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IUD Toolkit

Up-to-date evidence and best practices related to the Intrauterine Device

Brought to you by USAID's Maximizing Access & Quality Initiative

IUD Program Models

This brief provides an overview of diverse service delivery models for providing IUD services.

What is a service delivery model?
Why is knowledge about models important?
What are the components of a service delivery model?
How are potential clients identified?
What are the costs of diverse models?
How should one choose between models?

What is a service delivery model?
A service delivery model is a way of (1) organizing health and family planning services that facilitates planning, budgeting, monitoring and evaluating the operation, and (2) documenting the benefits and costs of any specific set of health services.

Why is knowledge about models important?
We already know a great deal about the IUD, its characteristics and the training required to provide it safely (see knowledge base section of this toolkit). We actually know less about the combination of components required to provide the IUD to clients in diverse settings that both meets their reproductive health needs and ensures that the providers have the supplies and support they need to provide the service at a given standard of quality and cost.

What are the components of a service delivery model?
The components of a comprehensive service delivery model include clinical guidelines for providers, training and supervision strategies, logistics arrangements for ensuring availability of the product and related supplies, the organization of services, marketing and educational strategies, procedures for counseling and ensuring choice and informed consent, and follow-up plans for clients. In short, these are all the elements that a program manager needs to understand in order to provide the service.

While all of these components are important, program planners and the managers of service delivery sites often characterize service delivery models for the IUD on a smaller number of critical dimensions:

Timing of IUD services: When is the IUD provided to the client; e.g., postpartum, postabortion, and/or during the interval between the birth of a child and a subsequent pregnancy?
Location of service delivery: Where will the counseling and service provision take place, e.g., on a hospital Obstetrics-Gynecological ward, at a fixed clinic facility, or through a mobile clinic or outreach program?
Type of provider: What type of personnel will provide the service, both counseling and clinical management, e.g., nurse, midwife, or physician? Would providers work in the public or private sectors?

Understanding these three critical dimensions allows the program manager to better plan the service, identify key participants and estimate the resource requirements. Typically, the IUD is only one of the options available to a client visiting any service outlet, so counseling about method choice and the requirements for method use should be key features of any service. The benefits of an IUD service include enabling clients to achieve their reproductive intentions, i.e. number and timing of children, in a healthy fashion, and the use of a highly cost-effective method, which potentially reduces the commodity costs of the service delivery system.

How are potential clients identified?
All service models also require a known source of client referrals. For example, within the context of Safe Motherhood Programs, potential clients for the IUD might be identified during prenatal care or in the early postpartum period during counseling on birth spacing. If the birth is planned at a hospital, the IUD might be offered immediately postpartum, during the 40 day return visit or at any time convenient to the client during the first year postpartum.

Alternatively, outreach and mobile clinics can identify potential IUD clients through community networks such as community-based distribution (CBD) programs, social marketing providers and satisfied users of the IUD. For this strategy to be successful, providers of IUDs have to ensure that potential clients know about the availability of services, that is, where and when will IUD services be provided, and how to access them, e.g., who to contact and how much they will cost.

What are the costs of diverse models?
The costs of the services depend on a number of factors, including the level of care, the type of provider and number of users of the service. Typically, the most efficient programs are those that provide the IUD service in the context of other services, e.g., postpartum and postabortion, and use lower cost providers such as nurses and midwives for both counseling and service provision. Nevertheless, the cost of any service is a function of the elements of care in each site.

How should one choose between models?
Within a health district, which includes hospitals and clinic sites as well as urban and rural client populations, it may be appropriate to utilize more than one model at a time. Which model is the most appropriate for a given setting depends ultimately on the:

Needs, mobility and resources of potential clients
Organization, human and financial resources of the health system
Expected costs and benefits of the models adopted in the settings selected