PSI Digital Health & Monitoring Helpdesk

RH Department, May 2010

For PSI platforms increasing access to long-acting and reversible contraceptives (LARCs)—namely IUDs and implants—health impact credit can be generated through two ways: distribution/sales of products and/or delivery of LARC services.  The conditions under which countries can report an IUD or Implant insertion or a sale/product distribution are described below.  An additional category for credit based on referrals to service points is under development and will be outlined in a subsequent policy document.

What counts as a sale/distribution? 

All IUD and Implants procured and distributed by PSI and its affiliates currently receive product distribution credit when sales/distributions are reported via the CTL or Lawson.

Starting in 2010 the DALY for IUD distribution will be updated to include a wastage factor, which was inadvertently left off the previous model. A wastage factor is currently applied to all other FP products, including implants, to account for the possibility that product distributed is not used. This change will result in an average reduction in the IUD distribution DALY by 20%.  The new DALY coefficients will be applied retroactively to all IUD sales/distributions.

However, countries that ensure insertion of a product now have the opportunity to get DALY credit without the wastage deduction, according to the guidance described below.

In the case that an IUD or implant is first sold/distributed and later inserted, health impact credit will not be double-counted.

What counts as an insertion?  

A service delivered at a clinic where PSI provides essential inputs and regular support can result in insertion health impact credit.  If a PSI staff directly delivers a service (for example, seconding or outreach models), insertion credit will be given without having to meet the requirements below.   

 For all other service delivery models, insertion credit will be given when the requirements below are met:

• PSI has a signed agreement/Memorandum of Understanding with a provider, which stipulates that the provider must comply with PSI Service Delivery Standards (see Annex 1).
• An initial assessment of the facility and provider has been conducted by PSI staff and an annual performance assessment is conducted to ensure that the provider continues to adhere to PSI Service Delivery Standards.
• Provider receives ongoing, regular support from PSI (this may include: monthly/quarterly supervision visits and/or technical update meetings, supportive supervision/coaching during event days, etc). 
• PSI reviews and collects documentation on clients served, such as client registry books.
• In addition to requirements 1-4, PSI provides at least one additional input outlined below (either facility improvements, provider training, demand creation, and/or franchising). 

Insertion credit will be given for services provided either with PSI product (i.e. product distributed by PSI) or non-PSI product (i.e. product from another source, such as MoH). 

Insertion data should be reported via the Health Services Report in DHIS2 at https://www.psi-mis.org.

Annex 1: PSI Long-acting and Reversible Contraceptive Methods Service Delivery Standards 

Taken from PSI Quality Assurance Manual, Section 2.1  

Complete manual available on KIX: http://kix.psi.org/display/srht/Quality+Assurance+Manual+English

Technical Competency Standards  

Standard 1:  Procedures must be performed by licensed and registered health professionals who are authorized to do the procedures by national laws.

Standard 2:  All personnel providing IUD or Implant insertion or removal in affiliation with the program must have received training from PSI or an accredited organization and demonstrate competency to a qualified PSI affiliated medical personnel in the procedure in a clinical setting (e.g. Not only on a model).  

Standard 3:  Provider must perform services according to protocol approved by PSI Global Medical Director.

Standard 4:  All PSI-affiliated providers will have a current letter of agreement or employment contract with PSI that clearly stipulates the roles and responsibilities of both parties and consequences of noncompliance.

Standard 5:  Agreements with PSI-affiliated provider must be renewed on annual basis, pending satisfactory evaluation of provider skills and procedural compliance. 

Client Safety Standards 

Standard 1:  Providers must properly screen clients for service eligibility, according to “PSI Service Delivery Protocols.” See Implant Protocols: Section 4 & IUD Protocols: Section 4

Standard 2:  All PSI-affiliated clinics must comply with the minimum facility standards as per the PSI Service Delivery Manual and are approved by a PSI medical representative before beginning service delivery.

Standard 3:  Provider must follow PSI-approved procedures for infection prevention. [see Implant Protocol Section 3 and IUD Protocol Section 4]

Standard 4:  Facilities must have all required insertion equipment, infection prevention equipment and sufficient supply of non-expired consumables (i.e. bleach, gloves, proper equipment, product).

Standard 5:  Providers and other project-affiliated staff must follow PSI mandated procedures for handling and reporting adverse events so that appropriate and timely follow-up care can be provided to clients if necessary. [See Adverse Events and Complications Policies and Procedures] 

Informed Choice Standards 

Standard 1:  Clients must receive appropriate counseling that includes comprehensible information about the benefits, risks, and side effects, of any chosen modern method prior to receiving that method (either by the provider herself or another designated counselor).

Standard 2:  Clients will have access to a range of modern methods or information on where to obtain such methods.

Standard 3:  Providers and program personnel must not be subject to any targets or quotas for the number of family planning acceptors or acceptors of a particular method.

Standard 4:  There must not be incentives to individuals in exchange for becoming acceptors or to program personnel for achieving targets or quotas for numbers of acceptors of a particular FP method.

Standard 5:  All Incentives Schemes for providers and recruiters must be documented and submitted for approval to PSI/Washington to assure that there is no coercion and unacceptable bias. 

Privacy and Confidentiality Standards 

Standard 1:  Services, especially IUD insertions, must be performed in a setting that offers the client privacy (i.e. the setting is screened from view of others). 

Standard 2:  Precautions must be taken to ensure that client records are stored safely and confidentially.

Continuity of Care Standards 

Standard 1:  The provider must inform clients about post-insertion and follow-up care, including circumstances under which she should return to the clinic or referral site.

Standard 2:  The facility must provide the client with information on who to call or where to go in case of emergency or if she has questions or concerns.

Standard 3:  If the provider is not available or not qualified to provide appropriate follow-up care (as with some event days or in case of an adverse event), client must be informed PSI-approved referral sites for follow-up care.

Standard 4:   PSI programs must have some mechanism to assess client satisfaction with services, including pre-counseling, insertion, provider access, and follow-up care.