Family Planning Integration: Overcoming Barriers to NGO Programming A Presentation of Preliminary Results from the CORE Group CBFP/MCH Integration Survey Paige Anderson Bowen, MPH CORE Group Consultant CORE Fall Meeting; September 15, 2010
Jul 07, 2015
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 [email protected]
The preceding slides were presented at theCORE Group 2010 Fall Meeting
Washington, DC
To see similar presentations, please visit:www.coregroup.org/resources/meetingreports