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Contents
List of Acronyms and Abbreviations: ............................................................................................. 3
FOREWORD .................................................................................................................................. 4
ACKNOWLEDGEMENTS ............................................................................................................ 5
1. Background ................................................................................................................................. 5
2. Situational Analysis .................................................................................................................... 8
3. SLOT Analysis.......................................................................................................................... 10
4. Rationale ................................................................................................................................... 11
5. Scope and Target Audience: ..................................................................................................... 12
6. Goal ........................................................................................................................................... 12
7. Objective: .................................................................................................................................. 12
Specific Objectives: .................................................................................................................. 12
8. Target ........................................................................................................................................ 12
9. Strategic Priorities .................................................................................................................. 13
9.1 Service Delivery and Access .............................................................................................. 13
9.2 Commodity Security ........................................................................................................... 16
9.3 Increase Demand for Contraception ............................................................................... 16
9.4 Create enabling environment for family planning program. .......................................... 18
10 Activities ............................................................................................................................... 19
11. Roles and responsibilities of stakeholders ......................................................................... 22
12. Ownership and sustainability .................................................................................................. 27
13. Monitoring and evaluation ...................................................................................................... 27
15. References ............................................................................................................................... 29

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List of Acronyms and Abbreviations:
BCC Behavioral Change Communications
CC Comprehensive Contraceptive
CBCM Catchment Based Clinical Mentorship
CPR Contraceptive Prevalence Rate
CYP: Couple Years Protection
DIP Development and Investment Plan
FP Family Planning
HEW Health extension worker.
HC Health Center
HP Health Post
HSTP Health Sector Transformation Plan
IUCD Intrauterine Contraceptive Device
LARC Long-Acting Reversible Contraceptive
MMR Maternal Mortality Ratio
MoH Ministry of Health
PMs Permanent methods
RHB Regional Health Bureau
SOJT Structured on the Job Training
SDG Sustainable Development Goals
SS Supportive Supervision
TWG Technical Working Group
TOT Training of Trainers
VCAT Value Clarification and Attitude
Transformation
VHL Village Health Leader
WoHo Woreda Health Office
ZHD Zonal Health Department

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 FOREWORD

The Ministry of Health is committed to improving family planning service through expanding access and
quality of family planning information and services and ensuring that all ranges of family planning methods
are available to the population.
Over the past decade, Ethiopia has made significant progress in increasing the contraceptive prevalence rate
and reducing unmet need. However, the family planning method mix was dominated by pills and injectable
contraceptive methods. In this regard, the Ministry of Health has been working on a 2030 commitment to
improve the family planning service in four areas that include increasing family planning financing, improving
contraceptive commodity security, improving access to adolescent and youth responsive health systems for
contraceptive use, and ensuring availability of quality family planning information and services.

The Ministry of Health maintains individuals and couples' rights-based family planning services with fully
informed voluntary choices and decisions. As part of this effort, the Ministry of Health developed different
strategies and guidelines to ensure access to a wide range of contraceptive methods and improve the use of
contraceptive services based on client needs and preference. In order to maximize this effort, the Ministry of
Health launched the IUCD Scale Up for Improving Family Planning Method Mix to improve the health status
of families and individuals, through expanding the provision of quality FP services. Cognizant of this, the
Ministry of Health has paid due attention to the quality and equity of health care services and incorporated the
provision of quality comprehensive FP service focus on provision of IUCD insertion and removal services as
per the client needs and preference. Based on lessons drawn from previous contraceptive scale up initiatives,
the objective of this IUCD scale up document is to reduce maternal and child morbidity and mortality through
improving access to a full range of quality family planning information and services.
Therefore, enhancing competencies of providers to provide long-acting reversible contraception’s information,
counseling, and services and ensuring the availability of commodity is vital to enhance the provision of high-
impact intervention of family planning information, counseling, and services at all service delivery points.

The Ministry of Health committed to ensuring that resources are in place and prioritized the low cost and high
impact practices in provision of long acting reversible contraception. The initiative will be owned by public
and private health facilities and supported by Donors and aligned partners. Moreover, the Regional Health
Bureaus and development partners are expected to implement the IUCD scale up for improving family
planning method mix based on preset national and regional goals and targets.

The Ministry would like to seize this opportunity to thank all who contributed for the development of this
document and to call upon all our RHBs, Donors, Partners, and Stakeholders to support the implementation of
IUCD Scale Up for Improving Family Planning Method Mix and advance the provision of quality FP service
in the country integrating with SRH high impact and low cost interventions.

Dr. Dereje Duguma

State Minster, Ministry of Health

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ACKNOWLEDGEMENTS
The Ministry of Health expresses its sincere appreciation to National Family Planning Technical
Working Group (TWG) members who were involved in the overall process of developing this
document called “IUCD Scale Up for Improving Family Planning Method Mix” and led and
coordinated by the RHFP-AYH Desk and MCAH Lead Executive office of the Ministry of Health.

The Ministry of Health would like to extend its appreciation and acknowledgement to
EngenderHealth-Ethiopia for their financial support to print this document.

The Ministry would like to extend its gratitude and acknowledge the following designated national
experts and organizations for their hard work and contribution in the development of this document.
CONTRIBUTORS
Dr.Meseret Zelalem MOH
Dr. Alemayehu Hunduma MOH
Dr. Siyoum Enkubahiri EngenderHealth
Dr. Zerihun Bogale MOH
Dr. Jemal Adem MOH
Dr. Birikty Lulu MOH
Motuma Bekele MOH
Berhane Assefa JSI
Dr.Tadele Kebede MOH
Segni Dufera MOH
Dr. Nega Tesfaw MSIE
Kassahun Kurmu Packard Foundation
Teferi Teklu PSI/E
Yalewlayker Wubishet Clinton Health Access
Yenew Birhan CoRHA
Marta Asefa EPHA
Dr. Abiyot Belai IPAS
Fantanesh Dessalegn MOH
Genet Deres MOH
Mohammed Mieso MOH
Eyob Getachew MOH
Abreham Kassahun MOH
Dr. Awol Seid EPHA

Dr Meseret Zelalem Tadesse (MD, Pediatrician)

