Research for Scalable Solutions (R4S) is a new, USAID-funded implementation science project that aims to increase the production and use of evidence to improve family planning programs around the world. Specifically, R4S focuses on generating evidence related to self-care and client-driven approaches for family planning, increasing information about the cost and cost-effectiveness of implementing High Impact Practices, and addressing equity within programs. Led by FHI 360 in partnership with Evidence for Sustainable Human Development Systems in Africa, Makerere University School of Public Health (Makerere SPH) in Uganda, Population Services International, and Save the Children, R4S works with a range of country-based stakeholders to strengthen research and research utilization capacity and support countries in their journey to self-reliance. For R4S’s inaugural blog post, we spoke with professors at Makerere SPH about the project, self-care, research, and capacity building.
Why are you excited to work with Research for Scalable Solutions (R4S)?
Rhoda: I am excited about R4S. The indicators for family planning have remained largely stagnant for decades in Uganda and several countries in sub-Saharan Africa. The fertility rate remains very high, and unplanned pregnancies abound despite pressures on the environment and on families. Equitable access to quality family planning is therefore a major development issue and should be at the forefront in the era of Sustainable Development Goals. We need to make big strides, and we certainly need evidence and innovations to drive this change.
Fred: Working with R4S will enhance the generation and use of evidence to reach women and families who have been left behind with regard to access and uptake of quality family planning services. R4S will also strengthen the partnerships of local, governmental, and international stakeholders in synergizing efforts toward improving the identification and delivery of services, especially to marginalized sections of the population.
March 8 is International Women’s Day. How do you see self-care and client-driven approaches improving the health of women in sub-Saharan Africa? How are these approaches related to this year’s theme of #eachforequal?
Rhoda: I like this year’s theme for International Women’s Day! Being able to determine whether and when to have a child is important. Self-care is empowering if it can be fully realized, and if we can make available the information and tools needed to fully execute it. We need to move quickly on this. I realize that we have several unanswered questions around self-care and self-injection, but this should not slow us down.
What are some of the main challenges that self-care can address in Uganda and elsewhere?
Fred: Injectables are administered primarily at health facilities by a cadre of health service providers. However, many potential users of effective, quality family planning methods have limited access to these health facilities. Self-care is likely to break this barrier or challenge. Secondly, many women cannot afford the time and money to make regular visits to their service providers; this too is an access issue, which I think self-care can minimize.
What are some of the key research questions that you hope to answer?
Rhoda: We need to better understand how to deliver information and support for correct and consistent administration of self-injections for all populations of women, including the most disadvantaged who are often left behind. We need to learn how to best distribute supplies for self-care and determine what other support is needed, for disposal, for example, among other needs. Certainly, this option will come with myths and misconceptions like other family planning methods. We need to explore and address such issues, too.
One of the project results is related to improving equity of family planning programs. What inequities do you hope to address through the project? What key questions do you have about equity of family planning programs?
Rhoda: We need to better understand and define equity, characterize who we are leaving behind and why, and then bridge the gaps to ensure equitable access.
Fred: Inequities include family planning programs’ inability to reach all women who need services, especially those in rural and urban-poor settings or members of marginalized populations. Understanding who such people are and what their locations are, as well as understanding their fertility desires and how they wish to be served—given community and family dynamics and spousal relations—remain key for designing strategies to address the equity of family planning programs.
Makerere SPH is a leading research institution on the continent. How have you seen research capacity within and beyond Uganda grow, and how do you envision this project strengthening local capacity to produce and use evidence?
Rhoda: Our research capacity in Uganda and the continent has grown significantly. However, Africa is still lagging in research capacity and outputs. Despite progress, Africa—with about 13 percent of the global population—still produces less than 1 percent of global research outputs! Advanced research training, infrastructure, and funding allocation is grossly limited. The scientific outputs are also heavily skewed even within Africa, with the bulk coming from fewer than 10 countries. We also have gender equity issues in research capacity and participation. Women’s participation in research and research outputs in health, especially in the biomedical sciences, remains low relative to men. We need more investment in research and more capacity to ensure the full participation of women and local institutions within Africa. R4S provides an opportunity to contribute to this growth.
Fred: R4S will likely strengthen research capacity through widening the scope of areas of specialization, some of which remain limited, including impact evaluation and cost effectiveness of health services.
How will Makerere SPH help to strengthen local capacity?
Rhoda: Makerere SPH evolved from the first institute of public health in sub-Saharan Africa. We have a big role to play in generating evidence and innovations to advance public health in Africa. We are excited to be a part of this consortium to advance family planning evidence and translation and especially research capacity within Africa.
Photo: Jessica Scranton/FHI 360