It’s Got Promise! Recent Advances in Family Planning and Immunization Integration

Throughout the Reproductive Life Course: Opportunities and Challenges for Empowering Girls and WomenApril 2014

Chelsea Cooper, Social & Behavior Change Communication Advisor, MCHIP Trinity Zan, Senior Technical Officer, FHI 360

Overview

• Rationale for integration• Recent and emerging evidence• “Promising” High Impact Practice

– Programmatic recommendations

Why Integrate?

FP & Immunization Integration

High Unmet Need in PP

Period

Importance of Healthy Timing & Spacing for MCH

Low Use of Postpartum

Services; High Use of Immunization

Up to 5 contacts with Mothers in

First Year

Women & Providers

Supportive

• Cluster randomized, two-group, separate sample, pre/post-test designs

• Intervention in both studies: Job aid for individual risk/need assessment based on LAM criteria for use at each immunization contact; Same-day FP services at same location

• Intervention in Rwanda: Group talks, brochure, supportive supervision

FHI 360 Studies in Ghana/Zambia and Rwanda

Results: Use of Any Family Planning Method—Ghana & Zambia

Results: Use of Any Family Planning Method—Rwanda

Control Intervention0

20

40

60

80

100

5851 49

57

Baseline Follow-up

%

*statistically significant at p=0.1Model accounts for clustering by facility and facility*time, age, parity, education, religion and partner approval of FP

+ 8%

+8 % Intervention- (7)% Control15% point difference *

- 7 %

N=403 N=403N=422 N=426

Results from Rwanda continued: Immunization Rates Not Affected by Intervention

Jul-10 Sep-10 Nov-10 Jan-11 Mar-11 May-11 Jul-11 Sep-1160

70

80

90

100

Average number of Measles immunizations, by month

Intervention Control

Month - Year

# Im

mun

izati

ons

All dates are post-intervention

Challenges to Integration: Lessons from FHI 360 Assessment in Jharkhand, India—2010-2011

Health system:• Inadequate

infrastructure • Supply-chain

problems for family planning

• Weak record keeping and reporting for both services

Human resources:• No specific policy• Insufficient training

on integration • Provider myths &

misperceptions • Gaps in staffing• Insufficient

management of frontline staff

• Lack of IEC materials

Community-level:• Misperceptions

among women, husbands, & mothers-in-law

• Inadequate mechanisms to involve husbands

• Limited knowledge on community resources

• Descriptive assessment in Lohardaga District included interviews with mothers, providers and managers

Development of Standard Operating Procedures and IEC/IPC Materials for Providers

The Integrated Service Delivery Model in Liberia

Collaboration between MoHSW + MCHIP

Combined Service Provision Model: Use of routine immunization contacts at fixed facilities where vaccinators provided one-on-one immunization and FP messages and referrals for same-day FP services

Piloted at 10 health facilities in Bong and Lofa counties from March-Nov 2012

Designed as a pilot program using a scalable model per MOHSW guidance10

The Approach

11

ALL women who bring infants for vaccination receive messages and referrals for FP

Job aid to guide vaccinator communication

Key messages designed strategically to address barriers and enablers identified through formative assessment Stigma and sensitivity regarding

contraceptive use by mothers of babies who are not yet walking

Clients offered a leaflet to take home which describes benefits of FP

Source: MCHIP

Participating Facilities New Contraceptive Users

March-Nov 2011 v. 2012

LOFA BONG

12

90% increas

e

73% increas

e

New Contraceptive users during March-Nov 2011 and 2012 in Participating

Facilities

13

0

500

1000

1500

2000

2500

Bong Lofa

2012 NEW FP USERS REFERRED FROM EPI2012 NEW FP USERS NOT REFERRED FROM EPI ON SAME DAY2011 NEW FP USERS

44%

66%56%

34%

Source: MOHSW/CHT/MCHIP Supervision Data

BONG LOFA

1182

2039

517

983

Immunization Findings: March-Nov 2011 vs. March-Nov 2012

14

Pilot facilities All other facilities0%

2%

4%

6%

8%

10%

12%

9%10%

5%

11%

Bong : Percentage Change in Penta 1, 3 doses admin-istered

Pilot facilities All other facilities

-20%

-10%

0%

10%

20%

30%

40% 35%

-11%

21%

-6%

Lofa : Percentage Change in Penta 1, 3 doses administered

Penta 1Penta 3

“Crowd sourced” interactive map on HIP implementation on K4Health website

High Impact Practices (HIP): FP & Immunization Integration in “Promising” Category

HIP brief endorsed by over 20 organizations

Interagency Working Group: What Have We Learned?

Lessons: FP & Immunization

Integration

Integrate During

Routine Immunization Services

Collect Data on Impact of Integration

on Immunization Services

Political & Community Support are

Critical

Health System

Issues Must be Addressed

More Evidence Needed…

• Communication• Integration

models• Cost-

effectiveness• Scaling up…Etc.

The FP & Immunization Integration

Toolkit houses relevant

resources developed to-

date!

FHI 360 & MCHIP Teams Lisa DulliGwyneth VanceKate Rademacher Mackenzie GreenMarga EichleaySteve SortijasThéophile NsengiyumvaShrabanti SenDeepika YadavJennifer WessonBill FingerJohn StanbackFidèle Ngabo

Nyapu TaylorRebecca FieldsAnne PfitzerElizabeth SasserElaine CharuratRobert SteinglassMarion Subah

THANK YOU! PROGRESS PPFP portfolio:

http://fhi360.org/projects/progress-technical-area-postpartum-family-planning

MCHIP: http://www.mchip.net/ppfp HIP Map:

http://www.k4health.org/topics/high-impact-practices-family-planning

FP/Immunization Integration Toolkit: http://www.k4health.org/toolkits/family-planning-immunization-integration

Working Group: krademacher@fhi360.org or chelsea.cooper@jhpiego.org