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A Community Rallies against Female Genital Cutting

A PRIME II-assisted program in Ethiopia has made encouraging strides against female genital cutting (FGC) in Jijiga, a city located in the Somali region, which has a very high prevalence of the harmful traditional practice. Surveys show that as many as 80% of Ethiopian women have undergone FGC.

In May, the Ethiopian News Agency reported that Mrs. Aisha Ismail, a circumciser in Jijiga for 31 years, had decided to stop practicing FGC after participating in a workshop organized by PRIME II, the National Committee on Traditional Practices of Ethiopia (NCTPE) and the Somali Region Women’s Affairs Bureau, in collaboration with the Ministry of Health.

While Mrs. Ismail’s change of heart is especially compelling, efforts to permanently alter an ingrained cultural belief system like FGC must involve entire communities. With Mrs. Ismail enlisted as one of the teachers, the community mobilization component of the program in Jijiga began with the training of 100 community members to be advocates against FGC. This community group chose 20 representatives—including fathers, mothers, and adolescent boys and girls—to draft an anti-FGC rule for their community. Declaring that FGC is prohibited by both Islam and Christianity, and is a violation of human rights and especially women’s rights, the rule proscribes criminal and financial penalties on families who force FGC on their daughters.

Community mobilization activities in Jijiga included a music and drama show that drew more than 300 spectators, a demonstration with banners, and distribution of 1,000 copies of the community-derived anti-FGC rule. The imams of the city’s 13 mosques delivered anti-FGC speeches at Friday prayers on May 21, and community leaders also agreed that infibulation (removal of the clitoris, partial or total removal of the labia minora, and stitching together of the labia majora) is a crime and that less severe forms of FGC are also unnecessary and have nothing to do with religion.

Launched in December 2003, the program is working in the regions of Somali, Oromia and Harari to educate communities about the harmful effects of FGC on reproductive health. In addition to building community mobilization teams, PRIME and partners are working to understand the motives of “FGC demanders” and guide them toward information-based anti-FGC decisions, and link FGC knowledge to health, gender, human rights and religious issues.


PRIME II at Global Health Council 2004

Five presenters from the PRIME II Project are featured at the 2004 annual conference of the Global Health Council, which focuses this year on the health needs and issues of the world’s burgeoning population of young people. The conference, “Youth & Health: Generation on the Edge,” takes place in Washington, D.C. from June 1-4.

Strengthening Condom Use among Adolescent Female Sex Workers
Friday, June 4, 10:30-12:30 (Panel, Regency Ballroom)

PRIME’s activities in the Philippines to increase condom use among adolescents who engage in risky sexual behavior are presented by Linda Bruce. Bruce is Senior Program Officer for PRIME partner PATH, which has been working in the Philippines to foster safer reproductive health behavior among high-risk groups through the USAID-funded AIDS Surveillance and Education Program (ASEP). With ASEP partners, PRIME helped to improve adolescent access to family planning information and services by focusing on two cadres of non-traditional providers, community health outreach workers and peer educators. The year-long intervention produced encouraging gains in reported condom use and adolescents’ seeking appropriate treatment for sexually transmitted infections and HIV. Bruce’s presentation is part of the panel “Getting the Message Out: Adapting HIV Education and Local Needs.”

A Community Model for Postabortion Care in Senegal
Friday, June 4, 10:30-12:30 (Panel, Palladian Ballroom)

The panel “Strategies to Address the Consequences of Unsafe Abortion and Prevent Unintended Pregnancies” includes Richard F. Mason, Jr., Monitoring and Evaluation Specialist for IntraHealth International/PRIME II. Mason will present PRIME’s approach to expand postabortion care services to rural communities in Senegal. The model relies on high-quality family planning services to help prevent unintended pregnancies and repeat abortion, meshed with fully functional referral and counter-referral systems among rural health huts and health posts and the district health center where women can receive treatment for complications from unsafe or incomplete abortion. The model’s referral systems and community mobilization components have been effective, increasing both the number of postabortion women successfully treated through the health posts and the number of postabortion women leaving health posts with a family planning method.

