Five health facilities in Togo drastically improved family planning services for and increased use among clients seeking care for postabortion complications, thanks to IntraHealth International’s signature quality-improvement approach: Optimizing Performance and Quality. These results were published this fall in Global Health Science and Practice.

Before the intervention, only 31% of postabortion care (PAC) clients received family planning counseling, and, of those who did, 37% accepted a contraceptive. During the intervention period, 91% of clients received counseling, and 60% of those women opted to use a contraceptive. Oral contraceptives were the most popular method before and during the intervention periods, but the uptake of implants increased significantly, from 4% to 27% of women who opted to use a method.

High-quality PAC services that include family planning counseling and a full range of contraceptive methods at the point of treatment are critical to saving lives and reducing unintended pregnancies and unsafe abortions. In 2014, at least 9% (16,000) of maternal deaths in Africa were due to unsafe abortion.

There is no one-size-fits-all solution to improving PAC services. Optimizing Performance and Quality offers health facility leaders a comprehensive approach to identifying customized and realistic solutions to health service delivery problems. The approach walks a designated quality-improvement team through assessing existing performance, defining desired performance, identifying gaps and solutions, and systematically monitoring progress and tracking results.

The facilities in Togo identified the following needs:

• Reorganizing services to ensure that contraceptives are provided at point-of-treatment for postabortion complications before clients are discharged
• Improving provider competencies in family planning services, including in providing long-acting reversible contraceptive implants and intrauterine devices
• Ensuring that contraceptive methods are available to all PAC clients free of charge
• Standardizing PAC registers and enhancing data collection and reporting systems
• Enhancing internal supervision systems at facilities and teamwork among PAC providers
• Engaging PAC providers in community talks.

The project established national- and facility-level quality-improvement teams to lead the process and develop solutions.

This work was completed as part of the Evidence to Action (E2A) project—the US Agency for International Development’s flagship global project for strengthening family planning and reproductive health services. IntraHealth is a partner on the project, which is led by Pathfinder International.

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