Strengthening systems to provide long-acting reversible contraceptives (LARCs) in public sector health facilities in Uganda and Zambia: Program results and learnings.

INTRODUCTION: In Uganda and Zambia, both supply- and demand-side factors hamper availability of long-acting reversible contraceptives (LARCs), including implants and intrauterine devices (IUDs), at public sector facilities. This paper discusses results of a program aimed at increasing access to and uptake of LARC services in public sector facilities through capacity building of government health workers, strengthening government supply chains, and client mobilization. METHODS: From 2018-2021, the Ministries of Health (MOHs) in Uganda and Zambia and Clinton Health Access Initiative (CHAI) worked to increase readiness to provide LARC services within 51 focal facilities in Uganda and 85 focal facilities in Zambia. Annual facility assessments of LARC-related resources were conducted and routine service delivery data were monitored. RESULTS: At baseline, few focal facilities had supplies and skilled staff to provide LARC services. At endline, over 90% of focal facilities in both countries had a provider trained to provide both implants and IUDs and 55% had the commodities and equipment needed for implant provision. In Uganda and Zambia, respectively, 65% and 38% of focal facilities had commodities and equipment for IUD provision at endline. Both programs observed significant increases in the number of implants provided at focal facilities; in Uganda implant volumes increased five-fold from 4,560 at baseline to 23,463 at endline, and in Zambia implant volumes increased nearly four-fold from 1,884 at baseline to 7,394 at endline. Uganda did not observe growth in IUD volumes, whereas Zambia observed significantly increased IUD service volumes from 251 at baseline to 3,866 at endline. CONCLUSIONS: Public sector facilities can be rapidly and sustainably capacitated to provide LARCs when both catalytic and systems strengthening interventions are deployed for health worker capacity building, supply chain management, and community mobilization to ensure client flow. Investments should be intentionally sequenced and coordinated to generate a virtuous cycle that enables continued LARC service provision.

Case Study: Using Task Analysis to Determine the Status of Education and Practice of Medical Licentiates for the Provision of Anesthesia in Zambia.

Task analysis methodology was used to identify gaps in the education and practice of Medical Licentiates, a cadre of primary care health providers in Zambia, related to the provision of anesthesia. Findings of the analysis indicate that Medical Licentiates who work in facilities where there are no fully qualified anesthesiologists or physicians often feel obligated to provide these services in order to save lives although they lack sufficient formal education or clinical practice opportunities. The government translated the findings into immediate modifications to the education, training and practice of anesthetic tasks by Medical Licentiates by developing an elective course within the pre-service education program and upgrading the certification of Medical Licentiates to a bachelor's degree.