Primary Providers and Integration of Family Planning/HIV Prevention
Wednesday, June 2, 2-3:30 (Roundtable 21, Ambassador Room)

Christopher Kigongo, HIV/AIDS Clinical Specialist for IntraHealth and PRIME II, will discuss PRIME’s strategies for integrating HIV prevention into primary-level family planning counseling and services. Under the overarching Performance Improvement approach, these efforts have concentrated on setting clear performance expectations for primary providers based on national standards and increasing provider motivation to integrate HIV/AIDS prevention into family planning visits. An expanded role for primary providers—including the involvement of a broad range of community health workers and other non-traditional providers—is essential in the battle to contain and manage the HIV pandemic in high-prevalence countries and prevent its spread in countries with rising rates or risk.

Young Mothers’ Clubs Educate Salvadorans about Reproductive Health
Wednesday, June 2, 5:30-7 (Poster #49, Exhibition Hall)

Two PRIME projects will be highlighted during the conference’s Poster Session and Welcome Reception on June 2. PRIME’s work to build awareness among providers and clients to improve adolescent reproductive health in three departments of El Salvador with high rates of adolescent pregnancy is presented by Sara Lewis Espada, Acting Director of the Field Operations Unit for IntraHealth and PRIME. As part of the effort to encourage healthier reproductive health behaviors among young Salvadorans, PRIME helped create clubs at the three departmental hospitals in which pregnant adolescents participate in reproductive health discussions combined with practical activities such as knitting clothes for their babies.

Linking Provider Performance with Community Mobilization for Maternal Health
Wednesday, June 2, 5:30-7 (Poster #69, Exhibition Hall)

Richard F. Mason, Jr. will present the results of a PRIME intervention to bridge communities, traditional birth attendants and health facilities to address low maternal health coverage and high maternal mortality rates in the Jinotega region of Nicaragua. Adolescents account for a disproportionate amount of morbidity and mortality in this area of the country. In addition to training primary providers in community-based life-saving skills and hospital providers in emergency obstetric care, the project helped to establish community maternal health committees, emergency fund pools, and transportation and referral plans. Improvements in provider performance have been matched by community efforts to ensure women are able to receive the services they need.

Plan to visit the PRIME II Project at booth #211 in the conference’s Exhibition Hall. Presentation support materials and other Project information and resources will be available.


Final Evaluation Lauds PRIME II

An evaluation published by the Population Technical Assistance Project (POPTECH) finds the PRIME II Project “unusually productive, innovative and promising.”

Underscoring the importance of PRIME’s focus on primary providers of family planning and reproductive health services, the evaluation highlights the benefits of the Project’s Performance Improvement approach for strengthening service delivery:

“In many cases the primary provider is the only health worker a woman and her children will see in a lifetime. The work of the primary provider is critical to the overall health and well-being of a population... PRIME II has proven that performance improvement is a successful way to ensure that providers are well trained, have the environment needed to perform their work, and are mentored. There is also a clear benefit on the number of clients reached for services and their satisfaction with the services they receive.”

The evaluation notes PRIME’s accomplishments in developing national policies, protocols and standards; improving management systems that support primary providers; building sustainable training capacity; implementing blended and self-paced learning approaches; and increasing client satisfaction and service quality by incorporating consumer perspectives on quality. In addition to Performance Improvement, PRIME’s approaches to monitoring and evaluation (“truly exceptional”) and global partnership (“a standard for future partnerships”) are singled out as models worth replicating in other projects.

Conducted in October 2003, the evaluation assesses PRIME’s performance during the first four years of the five-year project, and provides guidance to the United States Agency for International Development (USAID) for designing future projects. The evaluation team reviewed key project documents, solicited feedback from the 26 countries where PRIME has worked, and visited PRIME programs in Ghana, Bangladesh, Armenia and Paraguay.

The full report, Evaluation of PRIME II, is available on the POPTECH website.


IntraHealth Leadership Transition

Dr. William H. Jansen II has announced plans to step down as president of IntraHealth International, a nonprofit organization dedicated to improving reproductive health care in developing countries.

During the past six years at IntraHealth and the University of North Carolina School of Medicine, Jansen directed the implementation of the $88 million PRIME II Project award from the U.S. Agency for International Development. PRIME has significantly improved the quality, access and use of reproductive health services around the world. Jansen was named President when IntraHealth became an independent nonprofit corporation in July 2003. Prior to his work with IntraHealth, Jansen’s 26-year career in international health included two decades living and working overseas. As a Foreign Service Officer, he designed and managed programs to improve health care services in Morocco, Jordan, Pakistan, Bangladesh and the Philippines.

