Its Got Promise!

Recent Advances in Family Planning and Immunization Integration

Throughout the Reproductive Life Course: Opportunities and Challenges for Empowering Girls and Women April 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?
Women & Providers Supportive High Unmet Need in PP Period Up to 5 contacts with Mothers in First Year

FP & Immunization Integration

Importance of Healthy Timing & Spacing for MCH

Low Use of Postpartum Services; High Use of Immunization

FHI 360 Studies in Ghana/Zambia and Rwanda

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; Sameday FP services at same location Intervention in Rwanda: Group talks, brochure, supportive supervision

Results: Use of Any Family Planning Method Ghana & Zambia

Results: Use of Any Family Planning Method Rwanda

100 80 60 % 40 20 0
+8 % Intervention - (7)% Control 15% point difference *

Baseline

Follow-up

58
51

57

49

-7%
N=403
N=422

+ 8%
N=403
N=426

Control

Intervention

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

Results from Rwanda continued: Immunization Rates Not Affected by Intervention

Average number of Measles immunizations, by month 100 90 80 Intervention Control

# Immunizations

70
60 Jul-10 Sep-10 Nov-10 Jan-11 Mar-11 May-11 Jul-11 Sep-11 Month - Year

All dates are post-intervention

Challenges to Integration: Lessons from FHI 360 Assessment in Jharkhand, India2010-2011

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

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 oneon-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 guidance

10

The Approach
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

11

Participating Facilities
New Contraceptive Users March-Nov 2011 v. 2012 LOFA
90% increase

BONG
73% increase

12

New Contraceptive users during March-Nov 2011 and 2012 in Participating Facilities
2500

2039
2000

1500

44%

1182
1000

983
56%

517

34%

500

66%
0

Bong

BONG

Lofa

LOFA

2012 NEW FP USERS REFERRED FROM EPI

2012 NEW FP USERS NOT REFERRED FROM EPI ON SAME DAY

2011 NEW FP USERS

13

Source: MOHSW/CHT/MCHIP Supervision Data

Immunization Findings:
March-Nov 2011 vs. March-Nov 2012
Bong : Percentage Change in Penta 1, 3 doses administered
12% 10% 10% 8% 6% 4% 2% 0% 5% 9% 11%

Lofa : Percentage Change in Penta 1, 3 doses administered

40%

Pilot facilities

All other facilities

30%

35%

21% 20% 10% 0% Penta 1 Penta 3

Pilot facilities
-10%

All other facilities

-6% -11%

14
-20%

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

HIP brief endorsed by over 20 organizations

Crowd sourced interactive map on HIP implementation on K4Health website

Interagency Working Group: What Have We Learned? Communication

More Evidence Needed Integrate During Routine Immunization Services
Integration models Cost-effectiveness Scaling upEtc.

Lessons: FP & Immunization Integration

Health System Issues Must be Addressed

Collect Data on Impact of Integration on Immunization Services

Political & Community Support are Critical

The FP & Immunization Integration Toolkit houses relevant resources developed to-date!

FHI 360 & MCHIP Teams

Lisa Dulli Gwyneth Vance Kate Rademacher Mackenzie Green Marga Eichleay Steve Sortijas Thophile Nsengiyumva Shrabanti Sen Deepika Yadav Jennifer Wesson Bill Finger John Stanback Fidle Ngabo

Nyapu Taylor Rebecca Fields Anne Pfitzer Elizabeth Sasser Elaine Charurat Robert Steinglass Marion Subah

THANK YOU!
PROGRESS PPFP portfolio: http://fhi360.org/projects/progresstechnical-area-postpartum-family-planning MCHIP: http://www.mchip.net/ppfp HIP Map: http://www.k4health.org/topics/high-impact-practices-familyplanning FP/Immunization Integration Toolkit: http://www.k4health.org/toolkits/family-planning-immunization-integration Working Group: krademacher@fhi360.org or chelsea.cooper@jhpiego.org