Stronger health systems. Greater health impact.
Components of successful Family
Planning Program
Dr. Halida Hanum Akhter, MBBS, Dr. PH
Global Technical Lead for Family planning and Reproductive Health ,
Management Sciences for Health , USA
FP RH workshop for SHTP-II, Juba, South Sudan, August 24-27, 2010
Benefits of Family Planning:
Since the 1960’s, family planning (FP) programs have assisted in:
 Raising the global prevalence of contraceptive use from 10% to 60%
 Reducing the average fertility in developing countries from six to
about three births per woman1-3
Scaling up services to provide FP to all women would
prevent:
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52 million unintended pregnancies
23 million unplanned births
22 million abortions
7 million miscarriages
1.4 million infant deaths
142,000 pregnancy related deaths
505,000 children from loosing their mother4
Family planning Indicators and management Tools
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Contraceptive Prevalence rate
Birth rate
%of births with more than 2-years intervals (spacing)
Knowledge of contraceptives methods
Utilization rate of modern FP methods
% of women in couples with unmet contraceptive needs
%of health facilities providing modern FP methods
Range of methods provided in health facilities and at the
central warehouse
 Number of staff members trained in FP health facilities
 Number of FP awareness-raising sessions in schools
 Number of FP awareness-raising sessions in communities
Elements of successful family planning program
Supportive government policies
Evidence-based programming
Strong leadership & good management
Effective communication & outreach strategies
Contraceptive supply & logistics system
Well-trained, supervised & motivated staff
Client-centered care for all groups
Mix of service delivery points
Free or inexpensive services for poor
Integration with related health services
Access to services
 FP is offered in both Private and Public Institutions
including Community level.
 There is a strong integration of FP into other
services such as HIV services, MCH week, nutrition,
 Male involvement via ANC services at facility level.
 Community-based distribution in development,
integration of FP into other services,
 Introduction of community distribution of
injectables among others;
Special group emphasized- Youth-friendly services exists,
 Reaching out to men is emphasized,
Access to services
 Free contraceptive commodities in public sector
 Private Sector/Social marketing Involvement in
family planning;
 Free availability of Long-acting and permanent
methods
Provider s’ skill and availability
 FP providers knowledge and skills up-to-date by
doing On-the-job-training
 Task Shifting where nurses can provide long term
methods and Capacity Building for health care
providers;
 Care providers turnover issues;
Sensitization and BCC
 Community sensitization efforts (through mass
media and other method of community
entertainment to discuss the importance of FP and
clearing up misconceptions.
 Open discussions on FP – Empowerment at various
levels;
 Positive media coverage on family planning;
 Faith based and cultural factors
 Partnership promotion with both international and
local partners
Family planning environment
 A strong political commitment
 Advocacy is carried out for family planning;
 Stakeholders supporting the programs;
 There is Government budget line designed for FP
commodities purchase
 Innovative financing systems such as performancebased financing (health center and community)
 Community health insurance scheme
 There is a strong public-private partnership in FP
 The logistics system ensures contraceptive security
 Quantification and forecasting performed jointly by all
donors under Govt. leadership
 Well-functioning district procurement and distribution
of commodities and supplies in place;
Enabling Factors/Achievements
 Political Commitment for example the involvement
and campaign of the 1st Lady on Adolescent
Pregnancy;
 Vocal Leadership to support the existing efforts
 Supportive Policy environment by the government
with service provision guidelines- FP, and integration
of family planning services into VCT, PMTCT, ART,
home based care, and Adolescent reproductive
health;
 Recognized huge unmet need due to lack of
resources.
 Government Commitment to support reproductive
health and family planning programs;
Enabling Factors/Achievements
 Service Delivery Expansion that includes Heath
Extension Program (health extension workers
supported by community health workers),
 Provision of Depo Provera and Implanon by health
extension workers, and model Families
 Communities promoting healthy behaviors,
including use of family planning;
 Conducive Policy Environment such as tax
exemption on contraceptives- 2007;
 National Family Planning Implementation Plan
Integration FP with other services
 Integration means offering multiple health care services at the
same facility or through a community-based program to benefit clients,
providers, and programs. Integrated Services Increase Program
Efficiency and Clients’ Convenience
 Clients. Offering multiple services at one location increases access and
convenience for people seeking health care. For example, women with HIV
often prefer to obtain family planning from their HIV care provider rather
than disclose their HIV status to another health care provider (Cooper et al.,
2007 #34).
 Providers. Integration of services enables providers to address the health
of their clients more holistically. Some providers report that they like the
opportunity to offer clients multiple services (Babcock, 2004 #12). They
caution, however, that adequate resources, training, and support are
necessary. Otherwise, the new responsibilities may overburden them.
 Programs. Integrated services are more efficient and so can serve more
people for the same expenditures. Program managers of integrated services
report that they avoid duplication of effort and save money that might have
been spent maintaining separate facilities (Kane et al., 2005 #101).
Family Planning Program Challenges
 Commodity stock-outs at Facilities hence the need to
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promote long term and permanent methods;
Community based distribution not done;
FP program is largely donor driven;
Inadequate resources for procurement of quality
contraceptives and capacity building of service providers;
Inadequate skilled health workers for provision of long
term methods IUD and Implants;
Inadequate demand creation activities at various levels;
Socio-cultural inhibitions as a barrier to the family
planning program;
Lack of male involvement in family planning programs;
and Weak partnership with private health facilities.
Best practices :
 Bringing Family Planning to Every Door step
through Health Extension Program with majority
women as part of task shifting.
 Community level intervention on demand creation,
referral and access to services in States with high
unmet need in Family planning.
 Inclusion of FP service in National health Insurance
scheme/Community based health insurance
scheme;
 Community based Depo- provera injectable
contraceptive method-piloted;
 Pilot use of standard day’s method using Cycle
beads;
Recommendations:
 Increase budgetary allocation for FP by the
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government;
Scale up of Community based distribution of FP
services;
Demand creation activities such as community
sensitization;
Integrated Maternal Newborn and Child health
(IMNCH) budget line 2010;
Functional contraceptive logistics management
system with user fee;
Forecast of 5 years contraceptive requirement done;