IntraHealth’s board of directors has asked Pape Gaye to serve as Acting President. Gaye brings to this position 25 years of experience managing health care programs in the developing world, most recently as Regional Director of IntraHealth’s West and Central Africa office in Dakar and as Senior Vice President.

“We all appreciate Bill’s leadership of both a very successful project and the IntraHealth transition to an independent nonprofit organization, and we wish him the best,” said Gaye. “Our dedicated team will carry on, building on the successes of the PRIME II Project. I am looking forward to continuing and expanding our important work in international health.”


Maureen Corbett Named Champion of Reproductive Health

Maureen Corbett, Senior Reproductive Health Program Specialist at IntraHealth International and the PRIME II Project, has been recognized by Ipas as a Champion of Reproductive Health. Corbett was honored November 17 during the American Public Health Association’s annual meeting in San Francisco. Ipas, a North Carolina-based international organization dedicated to protecting women’s health and advancing women’s reproductive rights, is celebrating its 30th anniversary.

Much of Corbett’s work has been dedicated to developing and implementing programs in postabortion care (PAC) that treat women suffering from potentially life-threatening complications and prevent future unintended pregnancies through family planning counseling and services. Corbett has been instrumental in shaping PRIME II’s programs to scale-up PAC services by private-sector nurse-midwives in Kenya, to design a community-based approach for PAC in rural Senegal, and to improve postabortion family planning services in Kyrgyzstan, Haiti and Uganda. A leader of the PAC Consortium Community Task Force, Corbett helped to develop an updated model for PAC, as documented in an article she co-authored with Ipas’ Katherine L. Turner in the September 2003 edition of International Family Planning Perspectives.

“In recognizing Maureen, we honor one of the people who stands behind successful in-country programs and creates the institutional support and framework for these programs to flourish and serve the reproductive health and rights of women,” remarked Ipas Executive Vice President Barbara Crane. “Maureen has given meaning and content to terms that others use loosely, such as ’community-based’ and ’women-centered’ care.” Crane presented Corbett with a certificate citing “outstanding leadership in programs to save women’s lives through expanding access to postabortion care.”

When asked what she considers her principal accomplishments on behalf of women’s health, Corbett cited the importance of working on the frontlines of health care: “For those of us who promote and advocate for primary providers, our accomplishments are really about theirs. I feel honored to work with them because they make a difference in the lives of so many women and their families. One key accomplishment—interwoven with the work of many others in the US and around the globe—is that many more primary providers of health care around the world now offer postabortion care and other reproductive health services. More women and adolescent girls have access to these services, and are using them.”


Exciting PRIME II Events at APHA

Seven presentations from the PRIME II Project will be featured at the 131st annual meeting of the American Public Health Association, November 15-19 in San Francisco. The theme of this year’s conference, “Behavior, Lifestyle and Social Determinants of Health”links with PRIME’s global efforts to reach more people with critical family planning and reproductive health services and counseling. The Project builds the capacity of a wide range of primary providers in 25 countries around the world. The PRIME II presentations include:

Mobilized for quality: Community-provider partnerships foster increased use of reproductive health services in Rwanda (Margaret Rabb)
Poster session: Availability, Access and Quality of Global Reproductive Health Services, Nov. 17, 8:30 a.m.

Overcoming obstacles, increasing access and quality: A plan for family-friendly reproductive health care in Armenia (Leah Levin)
Panel: Global Exchange: Domestic and International Reproductive Health Programs, Nov. 17, 8:30 a.m.

Hear them and they will come: Community-provider dialogue improves services and increases clients at a Dominican clinic (Ann Lion Coleman)
Panel: Community Involvement, Nov. 17, 12:30 p.m.

Rising above the stigma: Promoting VCT and partner involvement for pregnant women in Rwanda (Pape Gaye)
Poster session: Bridging the Gap: Integrating Maternal and Child Health and Reproductive Health, Nov. 17, 12:30 p.m.

Measuring provider performance: Challenges in capturing behavior and accomplishments for evaluation of FP/RH programs (Alfredo Fort)
Panel: Revisiting Family Planning Management and Sustainability: New Ideas for the 21st Century, Nov. 17, 12:30 p.m.

Putting it in practice: Applied learning improves health promoter knowledge in the Dominican Republic (Margaret Rabb)
Poster session: Strengthening the Delivery of Reproductive Health: The Issue of Quality, Nov. 17, 12:30 p.m.

