SITUATIONAL ANALYSIS OF UNSAFE ABORTION IN MOZAMBIQUE
Dr. Momade Bay Usta(a), Dr. Nafissa Bique Osman(b), Dr. Eduardo Matediana(c),
Dr. Leontina Dos Muchango(d)
a) Ministry of Health – Hospital Geral José Macamo
b) Ministry of Health – Hospital Central de Maputo
c) Ministry of Health – Hospital Central da Beira
d) Forum Mulher
I
INTRODUCTION
In Mozambique there is a restrictive and punitive law related to the practice of
Abortion, which has got a great influence on the index of the maternal morbi-mortality
due to Unsafe Abortion.
.
The study conducted at the Central Hospital of Maputo (HCM), shows that 11% of
Maternal Mortality is due to unsafe abortion (Machungo, F. at al, 1990 – 1999).
In spite of the officially reported data on maternal mortality due to unsafe abortion
indicating 11%, this proportion represents only the tip of the iceberg, because it only
reflects institutional maternal deaths, while it is known that most of them are not
registered at hospitals as such, due to fear of the social stigma and to the legal
aspects related to abortion which are still prevailing in the country. .
Figura 1 – Main Causes of Maternal Mortality – Moçambique, 2007
Other Causes
(Indirect),
30%
Haemorrhage,
34%
Anemia, 4%
Obstructed
Labour 4%
Sepsis 16%
Abortion, 11%
Hypertensive deaseses of Pregnacy
9, %,
1
Source : MoH, Departamento de Saúde Reprodutiva, Infantil e Adolescentes
Recognizing the magnitude and the consequences of Unsafe Abortion, the Ministry of
Health, issued, in 1985, a circular authorizing the Central Hospital of Maputo to
perform termination of pregnancy, if requested, up to 12 weeks of gestational age, for
cases of contraceptive method failure. These TOPs were only done with authorization
of the head of the Department, after he/she had confirmed the failure of the
contraceptive method.
The procedure was performed in theatre by a trained doctor. This arrangement did not
solve the problem of women with unwanted pregnancy, who continued to seek unsafe
abortion by illegal providers.
Because the maternal morbid-mortality rates continued high, in 1990 the Ministry of
Health authorized the termination of pregnancy with no restriction, if request, up to 12
weeks gestational age, not only at the Central Hospital of Maputo but in other selected
health facilities. In addition, there are also offered abortion options to women infected
with HIV, although there is no specific policies for TOP in women infected with HIV..
After studies done by Bugalho at al., with the use of “Misoprostol”, the service was
extended to other health facilities, namely provincial hospitals.
Even though, the access to safe abortion service, particularly in rural areas is still very
limited.
Fertility rate in Mozambique is still high, despite the results of DHS in 1997 and 2003,
which showed a reduction from 5,6 to 5,5 (4,4 in urban area and 6,2 in rural area).
.
The overall Contraceptive Prevalence rate increased to 17% in 2003, being 29% in
urban areas and 12% in rural areas.
II
INTERVENTIONS TO PREVENT UNWANTED PREGNANCIES AND INDUCED
ABORTIONS
1. In 2004 the Ministry of Health started a debate on Unsafe Abortion, involving
various sectors of the Mozambican society with the objective of making people
aware of the problem.
The debate carried out through seminars delivered the following recommendations:
2
a. To set up a supporting committee of members of the government and non
government organizations to discuss unsafe abortion in depth and produce
a document on services of safe abortion establishment, with the respective
approval of the law, by the Parliament.
b. To involve in the discussion the media, educators and parents.
c. To set up intermediate mechanisms authorizing the health professionals to
act in cases of unsafe abortion. without being penalized.
2. A multi-sector working group legitimated by the Council of Ministers was formed in
2005 with the following objectives:
a. Study the conditions in which Abortion should not be penalized.
b. Produce reform proposal of the law in the context of the general legal reform
c. going on in the country.
d. Conduct an open and inclusive debate to find out political and religious and
of the civil society sensibilities.
3. After the debate in the whole country the group produced a document which
reflected the consensus related to the future law on abortion:
a. The majority was in favor of total freedom of abortion performed in the
selected facilities.
b. The permission for abortion was indicated in the following situations:
i.
To save the mother’s life
ii.
Incest
iii.