Maternal Child and Adolescent Health Services Lead Executive Officer

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1. Background
Worldwide, 922 million women of reproductive age (or their partners) are contraceptive users
among these 842 million are using modern contraceptive methods and 80 million traditional
methods. Around 10% (190 million) women have an unmet need for family planning. The
proportion of women who have their need for family planning satisfied by modern methods is
76% in 2019 (1). Sustainable Development Goal (SDG) three has been set to ensure healthy lives
and promote well-being for all at all ages by 2030, reducing the global MMR to less than 70 per
100 000 live births by 2030. Particularly SDG 3.7: focus on ensuring universal access to sexual
and reproductive health-care services including family planning.
The second health sector transformation plan (HSTP II) aims at improving the health of our
population through the realization of accelerating progress towards Universal Health Coverage
(UHC). The plan aspires to achieve UHC through expanding access to services and improving
the provision of quality and equitable comprehensive health services at all levels. Building upon
the long-term achievements of the health sector and aligning with SDG3, HSTP-II aspires to
attain UHC through increasing effective coverage of essential health services by 2030 (2).
Following HSTP-II, the health sector’s medium term development and investment plan (HSDIP),
that spans for the period 2016 EFY – 2018 EFY (July 2023 – June 2026), developed after three
years of HSTP-II implementation. The HSDIP development process followed a participatory
approach with the engagement of various stakeholders. It was informed by an in-depth
situational analysis of the performance of the health sector, findings from the midterm review of
HSTP-II, the socio-economic situation of the country and aligned with continental and global
situations and commitments. It builds on the previous successes, and considers the current gaps
and challenges.
The MOH in its health sector’s medium term development and investment plan (HSDIP) has set
a target to decrease the maternal mortality rate (MMR) from 267 per 100,000 live births to 199
and increase the CPR to 47% and reduce the unmet need for FP to 10% by 2026 . To realize
these, the MOH has laid out specific strategies and initiatives including enhancing FP method
options initiative focused on IUCDs methods in the country.
The 2030 commitment vision stated that to see a healthy and prosperous society through
increased access and utilization of contraceptive service and identified four area of commitments
that comprises increase family planning financing, improve contraceptive commodity security,
improve access to adolescent and youth responsive health system for contraceptive use, and
ensure availability of quality family planning information and services
Family planning services are available in almost all public health facilities in Ethiopia, ranging
from 99% in health centers to more than 93% in general and referral hospitals. About 82% of
private health facilities also provide family planning services where 14% of clients get their need
of contraceptive (1). The contraceptive prevalence rate (CPR) for modern methods has
significantly increased from 3% in 1990 to 40% in 2019 (1) while 22% of married women have
an unmet need for family planning that13% for spacing and 9% for limiting (3)

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Over the past decade, the country has made significant progress in increasing the contraceptive
prevalence rate and reducing unmet need. However, the family planning method mix was
dominated by pills and DMPA injectable. In this regard, the MOH has intensified efforts by
implementing specific strategies to ensure access to a range of contraceptive methods and
improve or balance the use of contraceptive methods. The Ministry of Health employed an
innovative approach of task-shifting where Health Extension Workers were trained and engaged
in the insertion of the Implanon.
Ethiopia’s initiative to scale up Implanon through the Health Extension Workers (HEWs) that
started in 2009 has significantly increased the share of implants to the CPR. The Implanon scale
up initiative was one of the success stories of the family planning service in Ethiopia, made
Implanon available at the community level, and provided by the lower-level health professionals,
the health extension workers. Currently Implanon service is integrated with the rest of the family
planning services and available at all levels of health facilities.
Considering the remarkable and early success in Implanon scaling-up initiative in 2010, the
MOH launched the ―Ethiopia Intrauterine Contraceptive Device Revitalization Initiative,‖ a
program designed to revitalize IUCD in a phased based approach first in 100 urban/semi urban
Woredas then expanded in other facilities and continued through 2017. This program is
designed to expand access to the Copper T 380 IUCD by supporting public health centers in four
regions (Amhara, Tigray, SNNPR, and Oromia) by providing training to service providers in
voluntary IUCD insertion and removal techniques and increasing awareness about the method.
To further increase access to voluntary LARCs, the MOH initiated a pilot project in 66 health
posts in Oct 2016 where L4-HEWs trained to provide 1-rod etonogestrel contraceptive implant
(brand name Implanon) removals, two-rod levonorgestrel contraceptive implant (Jadelle)
insertions and removals, and IUCD insertions and removals at their health posts. This program
aligned with WHO guidelines, which recommend task sharing IUCD provision to auxiliary
midwives and nurses (4). Based on the results of the pilot evaluation, the MOH decided to scale
up the Comprehensive Family Planning service through L4HEWs with all ―Comprehensive
LARC Initiative‖ and subsequently developed a standardized implementation manual to guide
the revitalization (5) The MOH and its line regional health bureau (mainly in Amhara, Oromia,
SNNP, and Tigray) through the support of its partners including Amref Health Africa,
EngenderHealth, EPHA, IPAS, MSI, Pathfinder, and FGAE are launching the Initiative. The
Implementation Guide addresses demand creation and service promotion, quality, and safety of
services, defines roles and responsibilities at all levels of the public health system (federal,
regional, zonal, Woreda, health center and health post) and for implementing partners.
All initiatives have demonstrated that provision of long-acting and reversible methods is possible
through task-shifting using lower-level health care providers. Besides, it assured a broader FP
method choice and quality of FP services. Considering the successes from the Implants and
IUCD scale up initiatives, understanding the huge demand for long-acting FP methods and with
the objective of making all range of comprehensive family planning service that include
permanent family planning methods available to the population, the MOH has embarked on
further enhance the provision of LARCs and permanent family planning services in the country.

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IUCD's scale up for improving family planning method mix initiative will provide an
opportunity to expand contraceptive choice while ensuring people are fully informed to consider
the family planning method that is best for them among the range of available options.
Ultimately, the activities of this initiative are expected to be integrated into the ongoing family
planning program
Community education and sensitization will be done using all available communication means in
all FP options that focus on information about the benefits and advantages of modern family
planning methods particularly the most effective methods include Implant, IUCD and permanent
family planning methods through addressing the myths, misconceptions, and other identified
barriers. Family planning service providers including health workers and health managers will
be oriented to facilitate community education, counseling and address myths, misconceptions,
and establish referral links between the community and the different levels of the health system.
Value clarification and attitude transformations on FP will be integrated with different types of
family planning training. Public, private and NGO will engage and provide support to facilities
as per the national family planning services guideline. All stakeholders that include Government,
Donors, non-governmental organizations, and the private sector will actively participate in and
provide technical and financial support to the successful implementation.

2. Situational Analysis
Worldwide female sterilization is the most common contraceptive method. 219 million (23.7 %)
of women who were using contraception rely on female sterilization in 2019. Three other
methods had more than 100 million users worldwide: male condom 21% (189 million), IUCD
17% (159 million) and pills 16% (151 million) (6). In Ethiopia, the change in the contraceptive
method is significant in the last two decades but the progress towards long-acting contraceptives
is slow compared to short acting.

Share of Contracepti ve use in 2019

70.00% 65.70%

60.00%
50.00%
40.00%
30.00% 23.70%
20.50%
20.00% 16% 17%
8%
10.00% 4.80% 3.60%
2% 0.72% 0% 2%
0.00%
Pills Injectable Implants IUD Female Male sterilization
sterilization

Ethiopia Worldwide

Figure 1: Share of contraceptives use in Ethiopia and Worldwide in 2019.

