Elements of Family Planning Success

Staffing tops all other factors necessary to the success of family planning programs, according to results from a new worldwide poll of health care professionals. The same poll reports that finding adequate budget poses the greatest challenge to program success.
 
Over 445 health care professionals from 98 countries responded to the online survey, weighing in on the elements most important to success in family planning programs and factors that are hardest to achieve.
 
The INFO Project at the Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs conducted the survey. The survey paved the way for an online discussion forum focused on elements of family planning program success. Some 280 health care professionals in 63 countries joined the forum. The top countries represented included the United States (80), India (28), Kenya (12), Ghana (12), Ethiopia (11).
 
The INFO Project, in collaboration with the World Health Organization and partners of the Implementing Best Practices (IBP) Initiative, sponsored the two-week discussion on the IBP Knowledge Gateway (www.ibpinitiative.org). Catherine Richey, MPH, Senior Technical Writer at the INFO Project facilitated the forum.
 
The survey and forum launch a larger INFO project to create a community and supporting resources focused on the elements of successful family planning programs. In the survey effective communication strategies and outreach ranked second after staffing as one of the most important factors for success. Logistics and client centered care followed closely, and then supportive government policies. Survey respondents were asked to choose no more than three factors in answer to each question.
 
In general, survey respondents said that the most important factors for success are also the most difficult to achieve. The exception was adequate budget—far and away most difficult to achieve, according to the survey findings, but ranking 11th among 14 possible factors for success. 

Discussion Summary
Each day of the online forum focused on one or two elements for success that survey respondents had identified. Over the two weeks participants made 88 contributions. The most contributions came from India (18), Iran (8), Bangladesh (7), Canada (7), US (6), and Senegal (6).

Day 1: Well-trained, supervised, and motivated staff
The forum opened with a discussion on well-trained, supervised, and motivated staff. Asked to choose the 3 most important factors for FP program success, more survey respondents by far (41%) choose staffing. According to forum contributors, good quality services require motivated providers who are well-trained in clinical procedures, have up-to-date knowledge of contraceptive technology, and who have good interpersonal communication skills. Contributors offered suggestions for what a program manager can do to make sure that staff members are well-trained, supervised and motivated, such as offering financial incentives and in-service training, as well as ensuring supportive supervision.

Day 2: Client-centered care for all groups
The discussion for Day 2 focused on the program element that ranked second in the online survey (chosen by 31%) among the most important factors for success. Respondents also voted this factor fifth among the factors that are hardest to achieve (picked by 24%). Discussion on this topic focused on the universal expectations about what constitutes client-centered care. According to contributors, client-centered care is often difficult to achieve due to a lack of qualified staff, inadequate supplies and infrastructure, and a focus on achieving targets, rather than offering quality care.

Day 3: Logistics system that ensures a continuous supply of contraceptives & Broad range of contraceptive methods available     
The Day 3 contributions highlighted the necessity of providing clients with contraceptive supplies when they are needed. Contributors shared many examples of common logistics problems, including lapses in supply, insufficient funds, and unreliable transportation. Contributors also commented on the contraceptive method mix in their settings. Several contributors mentioned that clients are asking for implants, which are currently not available in their settings.

Day 4: Integration with related health services
In general, contributors thought that integrated services were a positive thing for clients, because they save the client time and resources. Contributors also noted, however, that integrated services may increase providers’ workload, overburdening them. Several contributors offered advice for program managers who are considering integrating services, such as assessing the feasibility of integrated services and offering in-service training for staff. One contributor recommended increasing linkages between family planning and other health services as a first step, before jumping into comprehensive integrated services.

Day 5: Mix of service delivery points—for example, clinics, community-based distribution, retail sales
Family planning programs in many areas of the world have found that offering services outside the clinic is an effective way to increase access to and acceptability of family planning, particularly in rural areas where health care infrastructure is weak. Contributors shared a variety of benefits and limitations of offering services outside the clinic, based on their unique program experiences. Several contributors report that their programs have already begun to, or plan to, offer injectable contraceptives outside the clinic.

Day 6: Effective communication/outreach strategies
Communication activities of participants’ programs range from interpersonal communication, to mass media approaches, to community activities. Contributors identified difficulties faced in undertaking communication activities, and how they have addressed these problems. For example, a lack of community interest in FP messages due to religious beliefs was addressed by using local leaders to disseminate the messages. Few contributors report using newer technologies to reach clients, such as cell phones or Web sites.

Day 7: Program guided by research, monitoring and evaluation (M&E), and a management information system (MIS)
Forum members described how they monitor and evaluate their programs, including specific approaches, frameworks, and indicators. In the online survey more respondents wanted to learn more about this topic than any other. Contributors recommended several resources to help program managers strengthen M&E and the MIS in their programs.

Day 8: Strong leadership, Good management & Up-to-date service delivery guidelines
The discussion for Day 8 focused on three topics. All contributors agreed that family planning programs need political support and good leadership to operate successfully. In response to the questions about service delivery guidelines, contributors noted that keeping guidelines up-to-date is not an easy task, often requiring a strong political commitment. 

Day 9: Adequate financial resources & Services for the poor
Contributors reported a variety of funding sources for their programs, ranging from government subsidies to assistance from foreign aid agencies. Few contributors considered their current funding situations sustainable. The importance of free or subsidized services for the poor sparked a great deal of debate. Some contributors contended that programs should offer family planning services free of charge. Others argued that free services are not sustainable and that people will value a service more if they pay even a small amount for it.


Forum Evaluation
Nearly 45 forum members responded to the forum evaluation survey. Over three-fourths of survey respondents reported being very satisfied with the forum discussion content, while one-fourth were somewhat satisfied. Nearly all respondents said they would be interested in an interactive Web site that contains information and resources related to success in family planning programs
Comments included the following:

• "The forum is very educative, it has made some of us working with NGO's with programs in Health related areas learn more."
•  "It was well structured and moderated. It was a useful update."
• “I really enjoyed discussions in the forum and participated on everyday questions. This discussion is going to be further helpful by way of framing of questions and defining research objectives. Thanks.”
• "It is amazing that the entire discussion moderated by you beautifully revolves around the core participants. Congrats."
• "Kudos to Catherine Richey and our respectful contributors for making the discussion platform an enlightened workshop."
• Many thanks for creating a forum for discussion on family planning issues which are so vital and have effect on almost all aspects of one’s life. I loved the discussion at the platform and the contributions made by different individuals and organisations in a wonderful environment."
• “Thank you for the wonderful forum you are operating. The topic ‘Elements of Successful Family Planning Programs’ really helps me look for different approaches, as well as innovative models to try out.
• "From our last discussions on the Element of Successful FP Programmes Forum, I learnt new ideas and techniques which were before then unknown to me. Therefore, I am of the opinion that it was a worthwhile effort. More of such is expected this year and I do hope it will translate to better workable idea."