Phase III: Supporting the Demonstration

In order to support a successful program with potential for scale-up and sustainability, the pilot focused on enhancing supervision, promoting cost-share and building and maintaining community support and awareness for PAC services.

Follow-up and post-training support to providers is also necessary to ensure high­quality PAC services. Providers might need help incorporating elements of PAC into their ongoing range of services or might need assistance in reorganizing services. Establishing a viable supervision and support system for the trained nurse-midwives presented a challenge as their formal supervisors, DPHNs, were overworked with public sector responsibilities and  often faced logistical problems, such as not  having enough fuel to drive to the nurse-midwives' facilities. Furthermore, PRIME did not have adequate staffing to provide sufficient post-training support. To supplement efforts by the DPHNs and visits from PRIME staff, nurse-midwives were encouraged to support one another as peers  and to build, strengthen, and expand their own provider peer networks, or clusters, to help solve problems, share  information and pool resources.

As mentioned earlier, providers shared the cost of their training. While providers participating in the pilot program received MVA kits free of charge, private nurse-midwives later purchased MVA kits at a subsidized rate (about one-fifth of the market price) from Ipas’ in-country distributor. Cost-sharing also occurred with implant training, with nurse-midwives paying a tuition fee to the training organization and PRIME and NNAK facilitating the process of selecting appropriate training candidates.

During the pilot program and scale-up, the POLICY Project conducted community advocacy to promote PAC services as a means of addressing the problem of death and disability from unsafe abortions. Extra effort on community outreach for PAC was made in conjunction with the training of providers during scale-up.

Phase IV: Going to Scale with Successful Change Efforts