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These proportions are far below the targets for 2020. Worldwide Around 10% women have an
unmet need for family planning in 2019 compared to 22% in Ethiopia (6)While family planning
use has increased since 2000, there remains a reliance on short acting methods.
Long-acting reversible contraceptives (LARCs) are highly effective and have lower failure rates
than short acting methods. In 2016, LARC use was nearly double in urban areas compared to
rural areas; 15.6% vs. 8.8% respectively. IUCD use was 4.6% and 2.0%, while implant use was
11.0% and 7.3% amongst urban and rural areas respectively (5). Despite the huge number of
potential clients for LARC & PM methods, a smaller number of women know about them
compared to the knowledge of short acting methods. In 2019, knowledge of married women of
any method was 96.2% or 96.1% for any modern method but there is a huge difference on the
knowledge of women on LARC/PM vs. short acting methods, which is for 32.1% Female
sterilization, 12.8% Male sterilization, 52.3% for IUCD & 87.1% for implants, but it was 83%
for Pill and 92.5% for Injectable.
LARC & PMs are widely utilized worldwide but the least utilized in Ethiopia due to different
reasons which include Lack of knowledge on the benefits & advantages, community & health
care providers' myths & misconceptions, provider biases & misunderstanding, poor counseling
on all available methods, poor male engagement, limited number of trained providers on PMs,
lack skill competency and lack of the necessary supplies/commodities. Pervasive socio-cultural
barriers also limit the acceptability of PMs. Addressing all the above factors will help to improve
the LARC & PMs services in Ethiopia.
Based on the L4HEWs evaluation study results in 2019, the L4HEW overall average insertion
procedures performed was 62%, with CI (58%--66%) and averaged 72% on the removal
procedures while the nurses and midwives averaged well above 65% on both procedures 75% on
insertion and 81% on removal. (7). The study also highlighted the critical areas that need to be
considered for scale up including health post infrastructure, utilities (water, electricity), and
infection prevention.

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3. SLOT Analysis
Aimed to scan items related the internal and external environment, SLOT (strengths, limitation,
opportunities and threats) related to IUCD Scale Up for improving FP Method Mix
Strengths Limitations
Trained human resource. Budget and dependence on donor

Availability of LMIS system Misconception on some methods

Strong partnership and good stakeholders’ engagement Low quality counseling

Availability of FP service at all levels (in both private and FP commodity interruptions and stock out
public)
Inadequate Supply chain management
Efficient reporting system
Inadequate facility readiness
Increasing government financial commitment (including FP
commodity compact) Provider bias and negative attitude

Improving political commitment. Lack of access to FP information

Intersectoral collaboration: School health, MISP for Clients knowledge disparity on FP methods
workplace/IPDC, MISP for humanitarian setting Religious and cultural barriers
Availability of functional support system (mentorship) Inadequate male engagement
Availability of community-based structure Poor infrastructure
HEP, WDA, HP Inadequate budget allocation by Gov’t, Inadequate private-
Adoption of new contraceptive technologies public partnership, Inadequate youth-friendly service

Existence of supportive FP regulations Lack of local manufacturing of FP commodities

Lack of access/Inadequate FP service at work places, IDP

HSDIP RH strategy, RHCS strategy, FP2030 commitment and
sites, schools and universities
ICPD commitment
Lack of inclusiveness , Lack of provider motivation
FP communication guideline: Quality standard,
High trained provider turnover , Gender inequality
FP integration guideline, SOJT, FP counseling pocket guide,
Mentorship guideline, CIP

Increased Demand for FP services

Opportunities Threats
Improving health seeking behavior Conflict/ Security problem and Drought, Inflation

Introduction of digital technology Global economy effect with unexpected rise in price of FP
commodities
Introduction of new contraceptive methods
Epidemics and pandemics ,Anti-choice movement
Health extension program optimization
Climate change , Politicization of family
Health service expansion planning/association with budget

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4. Rationale
Ethiopia has seen a dramatic increase in CPR from 15% in 2005 to 41% in 2019 while TFR has
declined from 5.4 children per woman in 2005 to 4.1 children per woman in 2019. Despite the
significant progress in CPR, there is a huge variation in CPR among urban and rural
communities and disparity across regions. The CPR is 3.4% in Somali compared to 50% in
Addis Ababa. There is also a huge demand for fertility limitation in which 22% of married
women reported that they were not using any contraception, although they do not want to have
more children for at least the next two years (3). Unmet need for both spacing and limiting of
births is 13% and 9%, respectively. About 9% of women who have unmet need for FP are
women who do not want any more children who are potential for LARCs and PMs but less
utilized especially IUCD and PM contraception methods. Even though the contraceptive
prevalence rate has increased significantly the discontinuation rate is still very high, the highest
(70%) for pills, 38% for injectable and only 13% for IUCD.
Multiple factors contribute to the low utilization of family planning, specifically IUCDs and
PMs, including limited access, myths and misconceptions, lack of information on advantages of
these methods, limited skilled providers, provider biases and misunderstanding, and lack of
facility readiness. Cultural norms lead women to avoid exposing their private parts of the body
like IUCD insertion that requires pelvic examination prior to insertion of the method. Low male
engagement during FP activities is also another factor for low utilization of FP services.
Therefore, IUCD scale up for improving family planning method mix initiative has the following
advantages:
Responding to individual needs.
Providing a range of methods gives clients more choices and helps ensure continuation which is
an important indicator of client satisfaction and quality of care. When multiple methods are
available, clients who are dissatisfied with one method can switch easily to another method to
avoid the risk of an unintended pregnancy. Women who have more contraceptive choices are
more likely to start using a method of family planning.
Contributing to the sustainability of programs
Modern contraceptive methods, particularly LARCs and permanent methods are the most
effective and cost-saving contraceptive for programs that lead to fewer unintended pregnancies
and fewer clinic visits. Total direct costs per CYP in Ethiopia ranged from $4 for injectable to $9
for implants. The exception was the IUCD, with a low cost per CYP of $0.30, due to extremely
low commodity and personnel costs (8). Evidence shows that through integration with long
acting and scale up of LARC and permanent FP services, millions of dollars are saved by
addressing unmet need for spacing and limiting births.
Reaching national health goals
Using family planning contributes to spacing and limiting births. It has the potential to prevent
32-40% of maternal deaths and 10% child deaths. The use of LAPMs would contribute directly
or indirectly to achieving national health goals. Therefore, enhancing the FP method options

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initiative document is mainly aligned with the 2030 commitment, the three years development
and investment plan, and the national cost implementation plan.

5. Scope and Target Audience:

Scope: IUCD Scale Up for Improving Family Planning Method Mix initiative has to be
implemented at all levels of the health system including public health facilities, Non-
Governmental Organizations (NGOs), Faith-Based Organizations (FBOs), and the private
sectors.
Target Audiences: IUCD Scale Up for Improving Family Planning Method Mix has intended to
be used by policymakers, program managers, supervisors and service providers, and community
health workers who working in the area of family planning program

6. Goal
Improve the health status of individuals and families through expanding access to quality Family
planning services and contribute to well-being of the Ethiopian population

7. Objective:
Reduce maternal and child morbidity and mortality through improving access to full range of
quality family planning information and services.

Specific Objectives:
 Increase demand and access to family planning services

 Improve the uptake of IUCD services though ensuring availability and choice of family
planning method mix.

