Evaluation of immediate and sustained effects of transitioning quality long-acting reversible contraceptives (LARCs) services to public sector health facilities in Ghana: a pre-post intervention study

This 5 year collaboration between MSI-Ghana and the Ghana Health Service increased the capacity of providers at 210 GHS facilities to provide high-quality LARC services. Future programs to improve LARC provision in the public sector may also consider including sustainable interventions to strengthen logistical management systems and targeting barriers to LARC access in the community. Increasing access to and use of modern contraception reduces unintended pregnancies and unsafe abortions, thereby decreasing maternal morbidity and mortality. Despite long-acting reversible contraceptives (LARCs) are highly effective at pregnancy prevention and favored by clients, utilization in many low- and middle-income countries has been low. In Ghana, less than half of women who want to delay, space, or limit childbearing use a modern contraceptive method. As the public sector is the predominant source of family planning services, improving the quality and provision of LARC services in the public sector has the most potential to increase women's access to LARCs. Marie Stopes International-Ghana collaborated with Ghana Health Service to implement a 5-year program to transition the provision of quality LARC services from its mobile clinic outreach model to public sector health facilities through a phased approach. We studied the immediate and longer-term effects on the provision and utilization of quality LARC services in the public sector. We collected three rounds of data from intervention facilities, associated providers, and clients. We found increased providers providing IUD services, trained in LARC provision, and increased and sustained knowledge needed for quality LARC services provision. Despite improvement, after the intervention ended, IUD availability at the facility decreased. Facilities that completed the intervention for at least several months were less likely to maintain the increased level of LARC provision than those still in the intervention or recently concluded. These findings underline the need for additional efforts to strengthen logistical management systems to ensure consistent provision of quality LARC services.