The 2030 Agenda for Sustainable Development: Family Planning

This article was exclusively written for The European Sting by Ms. Sadia Khalid, early-stage researcher (ESRs) at Tallinn University of Technology (TalTech), Estonia. She is affiliated with the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writers and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

By 2030, the Sustainable Development Goals (SDGs) aim to ensure universal access to sexual and reproductive health-care services which will include effective family planning, information, and education (CSE), and the integration of reproductive health into national strategies and programs.
Globally to meet this goal, countries need to commit to providing universal access to reproductive health by 2030. Living up to this commitment will require monitoring of key family planning indicators which in turn will assure 75% of the global demand for contraception by 2030. To attain the highest standard of sexual and reproductive health, states and national programs will need to bring together many challenging elements such as social and behaviour change, women’s and girl’s empowerment, gender and rights perspective, gender equality, commodities, and quality health service provision by adequately trained health providers.

The focus of this article is to discuss the key policy and program actions on optimizing the health workforce for effective family planning services.

Contraception is an affordable intervention, but access to effective contraceptive methods has been limited in many settings due to policies restricting the roles of mid and lower-level cadres and health workforce scantiness. Human resource shortages in the health sector pose a major threat to the attainment of health-related Sustainable Development Goals (SDGs). COVID-19 pandemic prompted healthcare staff storage and maintaining appropriate staffing in healthcare facilities is essential to providing a safe working environment for healthcare personnel (HCP) and safe patient care-seeking sexual health and family planning services.

In many countries, the lack and unavailability of properly trained health providers are concerning as youth and women living in remote or hard-to-reach areas may suffer the most as a result. The staffing shortage problem can be mitigated using contingency capacity strategies to plan and prepare for the anticipated problem. Contraceptive methods and Comprehensive sexual education (SCE) services can be allocated to other health worker cadres (task shifting) along with changes such as adjusting staff schedules, hiring additional HCP, and rotating HCP to positions that support educational, research, and awareness activities. The number of skilled health workers trained and allowed to provide family planning services can be increased by implementing sound international and national strategies to provide services in underserved areas and population groups. Furthermore, special attention should be given to the strengthening of public-private partnerships.

For optimal performance of the public health care system, capacity building of health workers in the non-government sectors is also critical along with rapidly transferable skills across the health system. In dire need, shifting HCP who work in the relevant areas to youth education and sexual health counselling centres to support other activities in the facility can significantly improve access to contraception for all individuals and couples. Ensuring these HCP appropriate orientation and training prior to transfer to new facilities in the areas that are new to them should be mandatory. These community health workers responsible for providing family planning services should receive appropriate recognition, support, and remuneration. During the preparation of the task-shifting force for family planning counselling and services, the adaptation of WHO guidelines should be adapted to the local context. The family planning program, staff training, and task shifting in any country should be carried out by an extensive organizational network at the national, provincial, and local government levels. In developing and implementing locally appropriate task shifting/ sharing, a set of technical resources adapted to the local context should be developed for dissemination and implementation. This package must include new and existing job aids, counselling tools, information sheets, sample training packages, and post-training support.

To provide quality family services, facilities should cooperate with a systematic approach to standardized, competency-based training with adequate supervision and monitoring, and clear protocols for referrals for these health workers. Facilities providing family planning services should carry out regularly recommended research actions including scrupulous studies to evaluate the cost-effectiveness of programs of various cadres and studies determining the safety and effectiveness of the procedures such as IUD insertion and removal, and male and female sterilization procedures when carried out by auxiliary nurses, nurses, or midwives. where it’s essential to also evaluate the policy and programmatic considerations of the emergency contraception services provided by other task-sharing cadres.

Many countries enabled and utilized mid-and lower-level cadres of health workers to deliver the contraception and sexual health education services either alone or as part of teams within communities and/or health care facilities have successfully established access to universal safe contraception. Undoubtedly the universal safe contraception cannot be achieved without social science and implementation research which allows not only healthcare providers but the public to understand the challenges, the dynamics, and organization of health systems and contraceptive services delivery and their role as an active participant to strengthen the healthcare system.

Reproductive health is a public health issue with far-reaching social and economic impacts.
Once and for all, it is wise to now consider this area through an optic of public health and understand its influences on reproductive welfare. It is time to move beyond the old medical model of simply providing contraception and reacting to reproductive symptoms.

Notes:
Guidance and further reading
1. https://www.un.org/en/development/desa/population/publications/pdf/family/familyPlanning_DataBooklet_2019.pdf
2. http://www.fptraining.org
3. Task sharing to improve access to Family Planning / Contraception
http://apps.who.int/iris/bitstream/handle/10665/259633/WHO-RHR-17.20-eng.pdf?sequence=1
4. http://www.optimizemnh.org/Annexes/Annex_8_Contextualizing_Workbook.pdf

Additional information:
Conflict of interest: None.
References:
WHO recommendations: OptimizeMNH: optimizing health worker roles to improve access to key maternal and newborn health interventions through task shifting. Geneva: World Health Organization; 2012 (http:// http://www.optimizemnh.org/, accessed 12 June 2015).

About the author
Sadia Khalid, early-stage researcher (ESRs) at Tallinn University of Technology (TalTech), Estonia. She has been working on her PhD research project  “The role of Helicobacter pylori intestinal microbiota in the development of liver diseases. under supervision of Dr. Pirjo Spuul at Faculty of Science, Institute of Chemistry and Biotechnology.,TalTech. Previously, she has worked as a research specialist in the institute of biomedicine and translational medicine, University of Tartu (UT), Estonia. She obtained her MD in emergency medicine in 2017 from the Dalian Medical university, China and MBChB in 2013 from the Weifang Medical university, China. Her current research interests include infectious diseases, bacteriology, hepatology, and gastroenterology.