 Enhance competencies of providers to provide long-acting reversible contraception’s

information, counseling, and services.
 Increase access to and the provision of high-quality family planning methods mix
information, counseling, and services.

8. Target
By End of 2026
 Increase CPR from the current 40% to 45% (HSDIP)
 Increase Contraceptive Acceptance Rate (CAR) from the current 72% to 78% (DHIS-2)

 Increase LARC from 30.8% to 32 % , IUCD from 2.1% to 4% (DHIS-2)

 Implement IUCD service in 15% of the HPs by L4HEWs

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  Implement IUCD service in 100% Comprehensive HPs, HCs and Hospitals

 Increase Immediate Postpartum Family Planning from the Current 11.7 % to 19%

 Strengthen permanent methods of contraception in selected health facilities

 Increase number of users of modern contraceptive from 6,867,424 to 8,612,547

9. Strategic Priorities
Four strategic priorities selected for scaling up IUCD for improving family planning
method mix. These are

• Service Delivery and Access

• Commodity Security
• Increase demand for contraception
• Enhance Enabling Environment for family planning program

9.1 Service Delivery and Access

IUCD scale-up for improving family planning method mix needs to ensure the availability of
commodity, supplies and equipment as well as making sure that the information and services are
culturally appropriate and acceptable to satisfy the needs and expectations of the target
audiences. To do so, the following sub-strategies need to be taken into consideration.
9.1.1 Enhance Health workforce development on comprehensive family planning
In- service training in LARC & PMs.
Comprehensive family planning training: comprehensive family planning training will be
provided for health workers who are not trained on comprehensive family planning
IUCD refresher Training: Health workers trained on comprehensive family planning services
will be refreshed on IUCD counseling, insertion, and removal services using the national
standard in-service training manuals. The potential candidates for this training are those health
workers who have been trained in comprehensive planning but currently not providing IUCD
service or lost their competency.
Post-partum family planning (PPFP): Health workers who are working in deliver ward will be
trained on postpartum family planning counseling and service using the national in-service
training manuals.
Permanent family planning methods: Ensuring the continuous provision of PM services
requires availability of trained and skilled providers who have positive attitude towards these
methods. Availability of PM service requires at least two teams each contains three professionals
includes OBGYN/IESO, Physician/Health officers and nurse/midwife have to be trained in
permanent family planning methods in each selected facility to minimize chances of service
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disruption. Training on permanent methods will be provided to selected hospitals and health
centers. Continue with capacity building on provision post training follow up and sharing of
experiences among the facilities.
Approaches: The approach for the training can be group-based training or refresher training or
using structured on the job training (SOJT) depending on the specific set up. In addition, VCAT
training and standalone client-centered counseling training will be provided for selected
providers based on the identified gaps.
There is a need for mapping of facilities to identify facilities where IUCD & PM service is
already initiated and new sites for service initiation to help us to design the approach and level of
support as per the specific needs and gaps identified.
Motivation for providers: Identifying and recognizing best performing providers and facilities
will help to strengthen and sustain the service. Innovative approaches will be used to motivate
providers, especially for LARC and PM providers based on specific set-up and conditions.
Trainees need to be carefully selected from health facilities to ensure that training opportunities
are given to health professionals who are motivated to apply their knowledge and skills and are
likely to remain in direct service delivery positions.
Catchment based clinical mentorship and supportive supervision.
All trained providers immediately after skill-based training will be enrolled into the regular
catchment based clinical mentorship programs based on the national guideline. Whenever the
CBCM & Sportive Supervision (SS) program is not feasible due to different reasons, a direct
focused post training follow-ups should be arranged. Supportive supervision has to be planned to
monitor facility performance in regular base to identify gaps and provide immediate, midterm
and long term solution.
Improve FP counseling skills of service providers through client centered counseling
training
Ensuring that clients get comprehensive information and proper counseling on all available
methods requires that all FP providers have the positive attitude towards these methods and have
the proper skills to counsel clients including male clients. Compressive FP and refresher client
centered counseling trainings will address gaps in counseling skills on IUCD/PPIUCDs and PMs
so that all FP providers will counsel and provide services and refer clients for PM services when
not in their capacity to do PM provision.
9.1.2 Enhancing service integration for LARC and PMs
Service integration has a big role in expanding FP use including LARC and PMs. Counseling
clients during ANC will be the best opportunities for postpartum FP methods like for PPIUCD
and Bilateral tubal ligation. Counseling of clients prior to abortion care services will be a good
opportunity for PAFP services like PA IUCD service.

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FP needs of all clients who visit health facilities at non-FP units can be addressed through
integration of the FP services at different service units. Targeted non-FP units included MCH
units (i.e., gynecology, labor and delivery, postnatal care, child immunization, and under-five
services), HIV units, outpatient departments, and selected others (e.g., emergency and triage,
antenatal care and prevention of mother-to-child transmission, and tuberculosis service units).
Providers and facility leaders need to discuss and design ways to arrange counseling and service
provision of clients at non-FP units. Selected successful service delivery outcome from different
facilities and partners will be used as benchmark to expand to different sites.
9.1.3 Engage HEP Optimization Roadmap with FP Program:
Engaging the HEP optimization roadmap with a family planning program is very important to
scaling up IUCD service and improving the family planning method mix. Introducing standard
service delivery modality including family planning integration with other health extension
service delivery packages and introducing quality improvement process at health post level is
helpful to improve service delivery outcome.
HEWs, health workers and Voluntary Health Leaders (VHLs) can support the family planning
program at health post and community level in creating demand on family planning, addressing
misconceptions, providing FP information about available methods and permanent contraception
methods through counseling and referral and promote less utilized services like IUCD.
Counseling & community dialogue by providing comprehensive information and counseling to
couples and communities.
9.1.4 Engage private health facilities in provision of LARCs and PMs through providing
training and commodities as appropriate.
There is a huge potential for increasing access to IUCD/PPIUCDs and PMs of contraceptive
service provision in private sectors. Therefore, enhancing public and private partnership in health
(PPPH) is very important to use untapped potential. Besides, FGAE and MSI have skilled
providers and clinics, which provide these services and will engage them in building the capacity
and in expanding counseling and service to the public sector.
9.1.5. Ensure family planning client privacy at service delivery points
One of the barriers of quality family planning services is the fact that the health infrastructure is
not conducive to provide client-centered counseling and services that ensure privacy and
confidentiality. The family planning counseling and service provision units of most of the health
facilities in Ethiopia are not positioned in areas that provide comfort and privacy (auditory and
visual). In addition, family planning units are most of the time staffed with many non-staff
service providers (such as medical and Para-medical students) that compromise the right for
receiving information and care with confidentiality and privacy. There needs to be commitment
to re-organize counseling and service provision units to fulfill the minimum requirement of
privacy and confidentiality. Multi-sectoral collaboration to design best approaches for training of
health workers (students) in a way that doesn’t affect the family planning program need to be in
place as well.

