Survey on The Role of Primary Health Care Providers in Sexual and Reproductive Health

1
Survey on The Role of Primary Health Care
Providers in Sexual and Reproductive Health
Pisa 30-31 August 2010 Laura
Guarenti Reproductive Health and Research WHO
Geneva
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Purpose of the survey

• In preparation of the SRH core competencies for
  PC, to gather information about SRH provided
  services
• What services
• Where delivered
• Which providers
• September - October 2009

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Why focus on PHC? ALMA ATA declaration on
PHC (1978)

• VII " PHC relies, at local and referral
  levels, on health workers, including physicians,
  nurses, midwives, auxiliaries and community
  workers as applicable, as well as traditional
  practitioners as needed, suitably trained
  socially and technically to work as a
• health team
• and to respond to the expressed health
  needs of the community"
• renovated in
  the
• 2008 WHR "PHC Now more than ever"

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Through PHC to attain the MDG 5B "Universal
Access to RH"
Through SRH care provided within Primary Health
Care systems Within PHC it is possible to make
Reproductive Health services accessible to the
people in greatest need SRH services, if
properly provided, promotes and fulfils the human
rights of the users the best contribution to
achieving the international goals
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Why define SRH competencies for PHC?

• Because SRH is the core of the renovated PHC
  within a well functioning health system
• To have a definition of the basic knowledge,
  skills and attitude needed to provide high
  quality SRH care
• Lack, at the international level, of a
  comprehensive SRH competencies list, instrumental
  while improving the service, to reach MDG 5B

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Cont

• Support countries in the design or re-design of
  the SRH care provision within the context of PHC
• To have a basis/core list for development of
  discipline-based or programme-based sets of
  competencies, a basis for development of
  curricula which can be easily translated into
  learning objectives
• therefore
• support capacity building for health workforce
  for PHC

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PHC to meet the UNMET NEED for SRH and DEFICIT in
PROVIDERS

• High maternal mortality
• HIV epidemic,
• Large unmet need in family planning,
• High sexually transmitted infection prevalence,

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Focus of the questionnaire

• Job positions
• Training - Community Health Workers
• (CHWs) and Midwives
• Where services are delivered
• Service provision in 7 technical areas

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Seven Technical Areas

• Ante-natal
• Childbirth
• Newborn
• Family planning and infertility
• Abortion,
• STI-RTI (including HIV and VCT), as well as
  Screening for sexual violence and cancers
• Sexual health education and counselling.

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Distribution and responses by WHO Regions

• 
  To COs filled
• RO for Africa
  37 25
• RO for the Americas 13
  9
• RO for Europe
  9 7
• RO for South East Asia 8
  8
• RO for the Western Pacific 9
  9
• RO for the Eastern Mediterranean 21
  9
• TOTAL
  97 69 (n 67)

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Overall FP and infertility services by different
providers by Regions
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Overall provision of ANC services by different
providers by Regions
13
Overall Childbirth and immediate Post Partum
services by different providers by Regions
14
Selected Sexual and Reproductive Tract Infection
services by different providers by Regions
1 - Management of symptomatic STI/RTIs by
syndromic approach 2 - Screening for or
detection of rape and other forms of sexual
violence 3 - Screening for
cancer of cervix using VIA / Pap. Smear.
15
Health education and counselling on sexuality and
reproductive health for adolescents
16
Overall newborn services by different providers
by Regions
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Some key findings

• Who is providing SRH services?
• SRH services in general are provided by non
  professional and professional
• Doctors and midwives seems to have similar roles
  in prevention and education activities
• Nurses have an important role in all the regions
  in providing SRH services
• Midwives have a bigger role in VCT,HIV prevention
  and PMTCT
• Doctors in general seems to have more prominent
  role in technical activities

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Some key findings

• Where the services are delivered ?
• CHW DTD are more involved in service provision in
  WPRO, EMRO, SEARO and AFRO
• CHW are providing services in the Health posts in
  27 of the countries
• 88 of the countries health professional in
  Health Centres offer SRH services

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Some key findings

• Length of training
• 18 to 36 months for midwives seems to be the
  optimum to provide most SRH services
• More than 70 of the countries provide more than
  2 weeks of training for CHW
• But 50 of SEARO, 40 EMRO and 28WPRO receive
  only 1 week training

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Some discussion points

• The important role of Nurses in delivering SRH
  should be taken in consideration when planning
  for SRH competency based training, job
  description
• The important role of CHW in SRH care calls for
  proper harmonization of training modules and
  curricula to be developed and applied where
  needed
• A team approach seems to be the most appropriate
  to face all the challenges that have to be faced
  to provide SRH at PHC level

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Thank you!Grazie!
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Some results Delivery points of SRH in PHC

• 
  

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Duration of CHWs training by WHO Regions
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Duration of midwifery training by WHO Region
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CHW and Midwifery activities rate by duration of
training
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Specific Abortion services by different
providers by Regions
1- Post abortion care 2- Surgical
method of abortion 3 -
Medical abortion