Q: What are the challenges to ramping up telehealth?
MS: In the United States, we’ve been trying to ramp up telehealth for years now in a very resourced environment and running into difficulties, so it’s not an easy thing to ramp up where resources are more scarce.
KN: That’s true that they’ve been trying to ramp it up for years, but it’s happening now, all of a sudden, it’s working in the US. We do think [implementing telehealth in LMICs will be] more challenging than the simple message of extending duration of implants, but I don’t think that it’s something that’s unachievable, it just will take more work.
EL: Sometimes setting up the systems for telehealth can be a little bit of a challenge particularly in countries where smart phone ownership is limited. In these settings, telehealth systems need to rely on SMS-based rather than app-based communications, which can be challenging and costly to set up and manage.
Q: What considerations do other stakeholders (e.g., policy makers, implementing partners, program managers) have to make in adapting their family planning programs?
KN: Extended use [of LARC] can be discussed at an individual provider level, but would be better if it came from the policy maker, which would lead to wider implementation. Telehealth can be done at any level, but to be more successful, it has to be at the broader level, so that systems are in place and telehealth visits can be conducted while maintaining privacy and confidentiality, etc.
MS: And reimbursement needs to be worked out.
KN: Also, not all telehealth has to be fancy video conferencing. SMS can be a little difficult to go back and forth, but a telephone call can be used to screen women for contraindications or to talk to women who are having side effects from methods. They don’t always need an exam. Sometimes they do, and in those cases, women will need to come in, but some side effects can be managed safely over the phone.
Q: If the reader had to choose only one recommendation to implement, which would you make a priority?
KN: I think all of them are important [laughs]. An easy one to start is the extended use of LARC. We’ve thought this was important for a long time. Especially now, it’s relatively easy to do and can be implemented at a policy level and could have a large impact on decreasing the need for new commodities and comply with social distancing.
MS: I agree. It’s actionable and saves resources. There are so many good reasons for it. It’s evidence-based that implants work much longer than they’re labeled for. Same for IUDs.
EL: More generally, ramping up the way we use telehealth in these situations is very important. We need figure out how to continue providing services and continue counseling women without having to see each other face-to-face, so we’re not increasing risk of spreading disease. But we have to continue providing services, and there has to be a platform for it.
KN: Telehealth for contraception is not in a vacuum. Other routine services also need to use telehealth. As that is expanded or rolled out, sexual and reproductive health services should be part of that.
Q: Are there other recommendations that are immediately actionable?
KN: Self-injection is immediately actionable. Sayana Press is available in many places and some women are using it, but that could certainly be expanded to make sure that women using injectables don’t drop off.
EL: Also, multi-month scripting, as commodities allow, of course. As an example, countries all have different guidelines about how many packs of pill you can receive at the same time, but there’s plenty of evidence that it’s fine to given women an entire year’s supply at one time. So, as commodities allow, it’s important to give women enough commodities so they don’t have to come back to a facility, pharmacy, or wherever they receive services.
KN: Another easily actionable item, especially with probable commodity shortages, is using telehealth to educate women on fertility awareness.