Promising Strategies and Approaches for Community Based Family Planning

1. Promising Strategies and Approaches for Community Based Family Planning Beth Outterson Save the Children May 29, 2006

2. Why Reinvigorate FP? • Differences among FBOs on FP methods • Cultural and Religious Barriers to FP • In the past, FP was seen more for population control; few programs promoted FP for its health benefits. • Increased Resources for HIV/AIDS • Reduced Resources for FP programming

3. Promising Strategies and Approaches • World Vision: India (Uttar Pradesh) • CS project, 30% FP • Partner: MOH • Working closely with community groups, good supervision, monitoring & follow up, timed counseling registers • Promoting appropriate access to FP for men & women, following MOH policies. Provide options, give referrals as needed for services • Strong TA from Flex Fund • Passionate staff

4. Promising Strategies and Approaches • ADRA: Guinea • FP Safe Motherhood Project (Extension) CS project (FP integrated later) • Partners: HKI, Prism and SCF • Overcame resistance to FP through dialogue and training of religious leaders. Active involvement of Imams, follow up via monthly supervision • Female CBDs adequately trained and supervised • BCC strategy using rural radio • A wide variety of methods are promoted. CHWs offer barrier and natural methods (condoms, spermicide, SDM, LAM) as well as education and referral for long term methods (injectable, implants, IUD and sterilization)

5. Promising Strategies and Approaches • SCF: Mali - Segou • Partnership to Maximize Access & Quality of Family Planning Services • Partners: 2 local NGOs; collaborating with mission bilateral FP programs – Keneya Chirwara & MOH • Health facility strengthening at local level • Male & female CBDs • Marketing & sales of contraceptives by peer educators & CBDs in villages where there is no health center • BCC through interpersonal & popular village channels assuring contraceptive availability • Counseling & referral to health centers. • Strengthening of health facility • SCF to conduct OR to compare CBD only with CBD & health facility strengthening as a cost effectiveness study

6. Promising Strategies and Approaches • HAI: Timor Leste • Promoting Community Demand for Child Spacing • Partners: UNFPA & MOH. • Good integration with MCH but new project; no results yet • Addresses need for increased knowledge & use of voluntary child spacing practices. • UNFPA & others are working with the MOH to improve quality of child spacing, but little focused effort to increase community demand for spacing or limiting births.

7. Promising Strategies and Approaches • WV: Madagascar (17 communes in 5 provinces) • Integrating FP through a network of 8 FBO partners including Malagash Lutheran Church, Episcopal Church of Madagascar, Seventh day Adventist Church, CSCMM (Muslim Council), Traditional Beliefs Network • Coordinated by SAF/JKM Madagascar • Strong national commitment to FP; support CBD • Complements mission goals of reaching religious constituencies • selection of strategies/messages consistent with religious structures & capabilities • Role of the network: program development, cascade training for community/church workers, Forum for increasing NGO capacity, larger voice for advocacy with religious & political leaders

8. WV Madagascar • Increasing knowledge & demand • via Education & sensitization (ongoing church activities, sermons, etc. & links with health centers) • Creating an enabling environment • via orientation & mobilization of religious leaders, advocacy based on BCC strategy, capacity building of religious NGOs in mobilization for FP • Increasing access to services • via strengthening CBD (cost recovery for motivation), logistics & supply at health centers, reinforce supervision between health centers and community workers. • Challenges to integration: • wide range in partner capacity & values, little experience in FP or in leadership/management

9. Characteristics of CBFP Programs • Many varieties of FP integration, & different degrees of focus on FP. Not all in health sector • CBDs: Although little/no OR has been done on CBDs, they have been shown to be effective. (provision of injectable Depo) CBDs link with health centers to provide as wide method mix as possible. • Community Mobilization including awareness raising and education (using male, female youth promoters) • Comprehensive BCC strategy including mass media and social marketing • Male involvement in FP (Imams, CBDs) • Partnership & Advocacy with national, state/local government to expand method availability

10. Characteristics of CBFP Programs • Build on/share with other FBOs & non FBOs • Work within national policies, educate clients on methods, refer out for services the FBO doesn’t provide • Promotion of long term methods, barrier & natural methods • Quality counseling (WV India), ensures women are informed about all methods available according to where they are in pregnancy. • Training providers in FP methods, counseling skills • GATHER approach: Greet, Ask, Tell, Help, Explain (side effects), Refer (determine best method, refer as needed). • Use of quality improvement tools and processes such as COPE, and PDQ)

11. Observations • No radical differences between in FBOs and non FBOs • Integration of FP in CS/RH programs seems to have a positive effect, and is doable. • FBOs may consider these approaches while keeping in mind the philosophical considerations of their religious beliefs.

12. Questions • How can we best scale up promising strategies and approaches? • Can/should the FBO community join together with a common approach to integrate FP into CS/RH programs? • Can/should the FBO community have a common approach regarding birth spacing?

13. Resources • USAID flexible fund documents and materials http://flexfund.org/resources/grantee_tools/guidance_docs.cfm • USAID child survival an health grants technical reference materials: www.childsurvival.com • Training materials- 5-day FP 101 workshop: http://www.flexfund.org/resources/training/pdme.cfm • http://www.communitybasedfp.org for strategies & approaches, virtual library, training methods,ICT updates, BCC Research • www.catalyst.org for research on life saving benefits of Healthy Timing & Spacing of pregnancy (HTSP) of 3-5 years. • For information on the why the IUD is being considered effective longterm method: www.iudtoolkit.com • For information on PDQ, go to the Core Group website at www.coregroup.org and search on PDQ.