A package of six low-technology interventions, aimed at strengthening existing primary health-care services and enhancing demand for these services, can effectively increase modern contraceptive use for up to a year post partum in rural settings in Burkina Faso and has the potential to be suitable in similar settings in this country and others. Funding: Government of France.

Appointment card for women. (PPTX 100 kb)

Invitation letter for partners. (DOCX 34 kb)

Promote mobility between South-South and South-North for improving level of researchers, staff and students through a platform.The methodology is based a filling of a questionnaire about offer or demand. Material is composed a computer connected Internet.we registered about 203 demands and 31 offers from partners.43 mobilities were executed completely.The results indicate a real need of mobility for researchers and health professionals in Africa. The important number of mobility demands made by external researchers and professionals (from outside the AFRICA BUILD Consortium) may be constrained by the difficulty to find adequate funding.