In Malawi, R4S is engaged in five activities: 1) a study to document emergency contraception (EC) provision in several channels as recommended in Malawi’s EC strategy, 2) replicating the HIPs assessment methodology, 3) country equity working group, 4) assessing COVID-19’s impact on FP service delivery and use, and 5) supporting the development of a family planning research and learning agenda (RLA). These activities are part of the five R4S portfolios below.
Self-Care Portfolio
R4S’ Self-Care Portfolio includes activities aimed at deepening understanding of self-care through a people-centered approach. Countries increasingly seek to integrate self-care into FP policies and programs. But there is little evidence available to create an enabling environment for self-care programming, despite the growing appreciation that self-care is a culturally relative concept. R4S has designed and implemented studies to capture attitudes, preferences and intentions regarding FP self-care from women, men and providers.
As part of the Self-Care Portfolio, and in partnership with PSI and Malawi national and district MOH officials and implementers, R4S is conducting a mixed methods research study to describe how the Malawi Emergency Contraception (EC) provision strategy has been implemented. The study describes the partner and program manager perspectives on implementation-related barriers and facilitators to EC provision, who is accessing EC, how it is being used, and what are client experiences in accessing EC. The results will provide Malawian stakeholders evidence to inform further scale up of the strategy, and add to the global body of evidence on strategies for expanding access to ECs and method choice.
HIPs Portfolio
Includes activities that assess multiple service delivery practices to inform programmatic decisions for scale-up – either vertically into local or national health systems and policies, or horizontally to new geographies or groups. Knowledge generated can facilitate advocacy efforts for the adoption and sustainability of interventions that are proven to enhance the impact of FP programs and investment of resources to address equitable access to services among traditionally underserved populations or groups.
This activity, part of the HIPs Portfolio, consists of replicating the HIPs assessment methodology. Planning for this activity will depend on findings from the assessment of HIP implementation with respect to scale, quality, reach and cost in Mozambique, Nepal, and Uganda. R4S is engaged with the MOH in Malawi to explore information that is anticipated to be learned, why it is valuable, how it may be adapted to the Malawi context, and how it can improve implementation of HIPs in Malawi.
Equity Portfolio
This portfolio seeks to advance the inclusion and measurement of equity considerations in FP program design, implementation, and monitoring. It brings together country-level efforts to define and measure equity in FP and identify strategies for monitoring when, where and how inequities shift, and global-level efforts to establish the FP/RH Equity Working Group to serve as a hub for thought leadership and knowledge sharing between national, regional, and global-level actors.
R4S supported Malawi to establish a country equity group and continues to support its operation. This is part of the Equity portfolio, which builds upon the country-level equity analyses and discussions that were part of the RLAs in four countries (Nepal, Malawi, Niger, and Uganda). The country equity groups work to define, measure and monitor equity in family planning. R4S partners PSI and Makerere University assist Malawi in the equity analysis.
COVID-19 Portfolio
The COVID-19 Portfolio was developed in response to the COVID-19 pandemic. R4S designed and implemented studies aimed at capturing the pandemic’s impact on FP service delivery and use, as well as documenting and disseminating the lessons learned from program adaptations. Knowledge generated can be used to support mitigation strategies for COVID-19 and future epidemics and emergencies.
To assess the impact of COVID-19 on FP service delivery and use, R4S worked with Viamo to leverage their 3-2-1 Interactive Voice Response (IVR) platform to deploy a panel survey efficiently and safely with women in Nepal, Niger, Malawi, and Uganda. Women who accessed content via their mobile phone on any topic through the 3-2-1 service were recruited for a brief survey. For those completing the survey, and eligible for a panel survey, they were re-contacted through a series of outbound surveys. This allowed for the documentation of FP access and use over time among the same women, as well as an assessment of barriers to care. Results are presented in this dashboard – COVID-19 Dashboard and summarized in this blog: What Did We Learn? Women’s Experiences with Family Planning Access and Use During the COVID-19 Pandemic.
Country RLAs
This activity supports countries to develop FP research and learning agendas (FPRLAs) that will help them meet their national FP program goals. It also helps to identify research questions that R4S can answer and programmatic and policy areas for which R4S can help produce, synthesize, or apply evidence to improve outcomes.
R4S supported the development of the FP research and learning agenda in Malawi, among other countries, via a multi-phase process that involved the review and analysis of data, consultation with local experts, and convening stakeholders to define concrete questions to guide family planning research and ultimately programming. The FPRLA for Malawi was reviewed and approved by the MOH in March 2021. R4S partner PSI supports the MOH in continued dissemination efforts. Details about the process, country context, and main takeaways is found here: FP Research and Learning Agendas and summarized in this blog: Towards 2030.
