title: Mentoring, Task Sharing, and Community Outreach Through the TutoratPlus Approach: Increasing Use of Long-Acting Reversible Contraceptives in Senegal.
abstract: To broaden access to family planning in rural areas and improve contraceptive prevalence, Senegal, in the context of wide method choice, is promoting implants and the intrauterine device, currently used throughout the country by only 5.6% of women of reproductive age who are in union, primarily urban women.
  
  
  
  The TutoratPlus performance improvement approach strengthens family planning clinical skills, particularly for long-acting reversible contraceptives (LARCs), through mentoring, task sharing, and community outreach. Following a 2013 baseline situation analysis, 290 participating facilities in 12 of Senegal's 14 regions developed action plans to address gaps identified in 3 areas: provider performance, equipment, and infrastructure. Between 2013 and 2014, 85 trained mentors coached, demonstrated skills, and observed 857 providers, including nurses, nonclinical family planning counselors, and community health workers (CHWs), in LARC service provision through two 5-day visits per facility at 21-day intervals. We used routine service delivery data and TutoratPlus mentoring data to assess changes in contraceptive use, including LARCs, 6 months before and 6 months after the mentoring intervention among 100 of the facilities with complete data.
  
  
  
  The baseline assessment of 290 facilities found that fewer than half (47%) had a provider who could offer at least 1 LARC method, and 64% to 69% lacked kits. Post-intervention, all 290 facilities were adequately equipped and clinically able to offer LARCs. Among the 552 clinical providers, the percentage with acceptable LARC performance (at least 80% of observation checklist items correct) doubled from 32% to 67% over the 2 mentoring visits. In the 100 facilities with available comparison data, the number of new LARC users rose from 1,552 to 2,879 in the 6 months pre- and post-intervention-an 86% increase.
  
  
  
  Success of the TutoratPlus approach in Senegal is likely in part attributable to addressing facility-specific needs, using on-site mentoring to assess provider capacity, and achieving workplace enhancements through community engagement. Without CHW-initiated community outreach, LARC uptake might have been lower. Although task sharing requires institutionalization within national health systems, TutoratPlus demonstrates that provider skills can be improved, facilities can be better equipped, and demand can be promoted using existing government and community resources.
authors.affiliation: IntraHealth International, Dakar, Senegal.
authors.forename: Babacar
authors.initials: B
authors.lastname: Gueye
authors.affiliation: IntraHealth International, Chapel Hill, NC, USA jwesson@intrahealth.org.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wesson
authors.affiliation: IntraHealth International, Dakar, Senegal.
authors.forename: Djimadoum
authors.initials: D
authors.lastname: Koumtingue
authors.affiliation: Palladium, Washington, DC, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Stratton
authors.affiliation: IntraHealth International, Chapel Hill, NC, USA.
authors.forename: Claire
authors.initials: C
authors.lastname: Viadro
authors.affiliation: IntraHealth International, Dakar, Senegal.
authors.forename: Hawa
authors.initials: H
authors.lastname: Talla
authors.affiliation: IntraHealth International, Dakar, Senegal.
authors.forename: Etienne
authors.initials: E
authors.lastname: Dioh
authors.affiliation: IntraHealth International, Chapel Hill, NC, USA.
authors.forename: Carol
authors.initials: C
authors.lastname: Cissé
authors.affiliation: IntraHealth International, Chapel Hill, NC, USA.
authors.forename: Boniface
authors.initials: B
authors.lastname: Sebikali
authors.affiliation: Ministry of Health and Social Action, Division of Reproductive Health and Child Survival, Dakar, Senegal.
authors.forename: Bocar
authors.initials: B
authors.lastname: Mamadou Daff
mesh_terms: D000293:Adolescent; D000328:Adult; D002983:Clinical Competence / Q000592:standards; D003159:Community-Institutional Relations; D003268:Contraception Behavior; D003271:Contraceptive Agents, Female; D004343:Drug Implants; D005193:Family Planning Services / Q000592:standards*; D005260:Female; D006268:Health Facilities / Q000592:standards; D006282:Health Personnel / Q000193:education; D006297:Health Services Accessibility; D006801:Humans; D007434:Intrauterine Devices; D000075523:Long-Acting Reversible Contraception / Q000706:statistics & numerical data*; D000071252:Mentoring; D058996:Quality Improvement; D012424:Rural Population; D012675:Senegal; D014937:Work; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D004343:Drug Implants