In Nepal, R4S is engaged in five activities: 1) a mixed methods study to advance understanding of self-care, 2) exploring interest in self-care approaches among youth, 3) the assessment of HIP implementation with respect to scale, quality, reach and cost, 4) capturing 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 four 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. 

1. R4S is conducting this mixed-method study in Nepal, Niger, and Uganda is to advance understanding of self-care among potential end-users and providers and identify opportunities and barriers for advancing self-care programming. R4S has consulted with the Self-Care Trailblazers Group (SCTG) to ensure that the work complements global and country priorities, and with the MOH and other stakeholders in each country on needs and priorities related to advancing self-care. The study was conducted in 2022-early 2023. Country dissemination in Nepal took place in June and July 2023. 

2. To generate information on adolescent self-care attitudes and preferences for health services R4S partners Save the Children and Makerere University provided technical assistance to add questions on interest in and preferences for self-care to two existing youth surveys—the Healthy Transitions for Nepali Youth Project (HTNYP) for girls aged 15-24 in Nepal (implemented by Save the Children and funded by Margaret A. Cargill Philanthropies), and the Adolescent Girls and Young Women (AGYW) survey for girls aged 10-24 in Uganda (implemented by Makerere University School of Public Health and funded by The Global Fund). The two countries are at different stages of introducing FP self-care practices; however, findings from both countries show high interest in accessing information on FP methods, side effects, and bleeding changes without seeing a provider. R4S produced a blog Exploring Interest in Self-Care Approaches Among Youth: Survey Findings from Nepal and Uganda and a set of infographics both Nepal and Uganda to highlight survey results. 

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. 

3. This activity, part of the HIPs Portfolio, evaluates the scale, quality of implementation, reach, cost and cost-effectiveness in Mozambique, Nepal, and Uganda. Four service delivery HIPs have been identified as the study focus: immediate postpartum family planning (IPPFP), community health workers (CHWs), pharmacies and drug shops (PDS), and Post Abortion FP (PAFP). The approach for this study includes: 1) development and implementation of a replicable methodology to establish a baseline for scale, reach, and quality, involving a review of the selected indicators as well as additional data collection through interviews with managing authorities; 2) collecting information about required resources and assigning unit costs via interviews with managing authorities; and 3) conducting readiness assessments at the service delivery level to assess adherence to the core components. Analyses of the data will also examine aspects of equity, efficiency, and economies of scope/scale. Study results will be used by governments (MOH, TWGs), donors, and implementers to inform program design, scale-up, monitoring, and to inform the framing of the HIPs evaluated in terms of health system costs (and cost-savings) and their effectiveness to increase FP provision overall. Four briefs have been produced to provide details on the first part of this study: 

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.  

4. 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 family planning research and learning agendas (RLAs) 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 Nepal, 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 process for Nepal started in August 2021.  Concurrence for the final RLA was obtained by the FP/RH Section Chief in December 2022 and disseminated nationally, including through a presentation at the Ninth National Summit of Health & Population Scientists of Nepal conference in April 2023, in Kathmandu.