Rape and sexual harrasssment
iv.
Economic reasons
c. There are opinions of some sectors of the civil society, for example the
Catholic church, which are in favor of the defense of life without giving any
kind of concession for abortion even for saving the woman
Any how, the Council of Ministers approved the final document and recommended it to be
submitted to the Parliament.
4. The Ministry of Health in partnership with some organizations namely IPAS –
African Alliance, carried out a Needs Assessment study to know the number of
health unities offering post abortion care, and staff trained for such services.
5. Training of staff to provide pot abortion care
.
This training is offered to all MCH nurses and general practitioners in all hospitals in
the country through courses of COEB ( Basic emergency obstetric care) and COEC (
Comprehensive .Obstetric Care)
.
This training is offered to all MCH nurses and general practitioners in all hospitals in
the country through courses of COEB ( Basic emergency obstetric care) and COEC (
Comprehensive .Obstetric Care)
3
Post abortion care is now part of the formal curricula of the MCH nurses and medical
students.
III SITUATIONAL ANALISYS
TOPIC and indicator
Data points
Other information or comments
UNWANTED PREGNANCIES
Incidence of unwanted
pregnancies
% of births that are
unplanned (mistimed and
unwanted) (2003).1
% mistimed
% unwanted
% of births that are
unplanned among
adolescents (mistimed and
unwanted) (2003).1
No Data
19.7
16.0
3.7
Source is nationally representative 2003
survey; births in the five years preceding the
survey including current pregnancy, that were
either unwanted or wanted later (mistimed)
among women of age 15-49.
24.1
Births in the five years preceding the 2003
national survey including current pregnancy,
that were either unwanted or wanted later
(mistimed) among women of age 15-19.
% mistimed
22.9
% unwanted
1.2
Unplanned births (mistimed and unwanted) as
oppoted to the proportion of women who do
not want more children is a powerful indicator
of the degree to which couples successfully
control childbearing; also, it gauges the effect
on fertility of the prevention of unwanted births.
Determinants of unwanted
pregnancies (including
access to contraceptive
and user failure, violence
against women, and lack of
social support of pregnant
women).
Low coverage of contraceptive methods and
its use, mainly in rural areas, cultural barriers
(importance of family and children), low
involvement of the male partners in the Family
Planning.
Characteristics of women
All social levels.
High rate of illiteracy, mainly women
In the cities there is more information
compared to rural areas, but low use of
contraceptive. The reasons are not yet well
known.
4
TOPIC and indicator
Data points
with unwanted
pregnancies(health,
poverty, etc)
Other information or comments
Mean age in years (n=377)
25.9 (range 1
45)
Mean wks gestation (n=376)
Marital status (n=377):
Single
Married/in union
Other
Employment (n=375) :
Students
Employed
House wives
Other
Consequences of
unwanted pregnancies
7.9 (range
12)
55.2%
41.6%
3.2%
56.0%
28.0%
9.1%
6.9%
Illegal Abortions, infanticide, abandoned
children, divorces.
Cultural and Social
Barriers to certain methods
(providers and health
system barriers)
For IUDs - among health providers, deficit in
the training, attitude and organization of the
service
INTERVENTIONS TO PREVENT UNWANTED PREGNANCIES AND INDUCED
ABORTIONS
Contraceptive information and services including EC
Overall contraceptive
prevalence rate (2003).1
Any method (Total modern
and traditional)
Any modern method
Any traditional method
Specific methods (2003).1
Female sterilization
Male sterilization
Pill
IUD
17.0
11.7
4.7
0.9
….
4.9
0.1
5
TOPIC and indicator
Data points
Injectables
Condom
Periodic abstinence
Withdrawal
Other
Which methods are
approved and sold in the
country?
Which methods are
distributed for free or at
subsidized price through
public or private health
networks in the country?
What is the real availability
of methods in the public
health services
What data is available on
access to methods by
young people, unmarried
women and other
marginalized groups (rural
people, indigenous groups,
refugees IDPs).
4.8
1.1
3.1
0.2
1.4
Other information or comments
Injections, IUD, Pills, Tubal ligation
Free in public hospitals
All method listed below are free at public
sector
Fair
SEE TABLES BELOW
Comprehensive Sexuality Education
What is the current situation of
knowledge among women and
men on sexuality education?