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9.2 Commodity Security
FP commodities should be available to both men and women, including youth. Availability of FP
commodities is also a critical for successful FP program. Numerous supply-side barriers hinder
access to FP services in Ethiopia; for example, clients are often unable to access counseling and
receive commodities due to geographical distances and lack of supplies or equipment at
facilities.
9.2.1. Strengthening supply chain management system
Having fully functional supply chain management system is crucial to ensure availability of
commodities at the needed time and place. To strengthen the supply chain management system,
this initiative will create common platforms for all stakeholders to strategize on supplies
management and reduce stock-out by conducting annual joint review meetings. Annual
quantification of family planning commodities will also be undertaken. The discussions with the
stakeholders will help to generate and increase budget allocation for strengthening the supply
chain managements (SCM) system.
9.2.2 Advocacy for FP commodity budget allocation

The country needs to have self-reliant, sustainable financing as development funds are declining.
The government’s financial commitment needs to keep pace with increasing demand as well as
compensate for declining external financing by implementing high-priority interventions. Efforts
will be in place to ensure sufficient financial resource from both domestic and external sources.
Conduct advocacy activities for increasing budget allocation for family planning supplies and
commodity by using all available opportunities including annual review meetings. Stakeholders'
commitment to advocating RH/FP commodities and services will also be fostered (among
political and religious leaders, donors/NGOs, private sectors, Civil Society Organizations
(CSOs), media,
9.2.3 Strengthening Public Private Partnership for FP commodity security

The private sector has a significant role in the implementation of the national FP program. The
sector can also have immense contribution in the improvement of commodity security status in
Ethiopia. The initiative needs to strengthen existing TWG to implement PPM guideline and the
Supply chain PPP guideline to maximize the engagement of the private sector.

9.3 Increase Demand for Contraception

9.3.1. Demand creation using existing community structures (HEWs, VHLs, WDA, etc.)

16
While influencing perceptions of available health services and patterns of use will take time, a
key strategy is capitalizing on existing health structures and resource persons to create demand
and counseling as well as strengthen referral linkages between community and health facilities.
Given low literacy levels of women and men in Ethiopia, as well as limited access to mass media
in rural communities, interpersonal communication remains one of the most effective means of
increasing awareness of family planning including use of IUCD and PM services. In addition,
HEWs, health workers and Voluntary Health Leaders (VHLs) etc. being influential and trusted in
their communities and undoubtedly they are a primary source of health information at the
community level and are vital partners in the effort to address misconceptions and promote less
utilized services like IUCD and permanent contraception methods through counseling and
referral. Counseling & community dialogue by providing comprehensive information and
counseling to couples and community members including people with special needs through
HEWs and Health workers will be the key strategy in creating demand and uptake of IUCD &
PMs.

9.3.2. Implementing evidence based and culturally appropriate behavioral change

communication (BCC) to enhance the acceptability and uptake of IUCDs.
In addition to the intensive interpersonal communications to educate communities by health
workers and volunteers, evidence-based targeted BCC approaches employed to enhance
acceptability of IUCDs. Critical issues addressed through BCC identified through formative and
rapid acceptability assessments to guide the BCC interventions. Existing communication
messages reviewed and tailored to reach specific segments of the primary audience.
Local radio is a preferred media for FP including LAPMs communication for the rural
communities. Radio is popular to reach individuals and couples in rural areas. In urban areas,
innovative and targeted approaches can be used like mass and social media, digital applications
and m-health. Innovative approaches will also be working to people with special needs and
people in humanitarian settings.
9.3.3. Engaging men to enhance their roles as FP clients, FP advocates, and supportive
partners.
Evidence shows that engaging men in FP/RH has correlations with improved RH outcomes. Men
can play critical roles in promotion of FP as clients of male methods (vasectomy), as partners
supporting FP use by their spouses and as agents of change to promote awareness of FP and
gender equity in their communities. Realizing men’s critical roles in FP, this initiative will
employ innovative and evidence-based approaches to involve men with equal intensity as women
across all activities.
9.3.4. Implementing targeted informational campaigns and community
mobilization/sensitization events
Regional and sub-regional level orientation and sensitization involving key stakeholders
conducted to ensure that IUCDs and voluntary PM Service provision, as part of a comprehensive
approach to FP, are fully supported by local authorities and community leaders. Targeted and

17
structured community sensitization activities implemented to build momentum and sustain
community level conversations around IUCDs and PM. Religious and traditional/cultural
leaders, community leaders, community mobilizers/champions, self, or colleague witness, known
clients, satisfied clients, and media will drive community mobilization effort. Community
sensitization interventions aligned with service delivery activities to increase access to IUCDs
and voluntary PMs as part of a range of methods.

9.4 Create enabling environment for family planning program.

.
9.4.1 Leadership and coordination
Political leadership and commitment are key components for the success of family planning
program design and implementation. Particularly IUCD scale up is a top priority by the
Leadership of the Ministry of Health. IUCD scale up will help to improve the family planning
method mix particularly expanding the range of methods of options.
MOH will provide guidance to scale up the IUCD services and enhance availability of family
planning method options across the country. Therefore the Regional Health Bureaus leadership
and its subordinates will play a key role in implementation, monitoring and evaluation of IUCD
scale up with planned target and outcome. The health system takes the ownership for day to day
activities and closely follows as part of the leadership agenda. Maximizing the roles of donors,
NGOs and CSOs are vital to make the initiative successful.
9.4.2 Increase allocation of resources for family planning
The Ministry of Health will advocate and negotiate for allocation of funds to ensure the
successful implementation of IUCD scale up initiative. It will promote and assist the RHBs to
allocate a reasonable amount of funds for IUCD scale up activities. It is also works to make
available finance for capacity building, family planning commodities, demand creation and
enhancing the enabling environment. The Ministry ensures FP service is accessible to address the
universal health coverage and protects the population from financial vulnerability through the
social insurance scheme and other means.
The Ministry of Health and RHBs will implement the compact agreement and look for other
innovative financing mechanisms to enhance the family planning method options and fill family
planning budget gaps. In addition, national and regional level advocacy has to be made to
increase domestic financing for family planning.
9.4.3 Support, Lead and the IUCD scale up across all levels
The leaders’ commitment is important in safe-guarding policies and strategies for successful
implementation of family planning programs and to meet the expected target and outcome. The
MOH will establish a steering committee at national and regional level to provide technical and
policy guidance and offer recommendations to the Ministry of Health and RHBs. The steering
committee will prepare Terms of Reference (ToR) that guide the responsibility and duties of
stakeholders regarding the implementation of IUCD scale up for improving family planning
method mix.

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MOH with its partner organizations will be employed technical assistance personnel who can
assist and coordinate the implementation of the program across all level.
There is also a need to engage religious leaders, clan leaders and community leaders in planning
and implementation.
9.4.4 Enhance multi-sectoral collaboration platform with leadership of Ministry of Health
Family planning program is not the responsibility of the Ministry of Health alone. There is a
need to engage other ministries through multi-sectoral collaboration platforms. The Ministry of
Health will play a leadership role to engage key sectors such as MoE & MoWSA to integrate and
create collaborative support and ownership at different levels of the government.

