Bowen fp mch


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CORE Group Fall Meeting 2010. Family Planning Integration: Overcoming Barriers to NGO Programming. A Presentation of Preliminary Results from the CORE Group CBFP/MCH Integration Survey. - Paige Anderson Bowen, CORE Group Consultant

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  • % of respondents including the element in their definition of “integration” is noted in parentheses. These %s were determined by a content analysis of all responses (n=46).
  • % of respondents including the element in their definition of “integration” is noted in parentheses. These %s were determined by a content analysis of all responses (n=46).
  • Of note, 100% of HQ respondents felt “CHWs trained in FP methods and counseling” and “Postpartum FP” are effective entry points for integration.Additional effective entry points suggested included:Nutrition and IYCF counselingPACFamily health promotion
  • Other barriers discussed by respondents included:Poor infrastructure limiting access to populationCulturalReligiousPoliticalLinked health products/services damaged due to assumption that all products/services are FP
  • These %s were determined by a content analysis of all responses (n=41). Only those suggestions with at least 4 responses (7%) included here.Interestingly, the resource predominantly requested by respondents is training resources, yet the main barriers to integration (clinical and health systems/policy) included commodity stock-outs and lack of budgeted government resources for CBFP. The requested resources does not match up with the identified barriers.
  • n=38#1 recommendation – increasing mandate for FP in program designs, e.g.FP integration included in RFAsA portion of a project budgeted earmarked for FPFP included in MCH, CS, and nutrition proposalsOther recommendations mentioned:-Support scale-up of CBFP-Be flexible/open to FP-Strengthen supply chains-Health systems strengthening
  • n=38#1 recommendation – increasing mandate for FP in program designs, e.g.FP integration included in RFAsA portion of a project budgeted earmarked for FPFP included in MCH, CS, and nutrition proposalsOther recommendations mentioned:-Strengthen local health systems-Train service providers/NGOs in integration-Be open/flexible to FP-Facilitate NGO/government collaboration-Scale up successful integration programs
  • n=38#1 recommendation – facilitating/sharing resources, e.g.Devote sessions (Elluminate, Spring/Fall Meeting) to integrationFacilitating experience sharing between countries and between NGOsDisseminate successful (and failed) models, lessons learned, tools, etcOther recommendations mentioned:-Pilot integration programs-Scale-up successful integration programs or strategies-Mobilize resources for integration-Coordinate/harmonize interventions
  • n=38Other recommendations mentioned:-Pilot integration programs to demonstrate feasibility-Scale-up successful integration programs or strategies-Coordinate with partners in-country to maximize resources-Promote integration internally – initiate dialogue, emphasize integration in mission, encourage project coordinationNote: Less than one-quarter of survey respondents have conducted any “implementation research” on FP
  • Bowen fp mch