Are there governmental
programs for comprehensive
sex education?
FAIR
How comprehensive is the
coverage of sexuality education
programs? Out of school youth?
FAIR
YES
In 1999, the Ministry of Health and the
Ministry of Education developed a multi
sector program for adolescents and
youth, with the aim of promoting access
to information on quality services about
sexual and reproductive health and also
on STI/HIV/AIDS.
There are programs of sexual and
reproductive health for adolescents and
youths in school (youth friendly corners)
and in the community
.
These programs include Information
and education: debates,
videos,
expositions, cultural and sport events.
Face to face interventions (counselling).
Interactive theatre. Availability of
condoms.
6
TOPIC and indicator
Data points
How comprehensive and
adequate is the training of
teachers to provide sexuality
education?
FAIR
What is the technical orientation
(scope and content) of the
existing programs?
Other information or comments
Activist Teachers are trained on sexual
and reproductive matters, including
STI’s/HIV/AIDS. There is a project
called “we are together”, a bilateral
cooperation between Mozambique and
Brazil, to exchange
experience
between teachers from both countries.
In the formal education are raised
issues on sexual education but the
curricula is being revised to include this
topic.
There is s multi sector group involving
among others, the Ministry of Health
and the Ministry of Education, to define
the context and to give technical
orientation on the existing programs
Social protection of pregnant women and mothers of small children
Is employment of pregnant
women protected by law
during pregnancy and after
delivery and for how long?
Is the law enforced?
How long is the legal
parental leave? Is it paid?
Is it the same for all
populations within the
country?
Is maternal breast feeding
effectively protected for
working women?
How is the compliance with
the law on parental leave
and maternal breast
feeding?
Are there sufficient day
nurseries, preschool and
school for the children of
working women?
YES
YES
Two months
Salaries are full paid while on maternity leave
maternity leave
YES
Deficient in all sectors. There is a law which is
not adequate to the current policy. Maternal
breastfeeding is now for 4 months
GOOD
There is no fully compliance in the private
sector
NO
Adoption
Is there support for women
NO
7
TOPIC and indicator
who wish to give baby to
adoption?
Is there an effective
procedure for adoption in
the country?
Data points
Other information or comments
YES
ABORTION
Incidence
Reliability of data:
Sources of data
HMIS
UNSAFE ABORTION
Incidence
Not available
No national data on incidence of unsafe
abortion is available.
Not available
No representative data are available; a study
of 461 patients in 41 public facilities in the 10
provinces of Mozambique (a convenience
sample of about 10 patients in each facility)
provides some information on morbidity and on
women (fielded during July 2002- Jan 2003).2
The study provides information on the sociodemographic characteristics of women who
received PAC (regardless the type of abortion)
and opinions on quality of PAC services,
follow-up information received, contraception
and women's satisfaction with services. See
cells B-89.
Other available information dated back 14
years ago (1994) and it is based on a random
sample of 400 women treated in the Hospital
Central de Maputo for abortion related
complications.3 This study compares the
characteristics of women treated for abortion
complications with another group of 400
women having an induced abortion in the
same hospital setting.
Hospital studies
What data are available on
the magnitude and severity
of the problem of unsafe
abortion?
Sources of data
Characteristics of women
who come for abortion
(age, place of residence,
8
TOPIC and indicator
marital status, income)
Percentage of interviewed
women (461) who received
PAC in 41 health facilities,
Jul 2002-Jan-2003.2
% aged 14-19
% with any education
%
married/cohabiting/widowed
% currently employed
% with no previous
pregnancies
% with no previous
abortions
Characteristic of providers
of unsafe abortion and
method used
Availability of misoprostol,
is it registered/approved,
what indications?
Distribution channels, cost?
Data points
Other information or comments
26.6
75.1
66.4
12.0
14.5
56.1
NA
Most of them are health workers.
The method mostly used is induction with
misoprostol
Available over the counter.
The
registration is
in process
Quality of the care of women consulting for complications of abortion
What methods are used in
MVA
AND Doctors and MCH nurses
the country for incomplete
EXCEPTIONA
abortion? Who can provide LY
these methods?
CURETAGE
Percentage of heads of
Note: does not add up to 100% since more
uterine evacuation units (in
than one method is in use in each facility.