10 Activities
10.1 Main Activities: service delivery and access
10.1.1 Health workforce development on LARC and PMs.
• Provide TOTs on CFP /IUCDs and PPFP to have a pool of national trainers
• Cascade comprehensive family planning training to providers selected from
health centers, hospitals, and private facilities.
• Expand the implementation of national family planning quality standards to
selected hospitals and health centers
• Strengthen post IUCD insertion follow-up survey at SDPs through phone and
HEWs to ensure their satisfaction and reduce discontinuation
• Strengthen the capacity of social franchise clinics and increase their access.
• Strengthen mobile outreach to improve access and address inequalities
• Integrating IUCD service with other important health care services, such as
cervical cancer screening and other reproductive health programs
• Develop new digital and hybrid models for provider training
• Revitalize the use willow box of family planning services at the health post level
• Ensure the availability and use of FP counseling pocket guide in all health
facilities
• Provide post-partum FP training to provider’s selected from health centers,
hospitals, and private facilities.
• Conduct IUCD refresher training for selected health providers
• Conduct refresher training on client centered counseling for selected provider
• Conduct post training follow up/clinical mentorship in targeted health facilities

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 • Conduct a rapid needs assessment and mapping of providers particularly on PMs
for identifying health facilities with high caseloads for practicum.
• Conduct training of trainer to produce a pool of national trainers on PMs
through /TOT for PM/
• Cascaded PMs Training to providers selected from selected hospitals and health
center.

10.1.2 Enhance Family planning service integration

• Conduct a rapid baseline facility assessment to introduce FP service integration
and identify non-FP units and mapping trained providers availability at each unit.
• Introduce FP service integration in selected public health facilities.
10.1.3 Ensure family planning client privacy at service delivery points
 Facilitate miner maintenance in family planning rooms to ensure privacy and
confidentiality of services.
10.2. Main Activities: commodity security
10.2.1 Activities to Strengthening the Supply Chain Management across all levels.
• Create common platform for EPSS and health managers/health care providers to
have continuous/periodic meeting to strategize on supplies management and
reduce stock-out by conducting annual joint review meetings.
• Conduct biannual supportive supervisions jointly with EPSS and the health
system at regional level
• Conduct advocacy activities for increasing budget allocation for family planning
commodity and supplies using all available opportunities including annual review
meetings
• Support and follow the reverse logistic or redistributions of FP commodities
among RHB, and HFs to avoid wastage of contraceptive products
10.2.2 Strengthening Public Private Partnership for improving FP commodity security
 Create awareness on IUCD scale up for improving FP method mix to PPM and PPP
stakeholders
10.3 Main Activity: Demand Creation
10.3.1 Improve demand for family planning services through effective social and
behavioral change interventions
 Perform barriers analysis in low FP utilization areas

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  Promote adherence and change to policies informed by evidence-based decision making
 Undertake formative research to support the development of focused messaging and to
inform channel selection, program format, and broadcast schedules.
 Develop tailored FP communication materials for different segment of the community
and monitor their utilization at all levels
 Conduct and standardize family planning messages using different platforms (Mass and
social media,) mainly focusing LARC methods
 Conduct interpersonal communication and community engagement to promote FP
awareness
 Conduct advocacy orientation/training on FP- and RH-related policies.
 "Engage political, civic, local, cultural, religious, and business leaders, superstars and
social influencers to coordinate and scale up public and community outreach on the
benefits of FP"
 Conduct family planning message using IPC platforms ( face to face discussion,
community conversation, & print materials)
 Develop community posters and billboards mainly focusing on LARCs ( IUCD) per
regions with local languages
 Install posters and billboards in the community
 Assess the available Hotline that provides FP information, addresses myths and
misconceptions and address the gaps based on the finding
 Enhance male involvement in family planning service utilization
 Conduct communication and facilitation skills training to HEWs supervisors and or
linkage officers
 Orientation for national and regional radio and television presenters, and health topic
journalists on selected FP themes/LARCs methods
 Advocacy for parliamentarians and higher officials.
 Printing and distribution of a national FP communication guidelines
 Prepare FP Fact sheets for media personnel on LARCs ( Prepare and Print )
10.3.2 Enhancing demand creations for LARCs
• Utilize mobile platforms/applications for FP information on LARCs
• Leverage existing outreach models using HDAs , HEWs, and peer educators to educate
the community about the benefits of LARCs and PM

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10.3.3 Demand creation in humanitarian settings
• Advocacy activities with higher officials and humanitarian organizations to enhance FP
service utilization at Humanitarian settings
10.4 Main Activity: enabling environment
10.4.1 Activities to create enabling environment for family planning.
• Establish a steering committee at national and regional level to provide technical and
policy guidance and offer recommendations to the Ministry of Health and RHBs.
• Utilize the existing RHFP-AYH coordination and collaboration platform at national and
regional level to provide technical and policy guidance and offer recommendations to the
Ministry of Health and RHBs
• Enhance the coordination platform of technical working group for IUCD scale up for
improving family planning method-mix initiative at national and sub-national levels.
• Hire a technical personnel to assist and the coordination, implementation, monitoring
and evaluation of IUCD scale up for improving Family Panning Method-mix program as
per specifying in Job Description (JD)
• Assign family planning program focal person at all level to closely follow the IUCD scale
up implementation integrated with other RHFP-AYH services.
• Conduct high level advocacy meetings for political leaders and decision makers at
National and Regional levels
• Conduct high level advocacy meetings for religious, clan and community leaders at
National and Regional levels
• Conduct a workshop with donors, NGOs and civil society to familiarize the new initiative
to obtain a buy-in and garner technical and financial support

11. Roles and responsibilities of stakeholders

Stakeholders have different roles and responsibilities in supporting the implementation of IUCD
scale up for improving family planning method mix. The following are the roles and
responsibilities of stakeholders:
IUCD scale up for improving family planning method mix will be managed and coordinated at
different levels within the health-care delivery system at National, Regional, Zonal/Woreda,
health facility, and community levels. The Ministry of Health and Regional States and city
administration Health Bureaus shall lead, coordinate and manage the IUCD scale up initiative to
ensure the balance of family planning method mix. This has to be accompanied by strengthening
all pillars of the health system such as governance, financing, workforce capacity, supplies and
equipment to make the program successful and sustainable.

