By: Smita Gaith, Women Deliver
In 1998, Russia’s federal government withdrew funding for national family planning programs, leaving the task to municipal and regional governments. In response, USAID and John Snow Inc. stepped in to fund the Women and Infants’ Health [pdf] (WIN) pilot project from 1999 to 2003, followed by the scale-up phase called Maternal and Child Health Initiative (MCHI) from 2003 to 2006.
The goal of WIN was to provide a model of reproductive health care services that is evidence-based, and would increase access to and demand for the services. This was expected to increase preventative health behaviors within communities. Besides integrating family planning into the reproductive health care field, the WIN project also allowed for coverage and integration of several other reproductive health services, including promotion of evidence-based, family-focused, client-friendly antenatal care; maternity care; essential newborn care; support for exclusive breastfeeding; and family planning counseling and services, especially for postpartum and post-abortion clients.
The WIN project focused on two pilot regions, working with existing health care facilities, health care providers, and authorities to plan, make policies, provide hands-on training, and public education; the scale-up phase (MCHI) ultimately expanded to include 16 of Russia’s 89 regions, home to 26 million people (18% of Russia’s total population).
The WIN/MCHI strategy had seven crucial pillars, which ensured country support and ownership. By communicating to create a shared vision and best policies, the project gained the support of the Ministry of Health, gaining endorsement for policies and practices that went against existing ministerial orders. Incorporating a strong monitoring and evaluation system assured that client-derived data would inform project implementation and any changes that needed to be made. Using international standard evidence-based procedures required new training materials but created a team of well-versed trainers. These materials included monitoring and evaluation activities as well, developed from existing material by the World Health Organization (WHO), United Nations Population Fund (UNFPA), United Nations Children’s Fund (UNICEF), and other agencies. This training increased evidence-based practices and reduced unnecessary medical procedures, and ensured that family planning was included as part of other maternal and child health training courses. Creating supportive information, education, and communication/behavior change communication (IEC/BCC) materials increased demand for new, integrated services, and allowed for and encouraged healthy behaviors. Materials included posters, flipcharts, booklets, brochures, television and radio spots, and advocacy events, which informed and educated people.
The remaining three pillars: Developing a scale-up plan, planning for dissemination and replication, and continuing to innovate and anticipate next steps ensured that lessons learned always informed the next steps in scale-up, that strategies could be easily replicated in other regions or settings, and that the projects could continue to evolve in response to changing needs, such as HIV/AIDS prevention.
The impact of the program is evidence in itself that the WIN/MCHI projects were a success. Modern contraceptive use increased from 41% to 58% among women of reproductive age. More women reported discussing family planning with their health care providers, in antenatal, post-partum, and post-abortion care settings. Finally, abortions also decreased from 49.1 to 43.2 per 1000 women of reproductive age. Today, the project is a self-supported, locally-based, Russian NGO, further underscoring the project as a success.
For more information about the WIN/MCHI projects, please click here.
Flickr photograph via The Jewish Agency for Israel.