41 health facilities) who
reported that each
particular procedure is used
in their facility (2002-03).2
Electric vacuum aspiration
20.0
Manual vacuum
51.2
aspiration
D&C
97.6
Currently the curatage kits have been
removed from almost all hospital and replaced
by MVA kits.
Medical abortion
46.3
What is the real availability
Less than 50%
of those methods in the
of public health No cost for the client
public health services, and
services
how much they cost?
9
TOPIC and indicator
How is the access for
treatment of incomplete
abortion services by young
people, unmarried women
and other marginalized
groups (rural people,
indigenous groups,
refugees, IDPs)?
Are physicians and other
health professionals
training programmes
following WHO
recommended methods for
treatment of incomplete
abortion?
Is the country implementing
WHO guidance?
Data points
Other information or comments
Available to all. There is no specific program for (rural people,
Only 40% seek indigenous groups, refugees, IDPs)?
for
this
service.
Yes
Yes
Consequences of Unsafe Abortion
Abortion related to maternal
mortality
Not available
There are no official statistics on the
magnitude of unsafe abortion and its
contribution to maternal morbidity and mortality
at the national level,
Applying the sub-regional percent (17%) to the
estimated total number of maternal deaths
(4000) yields an estimate of 680 deaths due to
abortion.
Percentage of maternal
deaths that are due to
abortion in the subregion in
which Mozambique falls
(WHO estimate for 2003).4
Estimated number of all
maternal deaths (2005).5
Proportion of maternal
deaths of female 15-49
years old, reported (19981999).1
Percentage of maternal
deaths among all deaths of
women of reproductive age
17%
4,000
19%
Since there are no available data, we
recommend this estimate which is developed
by WHO, UNICEF, UNFPA and World Bank
and is adjusted based on all available data to
account for well-documented problems of
under reporting and misclassification; the
estimate is for 2005.
* Based on direct counts, DHS data (years of
DHS maternal deaths 1994-2003, mid point
1998-99)
25%
10
TOPIC and indicator
Data points
Other information or comments
(2005).5
Maternal Mortality Ratio
reported, (deaths per
100,000 livebirths, 19981999).1
Maternal Mortality Ratio,
adjusted 2005 (deaths per
100,000 livebirths).5
408
Magnitude and severity of
complications of unsafe
abortion.
Is there an established
national level mechanism
for monitoring and
evaluation of maternal
mortality and morbidity
resulting from unsafe
abortion?
Cost of unsafe abortion to
the health system, women
and families
NA
* Based on direct counts, sisterhood method,
DHS data. Likely underreported
520
Not
specifically for
abortion
We recommend this estimate which is
developed by WHO, UNICEF, UNFPA and
World Bank and is adjusted based on all
available data to account for well-documented
problems of under reporting and
missclassification; data refer to most recent
year available during period specified. Range
of uncertainty of the MMR ranges between 360
and 680
There are maternal mortality committees.
There are regular audits for all institutional
maternal deaths, including those due to unsafe
abortion.
NA
LEGAL SITUATION OF ABORTION AND REGULATORY FRAMEWORK
International standards
National Laws: Grounds on
which abortion is permitted
in Mozambique.6
To save the women’s life
To preserve women’s
physical health
To preserve women’s
mental health
Pregnancy resulting from
rape or incest
Severe fetal malformation
Socioeconomic reasons
Women’s choice (available
on request)
Regulatory framework-key
An abortion is only allowed to save the women
life to protect her physical lhealth.
YES
YES
YES
NO
YES
NO
NO
** According to Gallo et al,2 Induced abortion in
Mozambique currently has a quasi-legal
status. Although the penal code calls for
imprisonment for the provision of abortion
unless the women's health or life is at risk, a
1981 MOH intervention backed a broad
interpretation of the health and life risk and
abortion has been available upon request in
several public hospitals since then.
11
TOPIC and indicator
Data points
Other information or comments
elements
Provision of Legal Abortion Services
Is the law being complied
NO
with for each legal
indication?
What methods are used in
Misoprostol +
the country for legal
MVA
abortion?
What is the real availability
of those methods for legal
abortion services in the
public health services, and
how much they cost?
Only available
in selected
hospitals
How is the access to legal
Law not yet
abortion services by young
approved
people, unmarried women
and other marginalized
groups (rural people,
indigenous groups,
refugees).