Encouraging postabortion family planning in the Kyrgyz Republic: New approaches to address client and provider barriers (Leah Levin)
Panel: Misoprostol, Abortion and Postabortion Care: Service Delivery Challenges and Innovations, Nov. 19, 2:30 p.m.

Visit the PRIME II Project and IntraHealth International at Booth No. 330 in the Exhibition Hall!


Hareg Project to Fight HIV/AIDS in Ethiopia

At a ceremony in Addis Ababa on September 8, Aurelia E. Brazeal, the U.S. ambassador, and Ato Alemayehu Seifu, head of the Disease Prevention and Control Department at the Ethiopian Ministry of Health, officially launched the Hareg Project, the presidential International Mother and Child HIV Prevention Initiative in this country of 65 million people. The PRIME II Project is serving as overall coordinator of project activities for the United States Agency for International Development (USAID) and the Centers for Disease Control, who will collaborate with UNICEF, the Ministry of Health and Ethiopia’s HIV/AIDS Prevention Control Office (HAPCO).

Hareg, or “vine” in Amharic, represents the intergenerational links that are critical in the fight against HIV/AIDS. According to the Ministry of Health, an estimated 200,000 children are infected with HIV in Ethiopia; more than 90% of HIV/AIDS infections in children are transmitted during pregnancy, delivery and breastfeeding.

The $5 million, five-year Hareg Project will implement a comprehensive strategy to develop Ethiopia’s capacity for prevention of mother-to-child transmission (PMTCT) of HIV. Building on existing PMTCT programs and targeting health facility-linked prenatal care as an entry point for women’s services, the initiative will expand PMTCT to 15 medical centers and their catchment sites, providing comprehensive care including nevirapine therapy to HIV-infected mothers and their infants.

In a country where two thirds of mothers have no access to prenatal care services, PRIME II and partners will use the Performance Improvement approach to integrate PMTCT services with broader efforts to improve safe motherhood. Priorities include strengthening family planning linkages with PMTCT and enhancing prenatal, intrapartum and postnatal care by including services such as voluntary HIV/AIDS counseling and testing, PMTCT, nutritional support and birth preparedness.

Other partners in the Hareg Project include PRIME II supporting institutions Save the Children and the American College of Nurse-Midwives, along with I-TECH, Management Sciences for Health/Rational Pharmaceutical Management Plus, the LINKAGES Project, JHPIEGO and Johns Hopkins University’s Center for Communication Programs (JHU/CCP).


PRIME II at Global Health Council: Improving health in the primary environment

Five presenters from the PRIME II Project are featured at the 2003 annual conference of the Global Health Council, to be held in Washington, D.C., from May 27-30. The presentations connect PRIME’s global efforts to improve primary-level family planning and reproductive health care services to the conference theme, “Health and the Environment.” Taking into account physical, economic and social factors, the meeting will explore ways in which environmental conditions contribute to many of the world’s health care problems and disparities.

A New Sense of Place: Community Mapping in the Dominican Republic’s Bateyes
Friday, May 30, 1:30-3 (Panel, Congressional Room B)

PRIME II’s work to encourage healthy behavior, prevent HIV/AIDS and increase access to family planning in the low-resource environment of the bateyes is presented by Laura Murray, Community Projects Manager for PRIME’s Latin America and the Caribbean regional office. Part of the panel “Enabling Environments: Foundations to Mobilize Against HIV/STIs,” the presentation focuses on PRIME’s intervention strategy to train volunteer health promoters in counseling, outreach education, referrals, community-based provision of family planning methods and HIV/STI prevention. Extensive baseline data collection activities included a community mapping and survey exercise. In isolated communities that had never been charted on paper, the maps assumed broad significance in unforeseen ways, providing a newfound sense of place and pride and reinforcing the notion of the bateyes as permanent settlements rather than migrant camps. Murray will discuss the ways in which the maps have been used and other results from the project, including increased use of modern contraception by women in the intervention areas.

Skilled Providers, More Clients: Implementing an Essential Service Package in Bangladesh
Thursday, May 29, 10:30-12 (Panel, Palladian Ballroom)

The panel “Strengthening Provider Skills for Child and Reproductive Health” features Dr. Shalini Shah, Regional Clinical Manager for PRIME II in Dhaka. Shah’s presentation details the results of PRIME’s assistance in improving the knowledge and skills of private-sector paramedics and doctors in maternal health, child survival interventions and STI prevention and treatment. Through a separate project, PRIME has also helped the government of Bangladesh implement the essential service package through a national in-service training program for public health care providers. This dual effort in the private and public sectors is geared to meet the diverse needs of communities in every part of the country, increasing the accessibility and quality of reproductive health and child survival services for many thousands of Bangladeshis.