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11.1. Ministry of Health
The Ministry of Health is responsible for the overall leadership and coordination of IUCD scale
up for improving family planning method mix. The IUCD scale up initiative drives from FP
program based on the health sector development and investment plan made for the years 2016 –
2018 EFY.
The MOH will reestablish the existing steering committee at national and regional level to
provide technical and policy guidance and offer recommendations to the Ministry of Health and
RHBs. The steering committee will prepare Terms of Reference (ToR) to determine the members
of the steering committee and guide the responsibility and duties of stakeholders regarding the
implementation of IUCD scale up for improving family planning methods mix. The steering
committee at National Level shall lead by State Minister of Ministry of Health
The MCAH LEO /RHFP-AYH Desk will enhance the existing coordination platform like the
national FP Technical Working Group (TWG) and its sub committees and assigned a focal
person to follow the status of the IUCD scale up and family planning method mix. The TWG
will make a regular meeting and will advise and support the Ministry by monitoring and
evaluating the performance of the initiative. The Ministry of Health will conduct regular
integrated supportive supervision jointly with Regional Health Bureaus, development partners,
and other stakeholders to ensure the proper implementation of the planned activities.
The Ministry of Health cascades the in-service trainings to RHBs and Woredas to build the
capacity of service providers to provide comprehensive FP services particularly meeting the
competency gaps in Accelerating family planning method mix
The Ministry of Health with its functional wing, Ethiopian Pharmaceutical and Supply (EPSS),
works to ensure uninterrupted supplies of drugs, equipment, and other commodities necessary for
the Accelerating family planning method mix at all levels.
Moreover, The Research Advisory Council within the MCAH LEO advises the ministry through
regular policy briefing and generating relevant programmatic evidence. The Ministry of Health
also advocates and supports the implementation, monitoring and evaluation of the IUCD scale up
for improving family planning method mix at all levels.
11.2. Regional Health Bureaus
The Regional Health Bureaus are responsible to lead, manage, and coordinate the
implementation of IUCD Scale up for improving family planning method mix initiative. RHBs
will assign the family planning dedicated or focal person to closely follow the IUCD scale up
initiative throughout the regional health system. The Health Bureaus will also ensure the
communication and understanding of policies, strategies, standards, guidelines, etc. related to the
IUCD scale up for improving family planning method mix with zonal and Woreda health offices,
health facilities and other stakeholders.
The RHBs will reestablish the existing steering committee at regional level to provide technical
and policy guidance and offer recommendations to Zonal and Woreda health offices. The
steering committee will prepare Terms of Reference (ToR) to determine the members of the

23
regional steering committee and guide the responsibility and duties of stakeholders regarding the
implementation of IUCD scale up for improving family planning methods mix. The regional
steering committee could be headed by the Head/Deputy of the Health Bureau.
The Health Bureaus ensure the availability and allocation of necessary finance, competent
health-care workforce, uninterrupted flow of drugs and supplies. The regions also should work
with MoH and EPSS to ensure the availability and accessibility of FP commodities, supplies and
equipment. Bureaus
The Regional Health Bureaus share regular reports with the Ministry of Health including weekly
reports until the IUCD scale up becomes well institutionalized. The regions will also work with
MoH to conduct supportive supervision to track performance uptake and quality of FP services.
The regional health bureaus will communicate and orient zonal and Woreda health offices and
other stakeholders, both private and NGOs, on standardized data collection and reporting tools.
11.3. Zonal Health Office
The zonal offices in the regions are responsible for coordinating and implementing the IUCD
scale up for improving family planning method mix plan. The IUCD scale up is supported
technically and financially by the zonal health offices in collaboration with Woreda health
offices, health facilities, and communities. The Zonal Health offices will be accountable for
proper utilization of the IUCD scale up for improving family planning method mix initiative
including utilization of related resources such as finance, drugs and supplies, and equipment.
The zonal health offices assign trained and competent focal persons, who are responsible for
tracking and monitoring the implementation process, document, learn and perform the planned
activities.
The zonal office should have an updatable database that captures timely information about
trainers, trained personnel on FP, and the types of training they received. The offices will work
with the region and Ministry of Health on continuous education to service providers to improve
competency in knowledge attitude and practice. The zonal offices with Woreda health offices
will play a major role in identifying relevant trainees, organizing and conducting orientation
workshops and training.
The zonal health offices will be working with the Woreda health offices and regions on region-
specific social mobilization for behavioral change, prepare and disseminate behavioral change
communication materials.
11.4. Woreda Health Office
Woreda health office as a program leading, coordinating and implementing point along the
health system administration, should assign focal person to follow up the IUCD scale up for
improving family planning method mix to be implemented in their Primary Health Care Units
(PHCUs) means in primary hospitals, health centers, satellite health posts and community. The
Woreda office will also work with community-based organizations to address the social
determinants of family planning programs. The focal person will work closely with the health
extension program coordinator and health center service providers. Woredas focal person will

24
coordinate capacity building activities, data collection and reporting, and facilitate supportive
supervision activities.
Woreda health office shall work closely with the zonal and regional health offices to ensure that
health workers within the health facilities under its command have to be competent in
knowledge, skill, and attitude in implementing family planning services.
The Woreda office is responsible for timely collection of information on stock of FP
commodities, supplies and equipment, and reports to the next level for decisions to avoid or
minimize unnecessary stock out of supplies. The Woreda health office is also responsible for
promotion of social insurance mechanisms at community level so that the FP financial
vulnerability could be addressed.
11.5. Health Facility Level
Health workers and health facility board members should be well oriented about the accelerating
family planning method mix for IUCD scale up. This will enhance ownership and utilization of
services. The facilities with the Woreda health offices should update the referral protocol based
on the local context and in consultation with clients.
Health facilities should be ready to provide comprehensive FP services. They should properly
display on signboard the services they are rendering to the FP clients. Facilities should attract
and retain FP clients by providing quality information, services and supplies. Services should be
affordable, acceptable, and non-discriminatory. The health facility management team or board
should regularly conduct training, need assessment and communicate with the Woreda health
office in order that knowledge, attitude and practice gaps are filled.

Health facilities with the assistance from Woreda health offices and other stakeholders should
communicate behavior changing messages to the clients who are visiting the facilities. FP
messages can be communicated innovatively through different channels like posters, signposts,
films etc.
 Orienting responsible facility staffs on the initiative and create common understanding
 Developing facility-based action plans on specific targets.
 Assigning appropriate trained provider at FP services and strengthening intra facility referral
linkage
 Ensuring fair and appropriate selection of provider for training
 Ensure availability of all necessary supplies, equipment appropriate room for FP services
 Ensure that HEWs plan for comprehensive FP counseling and referrals
 Providing support as needed e.g., community mobilization, referral from HEWs, outreach service
 Regularly monitor progress in achieving target, the provider performance and take corrective
actions to improve performance.
 Ensure RRF is effectively managed.
 Provide regular updates to the next level system.