Is the physician and mid
level provider training
YES
following the WHO
recommended methods for
legal abortion?
Is the country implementing
YES
the WHO recommended list
of essential medicines that
Except the
includes mife/miso and
combination
essential commodities list
mife/miso
of WHO and UNFPA that
includes MVA? Are these
being used?
Are FIGO Ethics Committee
YES
Recommendations
recognized and followed by
the OBGYN society?
Extend this point.
Dilatation and MVA only in case of
misoprostol failure
In the public sector (except at the Central
Hospital of Maputo) there are no costs for
client except the fact that the client buys the
misoprostol. In the private sector still they have
to pay for the service.
According to the existing law, abortion is only
legal for medical reason, to save the women
life and to protect her physical life.
In situations of restrictive laws:
Are women being
YES
Only those with family problems. There is no
12
TOPIC and indicator
prosecuted and jailed after
induced abortion?
Are health
providers/facilities following
the ethical principle of
confidentiality of health
records in the care of
women with induced
abortion?
What are the
consequences for
physicians and other health
professionals?
Are professionals being
prosecuted and jailed for
providing induced abortion?
Data points
Other information or comments
information about women jailed.
Whenever
potsible
Not all health facilities have conditions for
confidentiality
None up to
date
In terms of the penal code, the physicians
should be prosecuted for inducing abortion
Up to date no
physicians
have been
prosecuted
due to
abortion
Sources:
1 Instituto Nacional de Estadística e Ministério da Saúde, Moçambique Inquérito Demográfico
e de Saúde, 2003, Maputo, Measure DHS+/ORC, Macro, Junho, 2005,
http://www.measuredhs.com/pubs/pub_details.cfm?ID=484&ctry_id=58&SrchTp=ctry#dfiles,
accessed April 17, 2008
2 Gallo MF et al. An assessment of abortion services in public health facilities in Mozambique:
women's and provider's perspectives. Reproductive Health Matters, 2004, 12(24) :218-226.
Supplement: Abortion Law, Policy and Practice in Transition (Nov 2004), ppt 218-226;
http:/www.jstor.org/estable/3776135, accessed April 16, 2008 at 12:22
3 Hardy E et al, Comparison of women having clandestine and hospital abortions: Maputo,
Mozambique, Reproductive Health Matters, 1997, Vol 5, No. 9, Abortion Unfinished Business,
(May 1997),108-115, http:/www.jstor.org/estable/3775142, accessed April 18, 2008 at 10:29
4 WHO. Unsafe Abortion: Global and regional estimates of the incidence of unsafe abortion
and associated mortality in 2003. Fifth Edition, Geneva 2007.
5 Maternal Mortality in 2005, estimates developed by WHO, UNICEF, UNFPA and the World
Bank, www.who.int/reproductive-health/publications/maternal_mortality_2005/mme_2005.pdf,
accessed January 28, 2008
6 Population Policy Data Bank maintained by the Population Division of the Department of
Economic and Social Affairs of the United Nations Secretariat. Mozambique, Abortion Policy,
http://www.un.org/esa/population/publications/abortion/doc, accessed March 21, 2008.
13
Knowledge and use of contraceptive methods among Adolescents and Youth
Studies done by Geração BIZ **
INDICATORS
MAPUTO CITY
MALE
ZAMBEZIA
FEMALE
MALE
FEMALE
00
03
05
00
03
05
00
03
05
00
03
05
51.6
39.9
57.5
70.1
63.9
66.5
34
46.9
46.9
49
49.3
62.9
% condoms *
90.2
92.0
89.2
85.5
92.8
88.5
74.0
90.2
93.3
57.0
82.0
88.9
% abstinence *
18.5
26.9
42.5
14.6
31.9
55.5
13.0
28.5
63.8
11.0
27.2
51.3
% contraceptive use -
10.4
20.6
46.5
21.8
47.7
63.3
16.0
32.4
75.6
23.0
47.5
75.9
12.4
4.8
10.0
17.6
4.7
22.8
28.0
12.9
21.4
34.0
20.2
29.5
56.6
87.8
82.5
57.7
91.5
70.2
34.0
77.4
73.3
23.0
81.3
75.0
% pill
*
first intecourse *
% use of pill - first
intercourse *
% Use of condom
-
intercourse *
* Knowledge about the method and its use.
