Sarah Brittingham, Technical Officer, FHI 360
Ameya Sanyal, Fellow, FHI 360
Lola Summer Flomen, Technical Learning Consultant, PSI
Kristen Little, Senior Technical Advisor of Strategic Research, PSI
Nandita Thatte, Technical Officer, WHO/IBP
Research for Scalable Solutions (R4S) is an implementation science project funded by the United States Agency for International Development (USAID) that aims to increase the production and use of evidence to improve voluntary family planning (FP) programs around the world. Specifically, R4S focuses on generating evidence related to self-care and client-driven approaches for FP, the cost and cost-effectiveness of implementing high-impact practices (HIPs), and measuring and addressing equity within FP programs. Led by FHI 360 in partnership with Evidence for Sustainable Human Development Systems in Africa (EVIHDAF), Makerere University School of Public Health (Makerere SPH) in Uganda, Population Services International (PSI), and Save the Children, R4S works with a range of country-based stakeholders to strengthen research and research utilization capacity and to support countries in their journey to self-reliance. In this blog, PSI shares experiences and lessons learned as part of R4S-funded documentation of FP program adaptations made during the COVID-19 pandemic.
We adapted how we work, how we interact, and how we do just about everything in 2020. Family planning is no exception. Across the globe, family planning programs are continually adapting to the austere circumstances of COVID-19. Lockdowns and social distancing make it difficult to continue activities as planned. Overburdened health systems suffer shortages of health workers, hospital beds, and supplies. Hesitancy to visit health facilities and lack of information among providers and clients alike are creating barriers to care. These are just a few of the challenges.
Starting in May 2020, the COVID-19 and FP/RH Task Team , co-hosted by the IBP Network, Knowledge Success, and Research for Scalable Solutions, set out to document unprecedented challenges and creative solutions in family planning during the pandemic. The task team collected information from partners about how they are adapting family planning activities via a spreadsheet and visualized these in a bilingual ARCGIS StoryMap. The map tells the story of the past year in family planning: paused activities, systems pushed to the brink. But next to each challenge, there’s the story of resilience. Programs pivoted to procure personal protective equipment (PPE) for community health workers and sent them door to door to dispel myths with tailored tools. Others adapted training content for virtual and hybrid platforms to provide instruction in self-injection and found new ways to reach target audiences online and over the phone.
In February 2021, we launched the ArcGIS StoryMap and analyzed the trends in a webinar alongside PSI, who presented the StoryMaps they used to track and visualize their programmatic adaptations to COVID-19 during the pandemic. You can read about some of the trends below. You can also explore the IBP network StoryMap and add to it via this form (available in English and in French) if you have something you’d like to share. We hope you’ll find inspiration in these maps; each data point tells a story.
Click on the highlighted countries on the map to learn more about the digital adaptations. Use the links above to access the full features of the map.
What trends are we seeing in the ArcGIS StoryMaps?
For COVID-19 adaptations trends in FP service delivery, PSI and other IBP Partners are seeing:
- An increase in last-mile service delivery approaches, using unconventional strategies (motorcycles, digital tools) to bring FP services closer to clients,
- Use of digital platforms to support and train providers on COVID-19 prevention including mental health support groups, and
- Strategic selection of methods or provision of additional supplies to minimize travel to health facilities.
In Pakistan, Palladium trained providers on infection prevention and is integrating family planning into primary health care, including postpartum family planning.
In Zimbabwe, the Zimbabwe Association of Church-Related Hospitals (ZACH) started to provide multiple pill packs to ensure continuity of oral contraceptives among its clients.
Pathfinder and the Ministry of Health, alongside private sector partners, have launched training for central government trainers and NGO providers on self-injection of DMPA-SC that comply with COVID-19 travel and social distancing restrictions in Democratic Republic of Congo. They are:
- facilitating small-group training sessions (5-10 participants/session),
- providing distance training through teleconferences coupled with PATH’s online eLearning course, and
- implementing onsite training for some facility-based providers.
