Dr. Marsden Solomon, Acting Chief of Party, Afya Uzazi Nakuru/Baringo, Kenya
Angela Akol, Chief of Party, Mhuri/Imuli, Zimbabwe
Njideka Ofoleta, Stanback Fellow, R4S, FHI 360
Aubrey Weber, Technical Officer, Research Utilization, FHI 360
Eden Demise, Research Coordinator, FP/RH, PSI
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 voluntary 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 third blog post, we spoke with representatives from two of FHI 360’s bilateral reproductive, maternal, newborn and child health (RMNCH) projects about strategies they have implemented to ensure continuity of family planning programming, including enhancing the capacity of community health workers (CHWs) to offer family planning while navigating country-level COVID-19 guidance.
During the current global health crisis, FHI 360’s bilateral RMNCH projects have found themselves at a pivotal moment. Restrictions in place to limit the spread of COVID-19 have forced ministries of health and partner organizations to develop and issue quick guidance on providing continuity of care during the pandemic. An interview with FHI 360 staff in Kenya and Zimbabwe revealed disruptions to basic counseling, delivery of products and care, and supply chain, and captured the innovative practices both programs are implementing to ensure vulnerable populations continue to receive care.
As the pandemic continues, virtual mentorship and telecounseling have risen in popularity, allowing trainings to continue and clients to still receive care amid travel restrictions and limited transportation options. Both Kenya and Zimbabwe teams have seen technology play an increasingly important role, as virtual health care worker trainings become more relevant and digital platforms are used to disseminate information to communities and health care workers. However, while the use of digital technology brings many new opportunities, it also presents challenges. Challenges include unreliable connectivity, limited access to the Internet, and — for most clients in rural communities — a lack of phones with relevant applications (e.g., WhatsApp, Twitter), highlighting just some of the equity issues associated with digital platform use.
CHWs have become increasingly critical in today’s environment. In Kenya, CHWs have become the primary link between households and health facilities, providing context-based messages and care and using technology to provide continuous bidirectional technical updates to communities and the Department of Health. In Zimbabwe, discussions are centered around allowing CHWs to be depot-holders for refills of short-term voluntary family planning methods such as oral contraceptives, condoms, and emergency contraception.
The two programs have adapted to reach extremely vulnerable populations differently. In Kenya, the project uses a peer-based approach to reach the most vulnerable, including youth and rural mothers in hard-to-reach areas. The project has segmented these vulnerable subpopulations and tailored specific and responsive interventions for each, working closely with national government administration officers to enable health care workers to travel during curfew hours in all subcounties.
In Zimbabwe, the program team has resumed facility-based family planning care; a team of health professionals, which includes individuals trained and/or certified to offer long-acting reversible contraceptive methods (LARCs), spends two or three days at a given facility to allow different villages to come in on distinct days to avoid overcrowding. By emphasizing provision of LARCs at facilities, decentralizing shorter-acting method distributions to pharmacies, and integrating distribution with allowable outreach programs (i.e., immunizations and food distribution activities), they successfully minimize congestion while allowing provision of care to continue for the most remote clients. CHWs mobilize clients on a village-by-village basis, allowing clients to come into the clinic in a controlled manner to minimize the number of people at the health facility at any one time.
As the pandemic continues and programs adapt, the best methods for empowering CHWs, tailoring facility-based programs, and partnering with the private sector to ensure continuity of family planning will emerge. R4S will be documenting these COVID-19 adaptations across multiple countries and programs, so check back soon for more details on the challenges encountered and lessons learned.
Photo: Jessica Scranton/FHI 360