One hundred rural health facilities in Senegal reported an 86% increase in the number of women choosing long-acting reversible contraceptives, or LARCs, after implementing IntraHealth International’s performance improvement and mentoring approach, TutoratPlus. The number of new clients choosing any type of modern contraceptive method rose by 64%. These results, reported in last month’s Global Health: Science and Practice, underscore the important role rural health workers play in increasing access to a full range of contraceptive methods.

Contraceptive prevalence in West Africa continues to lag behind other parts of Africa and the world. As of 2013, contraceptive prevalence in the region was 12% for modern methods, versus 28% in Eastern Africa. In Senegal, while the modern contraceptive prevalence rate remains low, after years of stagnation it jumped from 12% to 20% between 2010 and 2014. Expanding access to LARCs—particularly in rural areas—is part of Senegal’s strategy to accelerate progress and achieve a contraceptive prevalence rate of 45% by 2020.

IntraHealth has been working with the government of Senegal and other local partners to address this issue. In 2008, IntraHealth worked with the government to demonstrate that nurses—with the appropriate training and support—could successfully and safely administer LARCs. Previously, only midwives and physicians—who tend to work at more centralized and higher-level health facilities—were authorized to provide LARC services.

Since then, the government has instituted a task-sharing policy authorizing nurses in rural facilities to provide LARC services. IntraHealth’s TutoratPlus performance improvement and problem-solving approach provides the nurses and facilities with a method of monitoring and improving these new services through mentoring and community mobilization.  

TutoratPlus, named after the French word for mentoring, is designed to achieve high-quality delivery of high-impact maternal, neonatal, and child health services, including family planning. The process mobilizes all essential stakeholders (providers, supervisors, managers, community leaders, and clients) to address service delivery shortfalls by strengthening the work environment and health worker skills and competencies.

The TutoratPlus approach is based on the following principles:

• Standard trainings generally do not provide enough practical experience and also take providers away from their posts. The TutoratPlus on-site mentoring approach was developed in response to these challenges.
• Improving provider competencies is not enough to ensure high-quality services. The provider’s work environment must also be taken into account, including infrastructure, equipment, and supplies. TutoratPlus examines the environment through a situation analysis.
• The contents of provider training and mentoring should be based on empirical identification of performance gaps. Every TutoratPlus mentor is equipped with tools to measure and evaluate performance.
• Ensuring high-quality services is a whole-system process. TutoratPlus includes local officials and health committees in creating action plans and evaluating progress at regular review meetings.

IntraHealth trained 857 providers in TutoratPlus in 290 health facilities. In the subset of 100 facilities for which comparison data on family planning service delivery were available, the number of new clients receiving any family planning method increased by 64% across the two six-month time periods before and after the intervention. The number of new LARC users increased by 86%.

Read the full article:

Mentoring, Task Sharing, and Community Outreach through the TutoratPlus Approach: Increasing Use of Long-Acting Reversible Contraceptives in Senegal