Family Planning Integration: Overcoming Barriers to NGO Programming

A Presentation of Preliminary Results from the CORE Group CBFP/MCH Integration Survey

Paige Anderson Bowen, MPHCORE Group ConsultantCORE Fall Meeting; September 15, 2010

Survey Objective

To generate a set of recommendations directed to the CORE SMRH Working Group and USAID on information, tools and other publication resources, and guidance that is needed to mobilize and support organizations to integrate CBFP into community-focused MCH programs

Methods

• Online survey (SurveyMonkey)• 45 questions organized into 5 sections

1. Background Information2. CBFP Programming3. CBFP Integration4. Barriers to CBFP Integration5. Best Practices / Recommendations

• Survey open August 16 to 31, 2010• Key themes identified in open-ended questions using

content analysis techniques • Individual follow-up questions/interviews further

explored lessons learned, tools, best practices, success stories

Survey Sample

• Current/past CSHGP grantees and Flexible Fund grantees

• 132 individuals invited to participate; at least one HQ and one field representative invited from each target organization

• 51 respondents (39% response rate); 38 complete surveys

• Respondents…• Evenly distributed among HQ (35%), country head

office (37%), and field office (28%)• Primary role of almost half of respondents (45%) is

program design/management• Three-quarters (76%) are with an organization that

has implemented a CBFP program since 2002

Preliminary Findings

• CBFP Integration

• Barriers to CBFP Integration

• Best Practices / Recommendations

Elements of IntegrationElements of integration, as defined by respondents…

Coordination (70%): “Incorporation of different programs into one holistic package that can be easily delivered by an individual at the community level so as to avoid duplication due to parallel programs.”

Single, combined service (22%): “The Supermarket, or all inclusive service”

Convenience (15%): “A process whereby different but related health programs are brought together and implemented in a coordinated fashion for the same beneficiaries at the same time so that the beneficiaries can access all of them at the same time.”

(continued)

Elements of IntegrationElements of integration, as defined by respondents…

Expanding access (11%): “To take the opportunity offered by a service already delivered, often in routine, to ‘’vehicle’’ the delivery of another new service.”

Affordability (9%): “Collaboration and combination of all activities related to health promotion and diseases prevention to obtain optimum coverage and cost effectiveness.”

Improving Quality (7%): “Incorporation of one element into another (FP into HIV, FP into MCH, HIV into FP etc) so that the resulting combination is an improved, more accessible service package for the user.”

Integration Defined

Integration generally means two or more types of services previously provided separately being offered as a single, coordinated, and combined service(adapted from MSH Manager).

Integrating CBFP services can be a means of improving the quality of service delivery, expanding access to services, or making services affordable and convenientto clients.

Among respondents whose organization has implemented a CBFP program since 2002, 86% integrate CBFP with MCH

Effective Entry Points93.3%

84.4%

53.3%

77.8%

86.7%

95.6%

73.3%71.1%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Less Effective Entry Points

Sick child visits (53%): “When a child is sick, mothers are too upset to be able to understand or retain FP messages, plus the child is upset and likely crying - not a constructive environment for counseling.”

PMTCT (71%): “PMTCT is primarily to ascertain pregnant mothers HIV status and ensure she can access appropriate services if HIV positive. FP should be discussed after HIV status is determined…”

VCT/HCT (73%): “HIV/AIDS counseling and testing is usually a tense and stressful moment for many people. Adding in issues of FP may not be the most appropriate time.”

Discussion

Are there other entry points that should be included in this list?

• Effective?

• Less effective?

What makes an entry point less effective?

Barriers Ranking

• Barriers to CBFP/MCH integration considered in one of five categories: organizational, programmatic, clinical, donor/funding, health systems/policy

• Respondents ranked barriers on a scale of 1-5• Results cross-tabulated with primary office assignment; rating

averages used to order results

HQ Country Head Office Field Office

1 - Smallest Organizational Organizational Organizational

2 Programmatic Programmatic Programmatic

3 Health Systems/Policy Donor/Funding

4 Donor/Funding Clinical

5 - Largest Clinical Health Systems/Policy Health Systems/Policy

Clinical - Donor/Funding

Main Barriers to Integration

49%

61%

71%

66% 66%

59%

56%54%

71%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Internal financial situationStaffing capacity to link servicesCommodity stock-outsIneffective, overburdened, or non-existent referral systemUnder-staffing or improper staffingNo integration fundingNo CBFP fundingStove-piped fundingNo budgeted government resources for CBFP

Donor/Funding

Clinical

Helpful Resources to Facilitate Integration

7.3%

7.3%

9.8%

12.2%

17.1%

19.5%

43.9%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45%

IEC/BCC materials

M&E framework/tools

Step-by-step integration guide

Evidence to support in-country advocacy

Funding for integration

Document and share experiences(models, lessons learned, best practices)

Training resources for local partners and staff(teaching/learning aides, curricula, guides)

Integration Tools in Use

• Less than half (46%, n=19) of respondents use any tools to guide their CBFP/MCH integration

• Tools being used:• Frameworks: Postpartum FP Framework (Access

FP, JHPIEGO), 7-11 Framework (World Vision), Birth Preparedness and Complication Readiness matrix (JHPIEGO)

• Job Aides: CHW flipcharts, GATHER counseling tools, service checklists

• Training curricula: CHWs, TBAs, CORPs, community health agents, pictorial

• Books: FP Global Handbook, Where Women Have no Doctor, Helping Health Workers Learn

• Guides, modules, case studies published by WHO, USAID, FHI, local MOH , and other partners

• Integrated monitoring tools

Discussion

Does your organization use any other tools?

What tool or guidance document would help reduce largest perceived barriers (clinical, health systems/policy) and encourage FP integration?

Should any existing tool(s) be adapted and disseminated?

Is there a new tool that needs to be created?

Recommendations

• Respondents suggested actions that various stakeholders could take to facilitate integration of CBFP and MCH

• USAID/Washington

• USAID Missions

• Individual organizations

• CORE Group

Recommendations for USAID/Washington

13.2%

13.2%

13.2%

15.8%

15.8%

21.1%

28.9%

0% 5% 10% 15% 20% 25% 30%

Be the example- align USAID health programs (e.g. MCHIP)

Train service providers/NGOs in integration

Fund integration

Recommend minimum CBFP/MCH package

Advocate for FP/integration globally and in Washington

Provide technical assistance; share information

Increase mandate for FP in program designs

Recommendations for USAID Missions

10.5%

13.2%

13.2%

13.2%

18.4%

21.1%

0% 5% 10% 15% 20% 25%

Monitor in field; visit project sites

Fund integration

Convene partners across program areas

Advocate for FP/integration nationally

Increase mandate for FP in program designs

Provide technical assistance; share information

Recommendations for CORE Group

10.5%

15.8%

15.8%

23.7%

50.0%

0% 10% 20% 30% 40% 50%

Create integration training program

Develop resources on integration

Advocate for FP/integration

Provide technical assistance

Facilitate/share resources(tools, best practices, models)

Recommendations for Organizations

10.5%

10.5%

10.5%

15.8%

21.1%

25.6%

0% 5% 10% 15% 20% 25% 30%

Seek funding for integration

Share successes/lessons with partners

Conduct OR

Train staff in FP/integration

Add FP to existing community interventions

Link parallel programs in PDME

Thank you!

• We appreciate your participation in this process

• If you have anything additional to share, please contact Paige at paige@andersonbowen.com

The preceding slides were presented at theCORE Group 2010 Fall Meeting

Washington, DC

To see similar presentations, please visit:www.coregroup.org/resources/meetingreports