Birth Spacers: An Underserved Population for Family Planning
Thursday, May 29, 3:30-5 (Roundtable 5, Empire Room)

PRIME II has three presentations scheduled for the conference’s roundtable sessions on May 29. William Jansen II, director of IntraHealth International, will discuss the findings of PRIME’s analysis of the relationship between demand and unmet need for family planning, desire to space or limit births, and other variables such as age and parity. Drawing on Demographic and Health Survey data from 15 developing countries in Asia, Latin America and Africa, the study uncovered large differences in the levels of met need for spacing and limiting among countries. This research has important implications for how providers are trained, and how they tailor messages to clients to best meet their needs.

Diagnosing the Pain of Provider Performance
Thursday, May 29, 3:30-5 (Roundtable 10, Palladian Ballroom)

Identifying the most critical environmental barriers to improving provider performance is the topic of a roundtable led by Lauren Voltero, PRIME II Performance Improvement Specialist. Voltero will present the results of a PRIME study conducted in Armenia to ascertain the relative importance of five performance factors—clear job expectations, feedback, motivation or incentives, environment and tools, and knowledge and skills—for primary-level reproductive health providers. Although all of these factors are necessary for optimal performance, small intervention budgets often require prioritization. Study results show how the five factors relate to each other, as well as to overall performance, and will help planners in low-resource environments allocate funding more effectively when multiple factors affect provider performance.

Private Nurse-Midwives: An Ideal Cadre for Community-Level Postabortion Care in Kenya
Thursday, May 29, 3:30-5 (Roundtable 12, Empire Room)

Richard Mason, PRIME II Monitoring and Evaluation Specialist, will present results from a 2002 evaluation showing that private-sector nurse-midwives are capable of providing quality postabortion care services and handling a wide variety of complications and emergencies. The high percentages of clients receiving family planning counseling and services reinforce the importance of linking postabortion care with family planning as a main prevention strategy to reduce unwanted pregnancies and unsafe abortion. The private-sector status of the nurse-midwives and their accessibility to underserved populations in urban, peri-urban and rural areas throughout Kenya hold great promise for overcoming the economic and physical challenges to establishing a national, financially sustainable base for primary-level postabortion care services.

Supportive Supervision for Auxiliary Nurse-Midwives in Uttar Pradesh, India
Wednesday, May 28, 5:30-7 (Poster #26, Exhibition Hall)

Maj-Britt Dohlie, Supportive Supervision Specialist, will be on hand at the conference poster session to comment and answer questions about PRIME II’s work to reinforce the knowledge and skills of an important cadre of primary providers in India. The poster presents results from a study showing that PRIME’s supportive supervision strategy has enhanced levels of support and problem-solving from supervisors, improved providers’ performance and attitudes, and increased attention to quality-related issues such as counseling and informed choice in family planning services. The strategy is part of PRIME’s technical assistance to a training program for the auxiliary nurse-midwives and their supervisors in Uttar Pradesh under the Innovations in Family Planning Services Project funded by USAID.

Plan to visit the PRIME II Project at booth #207 in the conference’s Exhibition Hall. All presentation support materials, as well as other Project information, will be available.


Laurie Noto Parker Takes the Helm of the PRIME II Project

With sixteen years of experience guiding international health programs, Laurie Noto Parker has arrived in Chapel Hill to lead the PRIME II Project. Recently returned from New Delhi where she managed CARE’s health, nutrition and population programs in India, Parker brings fresh energy to PRIME’s mission of improving the performance of primary providers in family planning and other reproductive health care around the world.

During her four years in India, Parker focused on reproductive health, HIV, empowering women and strengthening local governance. She worked closely with programs that build capacity at the community level. Parker draws critical skills and experiences in implementing health programs from her wide array of previous work, both in the US and in the developing world—as chief of the USAID Yemen mission’s Office of Health, Population and Nutrition in Sana’a, executive director of the Western North Carolina AIDS Project, Population Specialist with the South Pacific Alliance for Family Health based in Tonga, and manager of the Maternal Nutrition and Health Care program for the International Center for Research on Women in Washington, DC. Both in the South Pacific and in Yemen, Parker was a fellow with the International Population Fellowship Program from the University of Michigan School of Public Health.

