This is a summary of a series of country desk reviews conducted by John Snow International (JSI) to assess the environment for improving family planning (FP) programming in the Eastern European (EE) and Eurasian (EA) region. This United States (US) Agency for International Development (USAID)-funded activity explores general issues affecting FP programming in Albania, Azerbaijan, Georgia, Kyrgyzstan, and Tajikistan, and makes recommendations for potential action to increase utilisation of modern contraception and reduce reliance on induced abortion. JSI identified 10 FP policy and programme best practices based on the 2005 Pinar Senlet and Andrew Kantner report, "An Assessment of USAID Reproductive Health and Family Planning Activities in the Eastern European and Eurasian Region", as well as a current literature review and field interviews in selected countries participating in USAID's Europe and Eurasia Regional Family Planning Activity programme.

This process led to the following list of best practices, against which progress in each country was reviewed:

1. National health regulations require that FP counselling and services are readily available through a range of health professionals.

•  General findings: Donor support for health reform allowed the integration of FP into primary health care (PHC) services provided by family doctors (FD), general practitioners (GP), and, in some countries, by midwives and nurses. This liberalisation of FP service delivery significantly increased accessibility of FP services, especially in rural areas.

2. FP counselling, services, and contraceptives are part of the Basic Health Benefit Package. At the primary health care level contraceptives are provided to all women, regardless of ability to pay.

•  General findings: In most countries in the region, family planning is part of the national Basic Health Benefit Package and is provided free of charge. Some countries (e.g., Kyrgyzstan, Kazakhstan) include contraceptives in the essential drug list. Nevertheless, each country is at a different stage of implementing its PHC reforms, ranging from successful national implementation (Romania, Kyrgyzstan, Kazakhstan) to midpoint piloting (Georgia, Russia, Tajikistan, Ukraine) to national health reform planning and RH strategy development (Azerbaijan, Georgia).

3. Up-to-date and evidence-based policies, regulations, guidelines, standards, and supportive supervision (SS) systems are in place to ensure the quality of FP services at all levels of health care.

•  General findings: Most countries in the region have developed and endorsed evidence-based guidelines and protocols for FP. Several have implemented new national guidelines and protocols (Russia, Romania, Georgia, and Ukraine). However, to date, there are few or no mechanisms for monitoring adherence to the new FP service protocols or uniform evidence that service providers are fully aware of the new provisions. In most countries, the recently developed guidelines do not include protocols for postpartum and postabortion family planning service delivery, an area of particular importance given the high reliance on abortion in the region. Further, the existing health quality assurance procedures follow an outdated, punitive model. SS that involves and assists providers to improve the quality of health care services is not widely practiced.

4. A broad range of FP methods are available, accessible, affordable, and acceptable in both rural and urban areas.

• General findings: Modern contraceptive methods are widely available through private pharmaceutical networks, although mostly in urban areas and mostly affordable only to higher socioeconomic groups.

5. Programmes are in place that are designed to meet the needs of vulnerable groups such as adolescents, internally displaced persons (IDPs), new urban migrants, prostitutes, and the very economically poor.

• General findings: FP programmes, including free counselling, services, and contraceptive distribution, as well as information, education, and behaviour change interventions are widely implemented for vulnerable groups in all countries. However, in the majority of cases these programmes are donor-driven and have little or no financial participation from the local or national governments.

6. FP is part of pre- and in-service training programmes for health care providers.

•  General findings: Commitment of the health authorities to improving service provider education in FP is evident in many countries by incorporating the World Health Organization (WHO) recommendations and other state-of-the art evidence into in-service medical training curricula on a national level (Russia, Romania, Georgia, Kyrgyzstan), pilot regions (Ukraine, Tajikistan) and, in case of early stage of health reforms, as a clause in the national reproductive health (RH) strategy (Azerbaijan). In addition, in some countries existing regulations related to medical licensing require that every provider receive in-service training in FP through a continuing medical education programme (CME) and take a licensing exam every 5 years (Georgia, Kyrgyzstan). But in the region, pre-service FP teaching has many limitations - e.g., the teaching methodology relies mainly on lectures and provides little opportunity for interactive learning and supervised clinical practice.

7. Planning within the government is guided by a well-functioning Logistics Management Information System (LMIS) that enables targeting of subsidised contraceptives and efficient supply chain management of all contraceptive commodities throughout the country.

• General findings: Although several countries in the region have included contraceptives in their essential drug lists, only Romania and Albania budgets and procures contraceptives for its FP programme. Donor-sponsored development and institutionalisation of contraceptive distribution systems have succeeded - from well-functioning computerised national contraceptive logistics management information systems (CLMIS) in Romania and Kyrgyzstan to successful CLMIS pilot programmes in Georgia, Russia, and Ukraine.

8. Adoption of a "culture" in which providers and clients engage in frank, regular conversation about sensitive RH issues, and in which FP and appropriate services are offered.

9. FP is actively promoted through social marketing and behaviour change/social mobilisation efforts, including wide distribution of quality informational materials for clients and "job aids" for providers.

• General findings: In all countries reviewed, USAID-funded HIV prevention and FP programmes have implemented social marketing of condoms and other contraceptives, with a special focus on high-risk groups including injecting drug users, sex workers and their clients, and youth. However, few examples of comprehensive family planning social marketing programmes exist in the region. Awareness-raising campaigns that partner with a low-cost generic contraceptive supplier could be a promising model for replication in other countries in the region.

10. A well-functioning national health management information system collects, analyses, and uses FP data to monitor progress and evaluate and improve programme effectiveness.

Based on the above, this overview ends with a summary of recommendations for each country for achieving best practices in family planning. In addition, specific-country analyses are available in the following related reports:

• Albania [PDF]
• Azerbaijan [PDF]
• Georgia [PDF]
• Kyrgyzstan [PDF]
• Tajikistan [PDF] 

Email from Tula Michaelides to The Communication Initiative on December 2 2008.