Prior to the pandemic, PSI’s Adolescent360 (A360) project in Nigeria had been targeting youth aged 15-19 with FP products and services through their free ‘hub and spoke’ facility model. As COVID-19 spread, the government-initiated lockdown prevented youth from travelling to access FP clinics. Funded by the Children’s Investment Fund Foundation (CIFF), A360 adapted by transforming spoke facilities into ‘mini hubs,’ by dedicating more youth-friendly days closer to young clients’ communities. The result: PSI saw an increase in young women (15-19), married and unmarried, adopting FP for the first time.
Social and Behavior Change
IBP partners and PSI are seeing adaptations to social behavior change programming that include:
- Rapid adoption of social media (Facebook, Twitter, Instagram) to promote FP demand creation and expand client reach,
- Radio show and hotline FP-COVID-19 prevention integration messaging for women of reproductive age living in rural areas, and
- Community group engagement to diffuse COVID prevention messaging alongside FP messaging.
In Mali, Conseils et Appui pour l’Education à la Base (CAEB) modified large community health fairs to provide smaller education sessions about social distancing, provision of kits (hand washing kits, hydroalcoholic gel, soap, bleach, washable masks, etc.).
Since 2015, PSI’s Social Enterprise (SE) in India has promoted FP self-care for young women through creative FP information social media campaigns. However, the COVID-19 lockdown lowered demand for FP products and services in India. Funded by the Bill and Melinda Gates Foundation, SE India rapidly accelerated their digital strategy to better target women aged 18-30 with FP self-care information through the Nivi chatbot. From July-November 2020, 9035 clients have interacted with the Nivi chatbot and 1512 e-referrals have been given.
To promote access to sexual and reproductive health services, particularly among adolescents and youth, and render the gendered impacts of COVID-19 more visible to community members and policymakers alike, Myanmar Partners in Policy and Research (MPPR) integrated information dissemination with material support, including the distribution of dignity kits containing health and hygiene supplies. They provided training to community-based organizations, community champions, and volunteers in the public health and social service sectors.
In Francophone West Africa, Breakthrough ACTION developed radio spots promoting confidence in FP methods and services, including calls to action to:
- promote couple communication about FP,
- obtain extra supply of a chosen FP method if possible,
- prepare for a conversation with a provider about FP method choices, and
- call existing hotlines that have information on FP methods.
A study from Breakthrough RESEARCH showed that exposure to the campaign is significantly associated with higher self-efficacy to speak to one’s partner about family planning and greater intention to get information about family planning from a nearby health center.
For adaptation trends in advocacy for family planning, IBP partners and PSI are experiencing new government partnerships, technical working group leadership opportunities and FP taskforce developments.
In Nigeria, the Balanced Stewardship Development Association (BALSDA) is developing knowledge products to engage policymakers, service providers, and community gatekeepers.
HP+ is coordinating Family Planning Committee meetings in Madagascar to address declining use of family planning services since the beginning of the pandemic and to ensure the supply chain for contraceptives.
IntraHealth International is providing technical assistance to the Burkinabe government for the adaptation of the WHO Essential services guide into a national services continuity plan. They are drafting six technical briefs to operationalize the national continuity plan at sub-national and facility level and have shared these with the West African Health Organization and other regional platforms to facilitate similar work in other countries across Francophone West Africa.
Utilizing StoryMap Insights
After the webinar presentations, participants engaged in a rich discussion. Several questions emerged about the measurement of adaptations – highlighting the importance of sharing indicators and what does not work alongside what does. The IBP StoryMap includes indicators when those were shared and the next iteration of the map will include whether partners plan to continue the adaptation or not and link out to formal evaluations, when these are available. Several participants noted interest in creating a similar map for adaptations in reproductive health.
These are just a few of the adaptations and activities highlighted in the ARCGIS StoryMaps. We intend to use this as a living tool to reflect the resilience and commitment among the family planning community and continue to collect new entries via a Google form (available in English and in French). We also hope that it will foster direct peer-peer learning and exchange. Contact information has been shared for each entry, so reach out for more information to support adaptation and replication of best practices.