Point of care quality improvement approach increases immediate postpartum family planning uptake: A field report from Sululta district, Oromia, Ethiopia

Abstract

Abstract
Background: Globally, majority of postpartum women who want to avoid pregnancy within 2 years after delivery, do not use contraception Supported by USAID‟s Transform Primary Health Care Activity, quality improvement teams of service providers and facility administrators, implemented a project to improve the very low immediate postpartum family planning (IPPFP) uptake in four health centers of Sululta district, Oromia region. This paper presents the process, lessons, and effect of improving PPFP service uptake using the nationally adopted quality improvement models.
Methods: The quality improvement intervention was preceded by identifying quality improvement teams and sub-teams, conducted facility baseline self-assessment, and provided orientation and training to service providers on quality improvement approaches and tools. Afterwards, each health center conducted root cause analyses to identify and prioritize problems using the fish bone diagram, developed change ideas, and implemented them, monitored progress using run charts and repeated the process following the “plan, do, study and act” cycle.
Result: Improving immediate postpartum family planning uptake was prioritized and the proposed solutions were categorized into four packages of intervention: improvement in quality of counseling; on-the-job peer to peer skill transfer using a mentoring approach; timely request and refill of contraceptive commodities; and community mobilization for PPFP awareness and demand generation. The run chart showed positive trend in service uptake with the introduction of each stepwise intervention. Immediate PPFP service uptake increased by 21% in Derba, 41% in Chancho, 44% in Gorfo and 69% in Duber health centers.
Conclusion: The quality improvement implementation process created the opportunity for all health centers staff to appreciate broader system issues, identify gaps, use data to monitor progress and find feasible solutions tailored to their context. Most importantly, this quality improvement intervention can be expanded to similar health facilities in Ethiopia and the best practices can also be adopted to fit into different local contexts. [Ethiop. J. Health Dev. 2021;35(SI-5):27-36]
Key words: Immediate postpartum family planning, quality, Integration, Service