Rapport de la réunion régionale sur le DIUPP a Ouagadougou

The meeting was organized by USAID/Jhpiego, MCHIP, and PSI Washington. The meeting brought together facilitators from Jhpiego, MCHIP, and PSI, as well as representatives from 12 countries: Mali, Togo, Burkina Faso, Niger, Madagascar, Guinea Conakry, Côte d'Ivoire, Democratic Republic of Congo, Cameroon, Haiti, and Mauritania. The meeting began with an address by the representative of the Minister of Health of Burkina Faso, followed by presentations from the representative of the World Health Organization (WHO), USAID, and PSI Washington. The first presentation focused on the scientific evidence on family planning in the postpartum period, highlighting the concept of PEIGS, which suggests that a woman should wait 18 years before her first pregnancy and that family planning can reduce maternal and infant mortality by 32% and 10%, respectively. The second presentation discussed the strategy for programming family planning in the postpartum period, including an outline of the key points of contact for determining programming, such as prenatal care, labor and delivery, postnatal care, and vaccination services for newborns. The third presentation focused on the DIUPP at the intersection of family planning and maternal health, highlighting four key points: women are exposed to the risk of unwanted pregnancies in the postpartum period, the offer of services must be made by healthcare providers, the DIU is a safe and effective method of family planning in the postpartum period, and healthcare providers must change their perspective on the DIUPP to achieve this. The meeting included a visit to sites in Kossodo, ABBEF, and CHU Yalgado Ouedrago to gain insight into the implementation of the DIUPP, discuss service organization, client flow, and verify materials. A plenary session was held to present the findings of the site visits, highlighting what impressed the participants and what lessons can be applied to each country's implementation of the DIUPP. A matrix on scaling up the DIUPP was completed by each country, with a score of 4 being retained for Mali. The experience of Burkina Faso on the DIUPP, which began in March 2013, was shared, with 50 healthcare providers receiving training on counseling and 30 on the insertion of the DIUPP. The largest number of insertions was recorded in hospitals and CHU. The second day of the meeting began with a film projection on the insertion of the DIUPP, highlighting the availability of necessary materials and the importance of confirming eligibility before insertion. The three essential questions to ask clients before insertion were also discussed: rupture of membranes for more than 18 hours, fever above 37.5, and unresolved hemorrhage. The elements of post-insertion counseling were also presented, including signs of danger, such as fever associated with nausea and vomiting, significant bleeding, and abdominal pain. The experience of inserting the DIUPP with a larger and more complex inserter than the one provided in the DIU T Cuivre 380A package, which is being experimented with by PSI, was also presented. To reinforce the knowledge and skills of participants, five demonstration stands on the insertion of the DIUPP were set up, with four stations for Jhpiego and one for PSI, allowing participants to simulate the insertion and inquire about the experience of MCHIP and PSI on the ground. The organization of the offer of DIUPP services was also discussed, with the experience of Guinea Conakry being presented, which showed that from April 2011 to September 2013, services were offered in 32 sites, with 293 healthcare providers trained in counseling for family planning in the postpartum period, 85 trained in the DIUPP, and 17 national and regional trainers trained. A total of 2,882 women received the DIUPP, representing 4% of births. A lesson learned from the experience of Guinea Conakry was the importance of coupling the training of the DIUPP with SONU to facilitate the effective integration of services. A first panel was held with representatives from Guinea, the Democratic Republic of Congo, Mali (PSI, MCHIP), and a representative from Jhpiego to answer questions from participants on the implementation of DIUPP activities in the context of each country. The discussions focused on the following points during the second panel: Madagascar, choosing a healthcare structure and orienting sites; Mali, engaging stakeholders and advocacy; Guinea, continuity of care. A rotation was made by participants around five stations to discuss the following themes: criteria for selecting sites, engagement of stakeholders and advocacy, informed choice, monitoring and information systems, and continuity of care. A recap of the activities was made to better fix the ideas retained. The third day of the meeting began with a plenary session on