PMID- 32124589 OWN - NLM STAT- MEDLINE DCOM- 20210226 LR - 20210226 IS - 2322-5939 (Electronic) IS - 2322-5939 (Linking) VI - 9 IP - 2 DP - 2020 Feb 1 TI - Scaling Up a Strengthened Youth-Friendly Service Delivery Model to Include Long-Acting Reversible Contraceptives in Ethiopia: A Mixed Methods Retrospective Assessment. PG - 53-64 LID - 10.15171/ijhpm.2019.76 [doi] AB - BACKGROUND: Donor funded projects are small scale and time limited, with gains that soon dissipate when donor funds end. This paper presents findings that sought to understand successes, challenges and barriers that influence the scaling up and sustainability of a tested, strengthened youth-friendly service (YFS) delivery model providing an expanded contraceptive method choice in one location - the YFS unit - with additional units in Amhara and Tigray, Ethiopia. METHODS: This retrospective mixed methods study included interviews with key informants (KIs) (qualitative arm) and analysis of family planning (FP) uptake statistics extracted from the sampled health facilities (quantitative arm). A multistage convenience purposive sampling technique was adopted to randomly select 8 health facilities aligned with respective woredas, zones and regional health bureaus (RHBs). A semi-structured interview guide soliciting information on 6 scaling-up elements (stakeholder engagement, roles and responsibility, policy environment, financial resources, quality of voluntary FP services and data availability and use) guided the interviews. Fifty-six KI interviews were conducted with policy-makers, program managers, and clinic staff. Recurring themes were triangulated across administrative levels and implementing partners. Relevant FP data (acceptor status, age and method uptake) were extracted from the 8 sampled health facilities for a thirteen-month period. Qualitative findings triangulated with FP service statistics assessed the influence of the 6 scaling-up elements with trends in long-acting reversible contraceptive (LARC) uptake before and after training. RESULTS: Our findings depict that respondents were knowledgeable and supportive of an expanded method mix. Statistically significant increases in long-acting contraceptive uptake were noted at 2 of the 8 health centers. Fidelity to the tested model was operationally constrained; respondents frequently mentioned trained staff absences and turnover as obstacles in offering quality FP services. CONCLUSION: Despite conducive policy environment, supportive stakeholders, favorable environment, and financial support for trainings, statistically significant increases in LARC uptake occurred at only 2 of the 8 health centers; indicating the influence of weak health systems, poor quality of voluntary FP services and a ceiling effect. Scale-up processes must consider potential bottlenecks of weak health systems and availability of financial resources by addressing these as crucial elements in any systematic scale-up framework. CI - (c) 2020 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/ licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. FAU - Fikree, Fariyal F AU - Fikree FF AUID- ORCID: 0000-0003-4327-9024 AD - Evidence to Action/PATH, Washington, DC, USA. FAU - Zerihun, Habtamu AU - Zerihun H AD - Pathfinder International, Addis Ababa, Ethiopia. LA - eng PT - Journal Article DEP - 20200201 PL - Iran TA - Int J Health Policy Manag JT - International journal of health policy and management JID - 101619905 SB - IM MH - Adolescent MH - Contraception/*statistics & numerical data MH - Ethiopia MH - Family Planning Services/*organization & administration MH - Female MH - Health Services Accessibility MH - Humans MH - Long-Acting Reversible Contraception/*statistics & numerical data MH - Pregnancy MH - Pregnancy in Adolescence/*prevention & control MH - Reproductive Health Services/organization & administration MH - Retrospective Studies PMC - PMC7054650 OTO - NOTNLM OT - Ethiopia OT - Family Planning OT - Mixed Methods Study OT - Scaling-up OT - Youth-Friendly Services EDAT- 2020/03/04 06:00 MHDA- 2021/02/27 06:00 PMCR- 2019/09/28 CRDT- 2020/03/04 06:00 PHST- 2019/03/14 00:00 [received] PHST- 2019/09/11 00:00 [accepted] PHST- 2020/03/04 06:00 [entrez] PHST- 2020/03/04 06:00 [pubmed] PHST- 2021/02/27 06:00 [medline] PHST- 2019/09/28 00:00 [pmc-release] AID - 10.15171/ijhpm.2019.76 [doi] PST - epublish SO - Int J Health Policy Manag. 2020 Feb 1;9(2):53-64. doi: 10.15171/ijhpm.2019.76.