On any given day at the Ratoma municipal clinic in Conakry, Guinea, Aminata Kaba and Sire Camara can be found offering advice to women about options in family planning, or training clinic staff on effective counseling methods. The two women doctors, both ob/gyn specialists, have been the driving forces in efforts to expand and improve postabortion care (PAC) services at their clinic. Kaba and Camara understand that PAC is often a particularly sensitive time for clients, but also a critical time to help a woman identify and obtain a family planning method of her choice.

With support and training from Jhpiego, Kaba, head of Ratoma’s maternity ward, and Camara, responsible for the clinic’s PAC services, “have really been the ones to shake things up at the clinic,” said Yolande Hyjazi, Jhpiego’s Guinea Country Director. “The doctors have successfully advocated for a steady supply of contraceptives and ensured that PAC services are available 24/7 in Ratoma.”

And their efforts have paid off in a big way—the percentage of women receiving a family planning method before leaving the clinic increased from just 11 percent to 83 percent, as of the most recent assessment. Kaba, a 55-year-old mother of four, and Camara, a 48-year-old mother of three, have been identified as “champions” of this initiative, which is funded by the U.S. Agency for International Development (USAID).

Hyjazi has seen firsthand the substantial gains the doctors have made since being trained by Jhpiego in 2009 in Standards-Based Management and Recognition (SBM-R^®), an innovative performance and quality improvement approach.

Through their work at Ratoma to ensure that women have options in family planning, Kaba and Camara are building upon Jhpiego’s past work in Guinea. Jhpiego has collaborated closely with the country’s Ministry of Health and Public Hygiene (MOH) since 1998 to support the introduction, expansion and improvement of high-quality PAC services. This work is part of Jhpiego’s ongoing efforts to partner with countries in building the capacity of health care workers and strengthening health systems to prevent the needless deaths of women and families. The organization develops innovative, low-cost technologies to address today’s global health challenges and works with communities to increase frontline health workers’ ability to deliver lifesaving care.

Dr. Sire Camara (standing) has helped lead gains in use of family planning services by women receiving care at the clinic where she works in Conakry, Guinea.

Despite significant gains, an evaluation of PAC services in Guinea in 2007 found that, on average, only 45.6 percent of women leave health facilities with a modern contraceptive method, and some sites show even lower percentages. At the same time, USAID Washington supported an assessment of PAC services in the sub-region of Francophone countries. A meeting was then held in Senegal with country representatives to share experiences, discuss assessment results, and identify problems and possible solutions.

Out of this meeting, the Virtual Fostering Change Program (VFCP) was established to improve the quality of PAC. Guinea assembled a team—which included representatives from the MOH, multilateral organizations, USAID and service providers—to join the fostering change program, and developed an action plan to increase the proportion of women receiving PAC services who leave with a contraceptive method of their choice. The identified goal was to increase the average percentage from 45.6 to 60.

The Ratoma clinic, which serves a population of 160,000, was among three municipal clinics chosen as a pilot site during VFCP’s first year of implementation from October 2009 to September 2010. The implementation team chose to use performance standards for PAC to provide guidance for service providers at the sites, evaluate services, identify gaps and fill them. The team also encouraged all providers to use these standards as reminders and job aids to improve services.

“Putting the SBM-R process in place allowed us to elevate the level of our services and to improve the quality of care. We involved all of our personnel in these activities,” explained Camara.

Kaba added, “We established a dialogue to motivate our personnel. We also encouraged teamwork and opportunities for feedback to improve the quality of services.”

Dr. Tsigué Pleah, Senior Reproductive Health Advisor at Jhpiego, worked closely with Hyjazi to lead technical assistance efforts in Guinea, in particular the ongoing virtual support of VFCP. Recently, when speaking of the Ratoma duo, Pleah said, “Both are very strong individually, and together they are a formidable team.”

Yolande Hyjazi (standing), Jhpiego’s Guinea Country Director, with Dr. Aminata Kaba, head of Ratoma’s maternity ward, and Dr. Bernard F. Tonguino, service provider at Ratoma's maternity ward, during a Jhpiego training on family planning methods.

The efforts of Kaba and Camara were recognized regionally during a ceremony organized for the sites that had achieved the best results according to their action plans. As part of the recognition, the sites received a donation of materials, including medical equipment, infection prevention supplies, examination gloves, job aids and posters illustrating family planning methods. Ratoma was singled out for special commendation for its work in reaching program objectives.

Kaba and Camara say they are both inspired by their desire to achieve good results that will help the women they serve. In this spirit, they are forging ahead with plans that will improve services at their facility even further and ensure that all women who desire a family planning method leave with one of their choosing.