** Is an adolescent and youth organization
Knowledge and use of contraceptive methods among Adolescents and Youth
Studies done by Geração
TETE
BIZ **
MAPUTO PROV.
GAZA
CABO
DELGADO
03
% pill
*
05
03
05
03
05
06
56.2
44.0
49.8
31.3
45.9
46.5
% condoms *
89.5
81.0
50.0
71.9
88.8
72.2
% abstinence *
31.6
29.4
51.1
11.7
42.4
23.4
% contraceptive use in the first
29.7
72
58.2
26.9
30.4
51.6
% use of pill in first intercourse *
2.9
20.1
14.8
22.0
29.2
11.0
% Use of condom in the first
63.3
51.1
38.6
71.4
70.8
12.7
intercourse *
intercourse *
* Knowledge about the method and its use.
14
** An adolescent and youth organization
15
COVERAGE OF POST ABORTION SERVICES
This table refers to health facilities that offer PAC services, some of them include safe
abortion
Table 1: Number of health facilities per Province that offers PAC
Vaccum Aspiration
Curetage
Manual
Electric
Electric
and
Manual
Province (Nr. of Health
Facilities
%
%
%
%
Cabo Delgado (4)
100
75
25
75
Gaza (5)
100
60
0
60
Inhambane (3)
100
67
0
67
Manica (2)
100
100
100
100
Hospitals (4)
75
25
50
50
Health Centers (2)
100
0
0
0
Hospitals (5)
100
60
20
60
Health Centers (2)
100
0
0
0
Niassa (2)
100
50
0
50
Sofala (4)
100
100
25
100
Tete (4)
100
25
0
25
Zambézia (4)
100
25
25
50
Maputo
Nampula
Among this are included the main hospital and some of the health centers at the
level of the capital of the district. It is in course a process of having the other
health centers available to offer these services.
16
IV MAJOR CHALENGES
1. To have the revised legislation on abortion approved by the parliament;
2. Increase the knowledge of men and women on Sexual and Reproductive
Health;
3. To increase the FP Prevalence;
4. Shortage of Personnel in Number and Capacity to perform abortion and potabortion care;
5. Expansion of these services, including the availability of commodities;
V MAJOR OUTPUTS TO BE ACHIEVED
The following main results and the work plan developed in the following chapter try to
address the main challenges identified.
Main OUTPUTS:
1. The Revised Legislation on Abortion approved by the Parliament;
2. Increased the knowledge of men and women on Sexual and Reproductive Health
in the reduction of the unsafe abortion ;
3. Family Planning Prevalence to be increased;
4. Rural, Provincial, General and Central Hospitals with capacity to perform
abortions and provide post-abortion care, and Health Centers Type I with
capacity to provide post-abortion care:
4.1 MCH Nurses with knowledge and capacity to provide post-abortion care, and
doctors and technicians of surgery with knowledge and capacity to perform
abortions and provide post-abortion care;
4.2 Ensured the availability of commodities to provide abortion and post-abortion
services;
4.3 Increase the data collection, report and notification of activities carried out
under the Post-Abortion Care Program
17
AMOG – MOZAMBICAN SOCIETY OF GINECOLOGISTS AND OBSTETRICIANS
V ACTION PLAN
Timetable
Budget (USD)
Process Indicators
2008
2009
2010
Expected Output/Activities
1ºS
Expected Output 1
The revised …
Continue advocacy activities for
approval of the law by the
Parliament
2º
1ºS 2ºS
S
1º
S
2º
S
F
n
Respon
sibility
Indicator
AMOG
Means of
verificatio
n
2008
2009
2010
TOTAL
...…
……
……
……
...…
……
……
……
...…
……
……
……
...…
……
……
……
Expected Output 2
Increased the knowledge of men and women on Sexual and Reproductive Health and the involvement and participation in the reduction of the
unsafe abortion
2.1 Technical assistance to the
Department of
SSR/SNNI/Adolescents in the
revision/definition of curricula,
Curricula,
manual syllabus on Sexual and
Manual
Existing
AMOG
Reproductive Health (SSR) for
sillabus/re Materials
School programs and Adolescents
vised
within the program BIZ (at school
and community levels ).