Parker succeeds William Jansen II as leader of PRIME II, an $88 million, five-year global project funded through a cooperative agreement with the United States Agency for International Development (USAID). Jansen now serves as the director of IntraHealth International at the University of North Carolina at Chapel Hill. IntraHealth International implements the PRIME II Project with four partners, Abt Associates, EngenderHealth, Program for Appropriate Technology in Health (PATH), and Training Resources Group, Inc. (TRG) and two supporting institutions, Save the Children and the American College of Nurse-Midwives.

Laurie Parker worked with IntraHealth previously, coordinating special projects for PRIME I. She also earned a Masters degree from the UNC School of Public Health, graduating with honors. Parker states “I’m very pleased to join a project with proven results and such an excellent track record. Primary providers play a critical role in improving reproductive health, and I look forward to contributing to PRIME’s leadership in this area.” With the scope of her experience and the vitality of her leadership, PRIME welcomes her back home.


PRIME II in Action:
The Project Reviews Year Three

Highlights of results detailed in our November 2002 annual review show that the PRIME II Project’s activities have:

  • Linked more than half of 1,600 women treated for complications from unsafe or incomplete abortion in Kenya with family planning methods
  • Attracted nearly five times the clients to facilities with trained paramedics in Bangladesh and built the capacity of local training organizations for long-term sustainability
  • Adapted two excellent training approaches to the needs of volunteer community health promoters working in extremely poor and marginalized communities in the Dominican Republic
  • Established reliable unit cost data for starting and maintaining community-based health planning and services zones in Ghana
  • Counseled more than 2,000 prenatal women about voluntary HIV/AIDS testing, tested 86% of them, and treated 49 HIV-positive women and 57 infants with nevirapine in Rwanda
  • Quadrupled the percentage of women who accepted family planning methods six-weeks postpartum and who were prepared to deal with complications during delivery in 40 villages and hamlets of rural Uttar Pradesh, India
  • Doubled the number of clients attending a peri-urban family planning and reproductive health care clinic in the Dominican Republic, and tripled the number who pay for their services
  • Posted significantly improved skills among private-sector midwives in the scale-up of a self-directed learning program to strengthen counseling and interaction with adolescent clients in Ghana
  • Tutored primary providers in Benin, 94% of whom described the correct process of care after their training in new national family health protocols developed with PRIME II assistance
  • Enabled community-based health insurance prepayment schemes in Rwanda to strengthen links between primary providers and the communities they serve, with a focus on improving the accessibility and quality of services
  • Worked in Mali with the Ministry of Health and nongovernmental organizations to develop a national performance-based curriculum to eliminate female genital cutting by improving the counseling and interactive skills of primary providers
  • Facilitated two important regional events in West Africa (a conference on postabortion care and meetings on Maximizing Access and Quality), which generated action plans that country teams have already begun to implement.



PRIME II’s focus on primary-level family planning and reproductive health providers and the communities they serve relates closely to the theme of the 130th annual meeting of the American Public Health Association (APHA): “Putting the Public Back into Public Health.” Six presentations on PRIME’s work will be featured at the meeting, to be held November 9-13 in Philadelphia. You can visit the PRIME II Project at booth #109 in the APHA Public Health Exposition.

Exciting advances in the area of postabortion care (PAC) are emphasized in PRIME’s contributions to APHA 2002. Postabortion care is an approach for reducing morbidity and mortality from incomplete and unsafe abortion and resulting complications and for improving women’s sexual and reproductive health and lives. During the session “Postabortion Care: Meeting Clients’ Needs,” Richard F. Mason, Jr., Monitoring and Evaluation Specialist, will present “Family Planning and other RH services: What primary providers say about services needed by women they see for postabortion care.” Mason’s talk details the results of a PRIME special study on the third component of the Postabortion Care Consortium’s original model for PAC services: linkages between emergency treatment for abortion complications and other reproductive health services. Drawing on interviews with private-sector nurse-midwives who participated in a PRIME-assisted PAC training program in Kenya, the study answers, from the providers’ perspectives: Which other RH services should women be offered or referred for? When would they be most receptive to receive the service and where would they prefer to receive the service? What is the feasibility of a standard “package” of other RH services to be offered to women at the treatment visit, preferably at the same facility?