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11.6. Providers

 Providing comprehensive FP counseling and services

 Managing side effects & complications related to Contraceptives.
 Sensitizing all health care providers to enhance their positive attitude for service integration.
 Develop a monthly target and implement it accordingly.
 Provide tailored and targeted counseling for clients in FP and non-FP units.
 Maximizing the use of windows of opportunities for FP service utilization such as Switchers,
post-partum, post abortion clients, early adaptor etc.
 Strengthening referral linkage with HEWs/VHA/HAD
 Creating and making use of champion clients among the community or staff.
 Completing and follow up RRF (Report and Requisition Form

11.7. The health extension workers /Kebele/ Community Levels

The health extension workers shall be oriented on the IUCD scale up for improving family
planning method mix to take advantage of their closeness to the community to promote FP
information, services and supplies. The HEWs shall report the FP performance to the next level
using the existing reporting channel. Village Health Leader (VHL) and Women Development
Armies (WDA) shall be oriented on the IUCD scale up for improving family planning method
mix. Health Extension Workers shall work with community volunteers, to educate, provide
services, and to facilitate referral. Health Extension Workers (HEWs) will perform the following
activities include
 Educating/Counseling clients on comprehensive FP service and correct misconceptions
and rumors.
 Recruiting volunteer clients and facilitating referral to HC/Hospitals as necessary.
 Follow up with FP clients and reassure for common side effects and facilitate referral for
complication/serious concerns.
 Assisting health centers in outreach FP programs.
 Collaborate and assist VHAs for demand creation activities
11.9. EPSS
 Making all the necessary FP commodities and supplies available.
 Providing regular updates on month of stock and overall FP commodity status for the
MOH and responsible bodies.
11.10. Partners
 Providing technical support as part of National/Regional TWGs
 Assisting the In service training to be provided for service providers and HEWs.
 Providing training follow up, coaching/mentoring and technical assistance to support
with the health system including their project sites

26
  Supporting Health facilities with basic equipment, instruments, and essential supplies in
their project-supported areas.
 Supporting RHB/ZHD/WoHo in supportive supervision and performance review
 Providing assistance in updating the training and commodities per supported sites.

12. Ownership and sustainability

Ownership is the best strategy to guarantee that a development initiative succeeds and expands in
the long run. Ethiopia has been committed to meeting the rights of family planning needs and a
lot has been delivered already. However, in terms of making all family planning methods
available for all clients and enhancing the knowledge of clients, there is a huge gap to be
bridged. Knowledge on some methods is very high while knowledge on others like IUCD and
permanent methods is very low. As a result of this, utilization of these methods remains
extremely low that compromises the informed voluntary decision making. Global experience
shows that these long-term and permanent methods which are unknown and underutilized
methods are preferred methods globally. Ethiopia is determined to change this situation and
enhance knowledge and information on all family planning methods, thereby enhancing
utilization of under-utilized methods for improving the family planning methods mix. Thus, the
IUCD scale up initiative will enhance client’s right to access all ranges of FP methods.
Collaboration of Government with supporting donors, partners, stakeholders and CSOs is critical
for successful implementation of the IUCD scale up initiative.
The IUCD scale up initiative at this stage will be led by high level government leaders at all
levels. Under the guidance of the Ministry of Health, relevant donors, partners and CSOs will
make their contributions for successful implementation and outcome of the IUCD scale up
initiatives.
Resource mapping (Gov., Partners, Compact…) will be prepared by strategic priority and main
activities. Accordingly, a gap analysis will be done to indicate the gap and mobilize more
funding and commitments. The federal and regional Government will allocate funds and other
resources for the initiative from the start and this contribution will increase by stages every year.
Eventually regions and the federal government are expected to generate the resources necessary
to integrate the initiative into its family planning program and run it in a sustainable manner.
Sustainability of the intervention will be supported by a positive policy environment and the
commitment of the health system at all levels to increase the FP services utilization including
partial cost recovery mechanism. As part of sustainability, it is important to make sure the
private health sector continues to play an important role in delivering FP services so the
government health system has to build the capacity of the private sector and create an enabling
environment for the health sector to function effectively and efficiently.

13. Monitoring and evaluation

Continuous monitoring the implementation progress and evaluations of the outcome will provide
the required evidence for decisions that foster effective, efficient, and synergistic for
implementation of the IUCD scale up for improving family planning method mix. The
implementation will be integrated with other health services as stated in FP integration

27
guidelines. Monitoring and evaluation will be done on the bases of a regular performance
tracking system at all levels of the health system through health information system (DHIS2).
Research and surveys will also be used to assess the progress made and to evaluate the outcomes
and impacts. IUCD scale up of activity plans will be monitored weekly, monthly and quarterly
through DHIS2 reporting mechanisms. Following data monitoring, a review meeting needs to be
conducted with implementers and supporting partners biannually to see the performance
progress, share experiences among each other and address bottlenecks. Data can be collected
using existing tools for the monitoring of the initiative. In addition, the initiative should also put
in place an evaluation tool to measure the outcome and impact of the initiative. The evaluation
indicators and annual plan should also be developed before the start of the IUCD scale initiative.
It is also important to find ways of collecting baseline data at the start of the initiative to measure
the outcome of the initiative accurately. To accomplish the monitoring and evaluation
successfully, FP TWG will assign a partner to lead the monitoring and evaluation of the IUCD
scale up initiative.
Monitoring and Evaluations Tools
1. Weekly, Monthly and Quarterly reports
The Ministry of Health, Regional Health Bureaus, Zone offices, Woredas and Partners should.
Involve in monitoring and evaluation activities.
The following are activities to be consider under M and E component:
 Develop a baseline assessment tool to monitor the progress of the initiative
 Produce quarterly reports to trace the progress and measure the output indicators
 Conduct a rapid facility assessment and mapping of facilities for LARC and PMs
 Conduct supportive supervision for national and regional level by quarterly
 Integrate the initiative key indicators with quality audits for quality assurance
 Strengthen quality assurance and PMT in each facility
 Conduct experience sharing visit among best and low performing regions
 Documentation and sharing of best practices
 Conduct review meeting at national and regional level by bi-annually

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15. References
1. Ethiopian Public Health Institute (EPHI) [Ethiopia] and ICF. Ethiopia Mini Demographic
and Health Survey 2019

2. FMOH. HSTP-II. Addis Ababa: FMOH. 2021.

3. Central Statistical Agency (CSA) [Ethiopia] and ICF. Ethiopia Demographic and Health
Survey 2016.

4. WHO. Task sharing on Family planning. Geneva: WHO. 2012.

5. FMOH. Implmentation plan for scaling up of long acting and permanent family planning
methods in Ethiopia. Ethiopia. Unpublished; 2015.

6. United Nations, Department of Economic, and Social Affairs, Population Division (2019),
united nations. Contraceptive Use by Method 2019. 2019 p. 4–8.

7. Katz Karen R, , Fekade Bethelhem, , Stankevitz Kayla, , Chen Mario, , Teklu Alula M, , and
Kebede Tadele, et al. Quality of Long-acting reversible contraception provision by Level 4
Health Extension Workers. Durham, NY & Addis Ababa: FHI 360, MERQ Consultancy
PLC-LLC, Ethiopia, FMOH, 2019.

8. USAID. The cost of family plnning in Ethiopia. Washington DC: USAID. 2010.

9. Chifra, W., Garedew, T., Lingerih, W., and, Malakoff, S. Service integration: A Winning
Strategy to Extend Family Planning Availability and Avoid Missed Opportunities—
EngenderHealth’s Access to Better Reproductive Health Initiative (ABRI) Project
Experience. 2020.

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30
Annexes

A. IUCD Scale Up Target by Health Facilities

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B. IUCD Scale Up Target by Users

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33