18
O
i
…
…
…
…
…
…
…
…
Timetable
Budget (USD)
Process Indicators
2008
2009
2010
Expected Output/Activities
1ºS
2.2 Advocacy in the Ministry of
Health to assure that the
Department of Reproductive
Health - SSR/SNNI/Adolescents
and the Department for
information on health to
revise/define messages, posters
radio and television spots about
Sexual and Reproductive
Health(including FP and Unsafe
Abortion);
2º
1ºS 2ºS
S
1º
S
2º
S
F
n
Respon
sibility
Indicator
AMOG
Existing
messages
, posters
,radio and
television
spots
about
Sexual
and
Reproduc
tive
Health(inc
luding FP
and
Unsafe
Abortion);
Means of
verificatio
n
2008
2009
2010
Existing
Material
19
TOTAL
O
i
Timetable
Budget (USD)
Process Indicators
2008
2009
2010
Expected Output/Activities
1ºS
Expected Output 3
Family Planning Prevalence Increased
3.1 Assist the MoH – Department
of SSR/SNNI/Adolescents in the
revision/elaboration of Norms for
FP and material for staff training
3.2 Assist the MoH – Department
of SSR/SNNI/Adolescents in the
training of MCH nurses, Surgical
and Medical Technicians, General
Practitioners FP:
3.3 Assist the MoH – Department
of SSR/SNNI/Adolescents in the
supervision of the quality of FP
services delivered:
2º
1ºS 2ºS
S
1º
S
2º
S
F
n
Respon
sibility
Indicator
Means of
verificatio
n
2008
2009
2010
TOTAL
O
i
AMOG
Group
of
“godfath
ers”
(Padrinh
os)
AMOG
and
MoH
Expected Output 4
Rural, Provincial, General and Central Hospitals with capacity to perform abortions and provide post-abortion care, and Health Centers Type I
with capacity to provide post-abortion care
4.1 MCH Nurses with knowledge and capacity to provide post-abortion care, and doctors and Technicians of surgery, Medical Technicians wi
knowledge and capacity to perform abortions and provide pot-abortion care;
20
Timetable
Budget (USD)
Process Indicators
2008
2009
2010
Expected Output/Activities
1ºS
4.1.1 Assist the Faculty of
Medicine, Institutes of Health
Education and MoH –
Department of
SSR/SNNI/Adolescents in the
revision of the curricula, syllabus
for the training of MCH nurses,
Medical Students, Surgical and
Medical Technicians, on abortion
services and post abortion care;
4.1.2 Assist the MoH in the
training of MCH nurses and
medical students on Post abortion
care
2º
1ºS 2ºS
S
1º
S
2º
S
F
n
Respon
sibility
Indicator
Means of
verificatio
n
2008
2009
2010
AMOG
MoH –
Departm
ent de
SSR/SN
NI/Adole
scents
AMOG
21
TOTAL
O
i
Timetable
Budget (USD)
Process Indicators
2008
2009
2010
Expected Output/Activities
1ºS
4.1.3 Assist the MoH in the
training of Surgical and Medical
Technicians on Post abortion care
2º
1ºS 2ºS
S
1º
S
2º
S
F
n
Respon
sibility
Indicator
Means of
verificatio
n
2008
2009
2010
MoH –
Departm
ent de
SSR/SN
NI/Adole
scents
Group
of
godfath
ers
4.2 Ensured the availability of commodities to provide abortion and post-abortion services
4.2.1 Assist the MoH in the
MoH –
definition and needs on equipment
Departm
and others for the program of Post
ent de
abortion care
SSR/SN
NI/Adole
22
TOTAL
O
i
Timetable
Budget (USD)
Process Indicators
2008
2009
2010
Expected Output/Activities
1ºS
2º
1ºS 2ºS
S
1º
S
2º
S
F
n
Respon
sibility
Indicator
Means of
verificatio
n
2008
2009
2010
4.2.2 During supervision visits to
scents
health facilities, produce the report
about the use of the existing
AMOG
equipment and other products and
needs
4.3 Increased the data collection, report and notification of activities realized under the Post-Abortion Care Program
4.3.1 Assist the MoH –
Department of
SSR/SNNI/Adolescents in the
revision of indicators and data
to be collected related to post
abortion services
4.3.2 During supervision visits
health staff must be continuously
trained to improve quality of data
registration
4.3.1 Research
AMOG
AMOG
23
TOTAL
O
i