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National Reproductive Health Program

National Reproductive Health Program. Voluntary Surgical Contraception in Cambodia Racha and The Partnership Focus Areas. Presented by Dr. Ky Kien Hong. HISTORY. Permanent method Used since abdominal surgery started

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National Reproductive Health Program

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  1. National Reproductive Health Program Voluntary Surgical Contraception in Cambodia Racha and The Partnership Focus Areas Presented by Dr. Ky Kien Hong National VSC Meeting June 2003

  2. HISTORY • Permanent method • Used since abdominal surgery started • Introduced in 1997 (NMCHC, Kampot, Pursat and Siem Reap province and RHAC) • Teams trained in Bangladesh and Indonesia • National VSC policy and guidelines published by MOH in October 1998 National VSC Meeting June 2003

  3. The principals of minilaparotomy & no scalpel vasectomy • Both methods: • Performed under local anesthesia • Small wound • Limited operating duration • Quick recovery • Less or no stay in the hospital • But requires special attention: • Gentle handling, contact with client National VSC Meeting June 2003

  4. The key principals of mini-laparotomy • Local anesthesia in a “diamond” plan • Small incision • (Modified) Pomeroy technique • Additional anesthesia drops if needed • Uterine elevator and tubal hook National VSC Meeting June 2003

  5. The key principals of no scalpel vasectomy • Introduced in China by • Dr. Li Shunqiang in 1974 • Since than over 9 million • vasectomies wold wide have • been performed National VSC Meeting June 2003

  6. Voluntary Surgical Contraception Criteria • When can tubal ligation be performed? • 1. Meet the MOH guidelines • 2. Interval • Any time if you are reasonably sure the woman is not pregnant. • During 7 days beginning with the onset of menses. • During the use of birth spacing methods: Pills, Injectable, IUD, Condoms... National VSC Meeting June 2003

  7. 3. Early postpartum • preferably within the first 2 days (48 hours) • postpartum. • But can be performed up to 7 days postpartum. • 4. Late postpartum • once the uterus is fully involuted (6 weeks). • 5. Post abortion • preferably within the first 7 days post abortion, • if you are sure the woman is free of infection. National VSC Meeting June 2003

  8. Voluntary Surgical Contraception Criteria • When can vasectomy be performed? • Whenever the couple meets the MOH guidelines and conditions, and the man is willing to get the intervention. National VSC Meeting June 2003

  9. Barriers and obstacles • Cultural Barriers: community views on fertility, fear of surgery, rumors • Physical Barriers: location of services, provision of services • Economic Barriers: posted costs, hidden costs (time, transport) • Lack of specific Counseling & IEC • Medical Barriers: screening criteria, target population. National VSC Meeting June 2003

  10. VSC Strategy Cambodia • Site visit and needs assessment • In-country, competency-based training • Theory and demonstration of techniques • Practice on models • Clinical practice guided by trained coaches • Equipment and commodities • Information session at OD level • IEC: leaflets, banners, video, .. • Free services and travel • Supportive supervision • Site visit and needs assessment • In-country, competency-based training • Theory and demonstration of techniques • Practice on models • Clinical practice guided by trained coaches National VSC Meeting June 2003

  11. How to move the barriers and obstacles? National VSC Meeting June 2003

  12. How to move the barriers and obstacles? • information sessions • for leaders and authorities • for health staff on the methods • for better counseling National VSC Meeting June 2003

  13. In-country Training • Started in 2001 • 4 sessions: 2001(2) - 2002 – 2003 (1+1) • surgeons: 30 (ML & NSV) • counselors: 36 (ML & NSV) • average # of clients: 62 (8 for each participant) National VSC Meeting June 2003

  14. Expansion and access Year New Cumulative • 1997: 5 5 • 2001: 5 10 • 2002: 6 16 • 2003: 3 (+3) 19 (22) National VSC Meeting June 2003

  15. VSC Expansion 1997 – 2003in 19 Operational Districts National VSC Meeting June 2003

  16. 1400 1267 1186 1200 1015 983 1000 800 672 528 600 423 416 400 256 252 188 195 203 134 144 142 140 105 200 2 7 3 6 5 2 0 1997 1998 1999 2000 2001 2002 <2003> 2003 may NSV TL Total Total number of acceptors National VSC Meeting June 2003

  17. Number Living Children Median (Mean) number Vasectomy: 5 (4.87) Mini-laparotomy: 4 (4.21) National VSC Meeting June 2003

  18. Age distribution of VSC Clients Median age Vasectomy: 36 Mini-laparotomy: 34 National VSC Meeting June 2003

  19. Other Birth Spacing methods used among elective clients National VSC Meeting June 2003

  20. What makes a program successful? Clients demand for services Quality Services Support National VSC Meeting June 2003

  21. sUmGrKuN Thank for your attention National VSC Meeting June 2003

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