Building on ten years of experience with the original PAC model, the PAC Consortium endorsed an updated and expanded PAC model that includes community and service provider partnerships, counseling, treatment, contraceptive and family planning services, and reproductive and other health services as the five essential components of PAC. Maureen Corbett, PRIME II’s Senior Reproductive Health Program Specialist, will present “Essential elements of postabortion care: An expanded and updated model” during the session “Improving Postabortion Care Services.” For the session “New Developments in International Reproductive Health Programs,” Corbett and Katherine L. Turner, Training and Reproductive Health Specialist at Ipas, will also offer a poster presentation on the new model, “Essential elements of postabortion care: Expanding the model to reflect better public health practice.”

PRIME II’s grassroots approach to improving reproductive and maternal health knowledge and care-seeking behavior in underserved communities in the Dominican Republic is the focus of a poster presentation by Laura Murray, Manager of Community Projects for PRIME’s Latin America and the Caribbean office, and Jim McCaffery, Vice-President of PRIME partner Training Resources Group, Inc. “Heard it through the grapevine: Promoting community reproductive health in the Dominican Republic’s bateyes” covers PRIME’s comparison of training and learning approaches for volunteer community health promoters and use of radio to broadcast positive health messages. The poster is part of the session “Ethnicity, Culture and Health: Partnerships in the United States and Abroad.”

Increasing the quality and accessibility of family planning and reproductive health services for villages and hamlets in Uttar Pradesh, India, is the topic of the poster presentation “Most primary, most public: Expanding the role of auxiliary nurse-midwives.” The poster illustrates PRIME’s assistance to the USAID-funded Innovations in Family Planning Services Project to support supervision and referral linkages between auxiliary nurse-midwives, traditional birth attendants and indigenous practitioners. Jim McMahan, Area Program Manager for Asia and the Near East, will present the poster during the session “Reproductive Health Services: International Perspectives.”

“From providers to the people: Applying new protocols for better family health care in Benin,” an oral presentation by Shannon Salentine, Program Associate for West, Central and North Africa, describes PRIME’s assistance in creating a practical and replicable method of disseminating and applying Benin’s national family health protocols. PRIME had significant input in the development of the protocols, which are organized in three volumes covering women, common reproductive health services, and men, youth and children. Salentine will participate in the session “Service Delivery: International Perspectives.”

For the times and locations of PRIME II’s presentations, check the PRIME II at APHA poster or visit for the complete conference schedule.


Encouraging Results from Kenya

A USAID team evaluating the past two years of PRIME II’s postabortion care (PAC) program in Kenya reported their extremely positive results in Nairobi on May 30. Funded by USAID and sponsored by Kenya’s Ministry of Health, the program has trained private-sector nurse-midwives to provide PAC services since 1999. From rural marketplaces to teeming urban slums, these nurse-midwives work at the primary level, reaching Kenyan women closer to where they live and work. In the provinces of Nairobi, Rift Valley and Central, PAC services have now been established at 120 primary facilities, 20 more than originally planned. As of March, 1,603 clients served for complications from unsafe or incomplete abortion had been successfully treated, 93% by PRIME-trained nurse-midwives using manual vacuum aspiration.

Linking family planning counseling and services with PAC—to help women prevent an unwanted pregnancy or practice birth spacing—is an essential component of PRIME’s comprehensive approach. The evaluation found that 81% of the PAC clients had received counseling for family planning, with 56% accepting a contraceptive method. PAC clients also received counseling for STI/HIV prevention (73.6%), breast cancer (48%), cervical cancer (38%) and nutrition (50%). In addition to viewing PAC as an opportunity to offer women selected reproductive and other health services, PRIME is committed to establishing community support for PAC and encouraging partnerships between communities and the providers that serve them.

“The PAC training helped me to help the clients, and the community is very thankful, has really accepted the services and is very positive,” says nurse-midwife Herman Kiarie of the Kahuho Private Dispensary in Kiambu district. “I am very encouraged, and I feel I am doing something good.”

The program has been supported by the Nursing Council of Kenya, which licenses the private nurse-midwives, and the National Nursing Association of Kenya, a professional organization. Successful collaboration among PRIME II partners IntraHealth International, EngenderHealth and PATH, with global partner Ipas, has helped to make this a sustainable program for reducing maternal mortality and unmet need for family planning and improving reproductive health services in Kenya. Recommendations from the evaluation report will help shape PRIME’s scale-up of PAC during 2002-2003 in more Kenyan provinces in conjunction with USAID/Kenya’s AMKENI project.