Policy imperatives for systems-oriented approaches to scaling up: Case example of taking the SDM to national scale Susan Igras, Rebecka Lundgren, Marie Mukabatsinda, Arsène Binanga, Foufa Touré International FP Conference, Uganda, Nov 2009
Strategic Choices for FAM Scale Up Lead to Selection of Inputs
User Organizations- Activities
Training and supervision
Community awareness raising (IE&C)
Resource Organizations- Activities
Capacity building in systems analysis
Transferring skills and ownership
ExpandNet Scale up Principles Influence Strategic Choices
Rights oriented and equitable (gender, vulnerability, and client)
Research Questions: Scale-up Outcomes Client What is the experience of women and men with the SDM when scaled-up? (Knowledge, attitudes and use of the SDM) Service offering Is SDM offered correctly by providers? How does SDM introduction influence quality, availability and use of overall family planning services? System integration To what extent has SDM been integrated into training, IEC, procurement and distribution, and HMIS? Is included in norms, protocols and guidelines? Resource mobilization What is the level of non-USAID resources dedicated to FAM?
Research Questions – Scale-up Process Resource team To what extent do user organizations assume the roles, responsibilities and ownership of the resource team during the scale-up process? Advocacy/ Dissemination What is the role of champions of the SDM? Organizational choices To what extent has the SDM been offered outside traditional public sector service delivery?
Data Sources for Scale up Monitoring, Evaluation, and Case Study
Findings from Baseline Research and Process Documentation
Monitoring Performance Benchmarks - Mali Selected Indicators (as of 6/09) No. of resource orgs 11 / 16 SDM included in key policies, norms, protocols 5 / 8 revision needed SDM in pre-service training Initiated Commodities in logistics & procurement systems In CPT SDM in IE&C materials Yes , revision needed SDM in HMIS In process Proportion of SDPs with FAM in method mix 66 % FAM in surveys (DHS) Under discussion Funds leveraged for FAM $75,000 (est’d) Providers trained 4575 / 5394
Hlth/FP Program Mgrs and Policy Makers in Guatemala (n=20) Political commitment to SDM scale up Commitment is there since SDM already integrated (in norms, training occurring, in materials) Political factors in SDM scale up Some stakeholders not convinced a natural method can be modern and effective and that there would be sufficient demand. FBOs, Church, and community based NGO networks strong supporters FAM knowledge/attitudes Almost all were knowledgeable about FAM (but not knowledgeable about efficacy trials and rates) Ability of MOH to manage SDM scale up Was within their mandate. If there is demand, they will support it. Integration of SDM into annual planning / budgeting processes Not yet in planning and budgeting processes centrally or regionally. Felt if SDM ‘proved’ it had high demand, it would be integrated.
Provider Interviews / Facility Assessments in Rwanda (n=155 and n=109) FAM integration into norms, guidelines, policies 2/3 of providers have seen protocols Most not familiar with norms and guidelines (newly introduced in Rw) Status of FAM services 60% of providers have offered SDM (42% in last 3 months) 15% have offered LAM (99% in last 3 months) 70% have been offering SDM between 1-5 years Correctness of SDM info by provider Most providers offer SDM competently, and do not find SDM counseling difficult Service deliv environment Providers only have 4-10 min for counseling on FP – not enough Status of FAM services 91% of visited facilities offering FP offered SDM. CycleBeads found in most. Only 17% of facilities displayed FP info (SDM/LAM are integrated into IEC)