    1. 1. Family Planning Integration: Overcoming Barriers to NGO Programming<br />A Presentation of Preliminary Results from the CORE Group CBFP/MCH Integration Survey<br />Paige Anderson Bowen, MPH<br />CORE Group Consultant<br />CORE Fall Meeting; September 15, 2010<br />
    2. 2. Survey Objective<br />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 <br />
    3. 3. Methods<br /><ul><li>Online survey (SurveyMonkey)
    4. 4. 45 questions organized into 5 sections</li></ul>Background Information<br />CBFP Programming<br />CBFP Integration<br />Barriers to CBFP Integration<br />Best Practices / Recommendations<br /><ul><li>Survey open August 16 to 31, 2010
    5. 5. Key themes identified in open-ended questions using content analysis techniques
    6. 6. Individual follow-up questions/interviews further explored lessons learned, tools, best practices, success stories</li></li></ul><li>Survey Sample<br /><ul><li>Current/past CSHGP grantees and Flexible Fund grantees
    7. 7. 132 individuals invited to participate; at least one HQ and one field representative invited from each target organization
    8. 8. 51 respondents (39% response rate); 38 complete surveys
    9. 9. Respondents…
    10. 10. Evenly distributed among HQ (35%), country head office (37%), and field office (28%)
    11. 11. Primary role of almost half of respondents (45%) is program design/management
    12. 12. Three-quarters (76%) are with an organization that has implemented a CBFP program since 2002</li></li></ul><li>Preliminary Findings<br /><ul><li>CBFP Integration
    13. 13. Barriers to CBFP Integration
    14. 14. Best Practices / Recommendations</li></li></ul><li>Elements of Integration<br />Elements of integration, as defined by respondents…<br />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.”<br />Single, combined service (22%): “The Supermarket, or all inclusive service”<br />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.”<br />(continued)<br />
    15. 15. Elements of Integration<br />Elements of integration, as defined by respondents…<br />Expanding access (11%): “To take the opportunity offered by a service already delivered, often in routine, to ‘’vehicle’’ the delivery of another new service.”<br />Affordability (9%): “Collaboration and combination of all activities related to health promotion and diseases prevention to obtain optimum coverage and cost effectiveness.”<br />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.”<br />
    16. 16. Integration Defined<br />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). <br />Integrating CBFP services can be a means of improving the quality of service delivery, expanding access to services, or making services affordable and convenient to clients.<br /><ul><li>Among respondents whose organization has implemented a CBFP program since 2002, 86% integrate CBFP with MCH</li></li></ul><li>Effective Entry Points<br />
    17. 17. Less Effective Entry Points<br />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.”<br />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…”<br />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.”<br />
    18. 18. Discussion<br /><ul><li>Are there other entry points that should be included in this list?
    19. 19. Effective?
    20. 20. Less effective?
    21. 21. What makes an entry point less effective?</li></li></ul><li>Barriers Ranking<br /><ul><li>Barriers to CBFP/MCH integration considered in one of five categories: organizational, programmatic, clinical, donor/funding, health systems/policy
    22. 22. Respondents ranked barriers on a scale of 1-5
    23. 23. Results cross-tabulated with primary office assignment; rating averages used to order results</li></li></ul><li>Main Barriers to Integration<br />Health Systems/Policy<br />Clinical<br />Programmatic<br />Organizational<br />
    24. 24. Helpful Resources to Facilitate Integration<br />
    25. 25. Integration Tools in Use<br /><ul><li>Less than half (46%, n=19) of respondents use any tools to guide their CBFP/MCH integration
    26. 26. Tools being used:
    27. 27. Frameworks: Postpartum FP Framework (Access FP, JHPIEGO), 7-11 Framework (World Vision), Birth Preparedness and Complication Readiness matrix (JHPIEGO)
    28. 28. Job Aides: CHW flipcharts, GATHER counseling tools, service checklists
    29. 29. Training curricula: CHWs, TBAs, CORPs, community health agents, pictorial
    30. 30. Books: FP Global Handbook, Where Women Have no Doctor, Helping Health Workers Learn
    31. 31. Guides, modules, case studies published by WHO, USAID, FHI, local MOH , and other partners
    32. 32. Integrated monitoring tools</li></li></ul><li>Discussion<br /><ul><li>Does your organization use any other tools?
    33. 33. What tool or guidance document would help reduce largest perceived barriers (clinical, health systems/policy) and encourage FP integration?
    34. 34. Should any existing tool(s) be adapted and disseminated?
    35. 35. Is there a new tool that needs to be created?</li></li></ul><li>Recommendations<br /><ul><li>Respondents suggested actions that various stakeholders could take to facilitate integration of CBFP and MCH
    36. 36. USAID/Washington
    37. 37. USAID Missions
    38. 38. Individual organizations
    39. 39. CORE Group</li></li></ul><li>Recommendations for USAID/Washington<br />
    40. 40. Recommendations for USAID Missions<br />
    41. 41. Recommendations for CORE Group<br />
    42. 42. Recommendations for Organizations<br />
    43. 43. Thank you!<br /><ul><li>We appreciate your participation in this process
    44. 44. If you have anything additional to share, please contact Paige at</li></li></ul><li>The preceding slides were presented at the<br />CORE Group 2010 Fall Meeting<br />Washington, DC<br />To see similar presentations, please visit:<br /><br />