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  • Title: Insertion and removal of Norplant contraceptive implants by physicians and nonphysicians in an Indonesian clinic.
    Author: Affandi B, Prihartono J, Lubis F, Sutedi H, Samil RS.
    Journal: Stud Fam Plann; 1987; 18(5):302-6. PubMed ID: 3120362.
    Abstract:
    This paper reports on a study in which the performances of physicians were compared to those of nonphysician health personnel in inserting and removing NORPLANT subdermal contraceptive implants. The study was conducted in Raden Saleh Clinic at the University of Indonesia, Jakarta, from September 1982 to August 1984. In a group of 828 women who accepted NORPLANT 285 insertions were performed by physicians and 543 by nonphysician health personnel. During the study period, 122 removals were performed (43 by physicians and 79 by nonphysicians). This small proportion of removals reflects the high continuation rate for NORPLANT. There was no significant difference between the two groups of acceptors regarding age, parity, education, or side effects. The average insertion times were 7.6 minutes for the physician group and 7.4 minutes for the nonphysician group (p greater than 0.1). The average removal times were 21.7 minutes for physicians and 21.8 minutes for nonphysicians (p greater than 0.9). Complications during and following insertion and removal were minimal for both groups, and no significant differences were found. It was concluded that nonphysician health personnel are qualified to administer the NORPLANT contraceptive implants. In developing countries such as Indonesia, where the number of people in need of contraceptive services far outweighs the supply of physicians, nonphysician health personnel can perform an invaluable function as family planning service providers. Indonesia had 17,000 physicians compared to 11,000 midwives and 150,000 nurses according to 1985 statistics. In a study conducted in Indonesia's Raden Saleh Clinic, the performances of physicians inserting and removing Norplant subdermal contraceptive implants were compared to those of nonphysician health personnel who received the same training. A total of 828 insertions were performed during the 2-year study period--285 by physicians and 543 by nurses and midwives. There were no significant differences between the 2 groups of Norplant acceptors in terms of age, parity, education, or side effects. Insertion time averaged 7.6 minutes for physicians and 7.4 minutes for nonphysicians. There were no significant differences between the 2 health manpower groups in complications (e.g. hematoma, wound infection, abscess) noted 1 week after insertion. A total of 122 removals occured in the study period--43 by physicians and 79 by nurses and midwives. Removal time averaged 21.7 minutes for physicians and 21.8 minutes for nonphysicians. These findings suggest that, after receiving training that follows established parameters, nonphysician health personnel can safely administer the Norplant contraceptive implants.
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