CARE BLOG

CARE’s influence on National Family Planning Policy change in Chad

4/30/14

CARE’s Supporting Access to Family Planning and Post-Abortion Care (SAFPAC) Initiative has been operating in Chad since year 2011. Chad’s national family planning policy has changed dramatically in these years. The work SAFPAC Chad has done in the country has played an important role in stimulating and shaping these changes, not only demonstrating what can be achieved in the Chadian context, but also using SAFPAC data to contribute directly to national level policy setting.

Before SAFPAC
In 2010, Chad Ministry of Health (MOH) and UNFPA enacted a Sexual Reproductive Health National policy, in which many restrictions applied:
·         IUD and implant insertion, and performance of manual vacuum aspiration (MVA) were not permitted in primary health clinics.
·         Midwives and nurses were neither allowed to insert IUDs and implant nor to perform MVAs.
·         Only physicians working in a hospital setting were permitted to perform the procedures mentioned above.
·         Only Jadelle and Norplant (two types of implants) were allowed to be imported into Chad.
 
During SAFPAC Phase I
From June 2011 to Dec 2012, SAFPAC Chad team had managed to support 10 health clinics in Logone Oriental Province and Moyen-Chari Province in Chad. They trained midwives and nurses to perform IUD and implant insertion and removal.  They also trained them to conduct MVA procedures. During the Phase I of SAFPAC Initiative, totally 4,394 women became new FP users in the 10 health clinics, and also 162 were treated with MVA and received adequate PAC services. 
 
While conducted with full involvement of district and facility level health officials, SAFPAC’s activities were not in compliance with the National FP policy at that time.  The SAFPAC Chad team believed that it was the policy that did not reflect what was going on in the field. The policy had become the barrier for women to receive family planning service.  They saw an opportunity to influence access to reproductive health services nationwide, rather than an insurmountable obstacle.
 
In 2012, SAFPAC Chad team engaged with UNFPA and RH National Program (MOH) about the content of the policy, as they had clear evidence that the National FP policy was inhibiting them from providing FP service to women who really need the service and that it was possible to provide those services in a high quality manner.
 
During SAFPAC Phase II
In 2013, UNFPA and MOH invited CARE Chad and ASTBEF (a key SAFPAC Chad partner and the local affiliate of International Planned Parenthood Federation) to be active partners in the revision and updating of a new national FP Policy in Chad.  The CARE Chad team was able to convince other partners to end the policy restrictions regarding IUD/Implant/MVA, midwives and nurses, health clinics, and implants.
 
In addition, there were many additional revisions to the policy:
·         Vasectomy and tubal ligation are included as permanent methods sanctioned by the national system;
·         Mobile phone is included as a way to reach out community and potential users;
·         Men’s engagement in providing FP service is encouraged under the new policy;
·         Also, adolescents are identified as a special target group for FP services.
 
This is a powerful example of how CARE’s work at local level can influence changes at national level. We would like to congratulate our colleagues working for CARE Chad who have been involved in this process for their achievement!
 
For more information regarding the FP policy change in Chad, please contact CARE’s Senior Regional Advisor Jimmy Nzau at jnzau@care.org.

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