From 5^th to 16^th February, 2024, ZAGO undertook onsite follow-up visits to Comprehensive Abortion Care (CAC) providers in all the 30 health facilities providing self-managed medical abortion care.

The purpose of the follow-up visits was to:

1. Assess the progress of rollout of self-managed medical abortion services
2. Assess the progress in addressing identified barriers to accessing self-managed medical abortion service
3. Conduct data audit and validation for self-managed medical abortion services
4. Gather feedback from healthcare providers, youth advocates/peer educators, and community-based health volunteers on how to improve the service.

These visits were crucial for ensuring the effectiveness and success of the Self-Managed Medical Abortion care (SMMAA) project implemented across 10 districts in three provinces. Among those followed-up include, CAC providers, youth, and Safe Motherhood Action Groups (SMAGs) who underwent training in self-managed medical abortion care. These onsite visits provided an opportunity to assess the effectiveness of the self-managed medical abortion care, and address any challenges, concerns, and complications; and also to provide support and guidance as needed.

During the follow-up visits, focus groups discussions were held in an honest and open atmosphere aimed at gathering information about the uptake of the service. Participants showed dedication, commitment, and willingness to engage in open conversation with regard to the impact the project is having in addressing maternal morbidity and mortality arising from unsafe abortions.

CAC providers displayed strong commitment to improving the quality of care to women and adolescents girls seeking the services. Their willingness to engage and interact with the ZAGO team demonstrated profound desire to providing compassionate and comprehensive care to women in need of this critical time-sensitive service.

The team noted the challenges involved, and appreciated the level of dedication to professionalism among participants.

The team verified the data which facilities had been sharing with ZAGO every month since October, 2023 – underscoring their commitment to the rollout of self-managed medical abortion care to communities and the desire to save life of women and girls.

As regard the youth and SMAGs, the onsite visits revealed the extent to which self-managed abortion care is reaching people across communities. Both youth and SMAGs demonstrated substantial support and cooperation towards successfully rollout of the option of self-managed medical abortion care in the facilities. The conducive environment helped participants to engage in meaningful interaction and learning experience.

The follow-up visits provided valuable insights into the progress and challenges of the self-managed medical abortion service rollout. And based on the findings of the visits, several recommendations were made to support the successful implementation of self-managed medical abortion care at the health facilities. These include:

1. Training of more CAC providers to ensure they have the knowledge and skills to offer self-managed medical abortion services effectively, and enhance service provision.
2. Ensuring availability of essential medical supplies such as MA drugs (Combipack), pain relief medications.
3. Need to share information materials including the revised 2022 national CAC guidelines, to support the provision of self-managed medical abortion services.
4. Improve communication and education for patients to ensure they have accurate information about self-managed medical abortion, the treatment process, and potential side effects.
5. Strengthen quality of care at the facilities, including listening to patient feedback and addressing any concerns or issues that arise.
6. The need to improve SMA reporting documentation
7. Address the issue of patients being charged to access self-managed abortion
8. The need to attend and address the negative attitude by healthcare providers towards women and girls seeking self-managed abortion services
9. The need for the provision of IEC materials for CAC providers, youth and CHVs to enhance service provision as well as community sensitization.

ZAGO encouraged CAC providers, youth and SMAGs to continue sensitizing communities against the dangers of unsafe abortion; integrate best practices and evidence-based approaches into their work – to enhance the quality of care provided to women seeking self-managed medical abortion service.