Uganda datasets.

Introduction
In Uganda and Zambia, both supply- and demand-side factors hamper availability of long-acting reversible contraceptives (LARCs), including implants and intrauterine devices (IUDs), at public sector facilities. This paper discusses results of a program aimed at increasing access to and uptake of LARC services in public sector facilities through capacity building of government health workers, strengthening government supply chains, and client mobilization.
Methods
From 2018–2021, the Ministries of Health (MOHs) in Uganda and Zambia and Clinton Health Access Initiative (CHAI) worked to increase readiness to provide LARC services within 51 focal facilities in Uganda and 85 focal facilities in Zambia. Annual facility assessments of LARC-related resources were conducted and routine service delivery data were monitored.
Results
At baseline, few focal facilities had supplies and skilled staff to provide LARC services. At endline, over 90% of focal facilities in both countries had a provider trained to provide both implants and IUDs and 55% had the commodities and equipment needed for implant provision. In Uganda and Zambia, respectively, 65% and 38% of focal facilities had commodities and equipment for IUD provision at endline. Both programs observed significant increases in the number of implants provided at focal facilities; in Uganda implant volumes increased five-fold from 4,560 at baseline to 23,463 at endline, and in Zambia implant volumes increased nearly four-fold from 1,884 at baseline to 7,394 at endline. Uganda did not observe growth in IUD volumes, whereas Zambia observed significantly increased IUD service volumes from 251 at baseline to 3,866 at endline.
Conclusions
Public sector facilities can be rapidly and sustainably capacitated to provide LARCs when both catalytic and systems strengthening interventions are deployed for health worker capacity building, supply chain management, and community mobilization to ensure client flow. Investments should be intentionally sequenced and coordinated to generate a virtuous cycle that enables continued LARC service provision.

引言
在乌干达与赞比亚，供给侧与需求侧双重因素均制约了公立医疗机构长效可逆避孕措施（long-acting reversible contraceptives, LARCs）的可及性，此类避孕措施涵盖皮下埋植剂与宫内节育器（intrauterine devices, IUDs）。本文探讨了一项项目的实施成效，该项目旨在通过强化政府卫生工作者能力建设、完善政府供应链体系以及开展服务对象动员，提升公立医疗机构LARC服务的可及性与服务接受率。

方法
2018年至2021年间，乌干达与赞比亚两国卫生部（Ministries of Health, MOHs）以及克林顿健康倡议组织（Clinton Health Access Initiative, CHAI）携手合作，致力于提升乌干达境内51家、赞比亚境内85家定点服务机构提供LARC服务的筹备能力。研究团队针对LARC相关资源开展年度机构评估，并对常规服务提供数据进行持续监测。

结果
基线调研阶段，仅少数定点服务机构具备提供LARC服务所需的耗材与专业技术人员。终线调研阶段，两国超过90%的定点服务机构均配备了接受过皮下埋植剂与宫内节育器放置培训的服务提供者，且55%的机构具备皮下埋植剂服务所需的耗材与设备。在终线调研阶段，乌干达与赞比亚分别有65%与38%的定点服务机构配备了宫内节育器服务所需的耗材与设备。
两项项目均观察到定点服务机构的皮下埋植剂服务量显著增长：乌干达的皮下埋植剂服务量从基线期的4560例增至终线期的23463例，增幅达5倍；赞比亚的皮下埋植剂服务量从基线期的1884例增至7394例，增幅近4倍。乌干达的宫内节育器服务量未出现增长，而赞比亚的宫内节育器服务量则从基线期的251例显著增长至终线期的3866例。

结论
当针对卫生工作者能力建设、供应链管理以及社区动员以保障服务对象流量的催化性与体系强化干预措施协同部署时，公立医疗机构可快速且可持续地获得提供LARC服务的能力。相关投入应进行有意识的时序规划与协调，以形成良性循环，保障LARC服务的持续开展。