Nyanwiir Ajou is a 28-year-old mother of four. She was married at the age of 13 years. After her husband got involved in a car accident that left him physically disabled, Nyanwiir became the sole bread winner of her family. She does not have a stable source of income. Nyanwiir volunteers her time and services as a counsellor at the Comprehensive Care Centre Clinic (CCC) unit in Aweil State hospital in South Sudan. Nyanwiir visited the WISH Adolescent Sexual and Reproductive Health (ASRH) clinic at Aweil State hospital clinic for family planning services after a referral from her friend who was a family planning user. Nyanwiir sought advice from the friend as she was not ready for another child. The friend recommended that she visits the ASRH/FP clinic at Aweil State hospital, which offers free services. At the clinic, Nyanwiir was counselled on different family planning methods. She voluntarily chose the Intrauterine Device (IUD) method. The nurses explained to Nyanwiir that the method she had chosen was a 10-year one, though she could have it removed at any time she felt prepared to have another child. “I need my body to rest, I got married early and gave birth to my children. I need more time to search for a better job. If I am financially stable even if it is in five years, I will come back and have the method removed then get another baby. But before then I will keep the method," said Nyanwiir. Referrals Nyanwiir has become an advocate of family planning services. She has been referring clients from the CCC unit to the ASRH/FP clinic where they can get free services. She recently referred one mother of 10 children, who is also breastfeeding. The mother could barely fend for her family and send her children to school due to the poor economic status of the family. Even though she was fearful about getting pregnant again, she did not know how to prevent that from happening. After a chat with Nyanwiir, she went to the ASRH/FP clinic where she was counselled and opted for Jadelle as her method of choice. Comprehensive counselling from service providers in Aweil ASRH/FP unit has effectively encouraged clients to make informed choices on long term reversible contraceptive methods, mostly implants and the IUD. Partnerships The Women’s Integrated Sexual Health (WISH) programme, under the strategy of ‘Leave No One Behind’, offers quality integrated and inclusive family planning and sexual and reproductive health services - to marginalized and hard to reach populations: the poor, youth under 20 and people living with a disability. WISH brings together service delivery with experts in the field of health systems strengthening and advocacy, social behaviour change communications, disability inclusion and humanitarian expertise. One such partner is the International Rescue Committee (IRC), which works in partnership with the government in Aweil State hospital to offer services in the ASRH/FP unit. IRC provides staff, medical supplies and commodities that support family planning services at the clinic. In addition, staff from the hospital are invited for trainings organized by the WISH programme.  The IRC strategically leveraged on the existing ASRH clinic supported by UNFPA by placing the WISH team to work together and provide family planning services while also targeting the youth. There has been a notable increase in family planning services uptake in Aweil State hospital. During the reporting period, 486 Couple Years Protection (CYPs) were provided at the clinic, an increase from 362 CYPs provided in the previous quarter. Médecins Sans Frontières (MSF) who are an implementing partner within the hospital, also refer clients for post abortion care, thus improving the comprehensive services offered within the facility. The staff have reported teamwork and that the bulk of the work has been shared with the staff working at the ASRH/FP clinic, hence reducing workload. By complementing different actions from different agencies and donors, the overall outcome of health services is improved within the hospital. There is improved coordination within the hospital staff in patient care management which eventually has improved on the quality of care for family planning and other health services. For more updates on our work, follow IPPF Africa Region on Facebook, Twitter, Instagram and You Tube.

Today, the world marks World Contraception Day (WCD). Launched in 2007, WCD is a global campaign which envisions that every pregnancy in the world should be wanted. It generates awareness of the different kinds of contraception that women can use. Ahead of the day, UN experts have issued a statement, reaffirming that “access to family planning and contraception services, free of coercion or impediment, is a component of the right to health that is central to women’s autonomy and agency and key in the realization of women’s rights to equality and non-discrimination, life, sexual and reproductive health rights and other human rights.” “Every women and adolescent girl has the right to access contraception and family planning services, information and education," the experts added. The benefits of family planning are well documented, from individual well-being, avoiding unintended pregnancies, enhancing the individual rights to reproductive choices up to the economic dividends associated with optimal family sizes.   The campaign believes that not only women, but also their partners, health care professionals, and other relevant persons, should be as informed about contraception as possible. Many individuals need to modify the type of contraception they use for a number of reasons, which is why they should be aware of the many options available. Furthermore, it promotes the notion of a person’s autonomy over their body. It also aids in the prevention of sexually transmitted diseases. The right of all couples and people to choose the number and spacing of their offspring independently and responsibly was stated during the International Conference on Population and Development in 1994, and is embodied in the 2030 Agenda for Sustainable Development within goal 3.7. During the 2012 London Family Planning Summit, world leaders, civil society organizations and leading private and commercial entities made commitments to improve access to contraception. This advocacy effort led to Family Planning 2020 (FP2020), a global call to add 120 million additional contraception users by 2020. Almost a decade later, there have been massive investments to improve access to contraception across the world. Funded by the UK Foreign Commonwealth and Development Office (FCDO) and led by IPPF and MSI Reproductive Choices, the Women's Integrated Sexual Health (WISH) programme is designed to contribute to this global effort. The WISH programme has focused on adding integrated and holistic sexual and reproductive healthcare to 3.3 million additional contraception users in 26 countries across Africa and South Asia. While this target is likely to be surpassed during the project's life, the challenges facing the health systems in these countries are related to the quality of care. Thus, improving reproductive health services delivery is crucial to address reproductive health problems beyond accessing contraception methods. Improving the delivery and quality of reproductive health services is crucial to attaining global family planning targets. Healthcare has witnessed significant scientific advances and technologies in the past 100 years to achieve a better quality of life. Healthcare quality improvement involves using appropriate processes to narrow the gap between the existing and expected levels of quality. Similar to the efforts to increase access to contraception choices, improving the quality of care in family planning is not a matter of science alone; it is more about commitments and collective decisions to achieve better experiences in the healthcare settings.   Healthcare services exist to meet the health needs and expectations of clients. Reproductive health services should be designed to meet those needs and expectations. By emphasizing quality of care, we strive to deliver healthcare processes that meet client needs and expectations. Many of us have had a routine check-up at our physician's office, probably an emergency surgery, or visited a sick relative at the hospital. There is increasing evidence of excellent amenities and facilities in healthcare service delivery settings. But we also know of more negative experiences. There are stories of disrespect, crowded clinics, delays in care, ineffective care, misdiagnosis, or sheer abandonment of the healthcare infrastructure by the relevant authorities. Patients are healthcare consumers, and understanding their needs is vital for quality service delivery. While investing in better access to contraception, it is paramount that respectful and dignified care is advanced as a minimum requirement in family planning service delivery. While ensuring that no one is left behind in accessing reproductive health information and services, the WISH programme has supported the establishment of institutions to govern quality. These include setting up quality improvement teams at management and service delivery levels because leadership structures are essential to guide the implementation of continuous quality improvement in family planning programs. Through collective efforts, each day, whether service providers or consumers of reproductive health services, we can contribute to better experiences in the healthcare sector. By Peter Mutanda, Technical Lead, Quality of Care - IPPF WISH Programme For more updates on our work, follow IPPF Africa Region on Facebook, Twitter, Instagram and You Tube.