Table 1 Summary of the interventions in FP and PNC sites

Pre-existing standard services

·Counselling & provision of FP methods

·Timing: Usually delivered on discharge if hospital delivery, with 6 week check:

·Dual protection counselling

·Content:

·Screening of STIs

·Immunisation

·HIV prevention counselling

·Growth monitoring/child welfare

·Counselling on sex & sexuality, childbearing and PMTCT.

·FP at six weeks postpartum (on request from mother)

·Refer FP clients for STI treatment/ syndromic management

(NB: this is what should happen according to the guidelines but rarely does at facility level)

·Refer FP clients for HIV counseling and testing

(NB: this is what should happen according to the guidelines but rarely does at facility level)

Strengthened or additional services introduced

·All clients receive strengthened Standard FP services using the Balanced Counseling Strategy Plus. This includes:

·Timing: within 48 hours of delivery, plus 7 day, and 6 week visit at facility

·Discussion of fertility desires,

·Content:

·Offering a range of FP methods

·Mother and baby physical examination to detect danger signs, complications, anomalies

·Ensuring suitability of FP methods

·Infant feeding counseling

·Condom promotion/provision

·Postpartum FP counseling and provision

·STI and HIV risk assessment

·Screening for cervical cancer (at 6 weeks)

·Check client HIV status

·HIV counselling & testing (mother and baby)

·HIV counseling and testing

·HIV treatment prophylaxis for

·Screening for cancer of cervix (via /vili)

·mother and baby

STI screening and management Arrange follow up appointments

Neonatal male circumcision (Swaziland only)

HIV negative clients Health promotion Risk factor exposure Risk assessment (routine) for STI/HIV

HIV positive clients Counseling on HIV care and treatment available Manages clients with CD4 count >350 CTX prophylaxis Referred to lab/ART unit for blood tests

Adaptation/ strengthening of protocols, guidelines and training materials

·Development, adaptation or updating of guidelines and protocols (where necessary) based on national guidelines and manuals

·Mentoring toolkit developed - includes trainers guide, log book for mentees, checklist

·Balanced Counseling Strategy Plus second edition adapted to include cervical cancer screening and postpartum car

Staff training & management

·Development of an appropriate training and monitoring/ supervisory package which was grounded on the mentorship methodology and used the Balanced Counselling Strategy Plus (BCS+) toolkit

·Facilitative supervision comprising initially of bi-monthly and later quarterly visits by supervisory teams from the Ministries of Health and Population Council

·Training on technical skills for provision of long acting FP methods (IUDs and implants)

·Training on HIV counseling and testing, conseling on HIV services available, ARV refills, screening for STIs and syndromic management of STIs

Organizational change and role clarification

·Organizational change of how services are provided (rooms identified for integrated services, partitions built to create more rooms and staff reallocated

·Role clarification with all staff - task oriented work changed to provision of services according to client need

Equipment & supplies

·Ensuring availability of minimum levels of equipment and supplies (e.g., implant/IUD insertion kits, blood pressure machines and stethoscopes) required for providing integrated services

Communication aids

·Improving the availability of information, education and communication/behavioral counseling and communication (IEC/BCC) materials. All IEC materials pertaining to FP/HIV and PNC/HIV reviewed and adapted to reflect provision of integrated services

Referral systems

·Strengthened referral system between SRH clinics and ART centres (introduction of new referral forms (Kenya only)

Data collection and management

·Strengthening data collection and recording systems through the development of data capture tools, (e.g., PNC registers and monthly data monitoring forms)