How Service Delivery Partners Are Safely Maintaining Access to Voluntary Family Planning Information, Products and Services
By Kristen Little, Sr. Technical Advisor, PSI; Lola Flomen, Technical Learning Consultant, PSI; Samia Khatun, Head of Region, IPPF; and Trinity Zan, Associate Director, FHI 360
Before the onset of the pandemic in 2019, the World Health Organization (WHO) published guidelines entitled “Digital Interventions for Health System Strengthening,” which recognized that digitizing family planning (FP) programs could potentially increase client reach and improve program effectiveness. Within just months of the report’s release, COVID-19 had spread around the world, leaving local partners, international non-governmental organizations (INGOs), and multilateral organizations racing to integrate digital approaches to FP programs to maintain crucial access to FP information, products and services while keeping their clients, health workers and communities safe.
Nearly a year into the global pandemic, the WHO/IBP Network, Knowledge SUCCESS project, R4S project and WISH4Results jointly hosted a webinar (below) on Wed., Feb. 17, 2021 to showcase the impact of and share lessons learned from the digital adaptations of service delivery partners’ FP programs. Following an overview of the WHO’s digital guidelines, the webinar highlighted digital adaptions across client and health provider streams including telemedicine, targeted client communications and digital training.
Looking for key takeaways? We outline below.
Client-facing Digital Adaptations
Telemedicine Project in Sudan:
Unable to provide FP services through its usual channels due to COVID-19 lockdown measures, Sudan Family Planning Association (SFPA) with support from the WISH2ACTION program, set up a call center to ensure continued access to FP services during the pandemic.
SFPA’s call center was established with support from the Ministry of Health (MoH) and other partners. Call center staff were trained on call center technology and effective communication. SFPA adopted the routine client register to the call center and set up an application for data entry, monitoring and gathering client feedback.
With one unified free number, the call center was promoted through SMS and social media. SFPA works closely with the telecommunication providers in Sudan.
Consultation and follow–up calls are handled through the call center while clients who need services are either connected with community-based distributors, given appointments at SFPA clinic or referred to partners’ clinics. To date, SFPA has received 89,000 calls through the call center and provided 9,900 direct services including 2,600 prescriptions. The majority of the callers are female at 71%, male callers are at 29%, while 18% of calls are from are youth below <20 years. The most requested services are contraceptives (28%), antenatal (22%) and infertility care (24%).
The call center has provided a unique picture of increased male engagement in FP issues and women are more open about contraceptives side effects. Young people and people living with HIV are seeking services without stigma. SFPA plans to sustain the call center beyond the pandemic and is looking at how they can reach other hard–to–reach populations.
“Our Sudan experience shows the importance of going digital to continue serving existing clients but also reach new clients. Anonymity provided through the call center broke down barriers on subjects usually seen as off-limits”. Samia Khatun, Head of Region (Lead for W2A Sudan Program), WISH2ACTION, IPPF
Targeted Client Communication in India:
To promote FP demand creation, link young women to customized e-counseling and facilitate access to high-quality FP products during the COVID-19 pandemic, Population Services International’s (PSI) Social Enterprise (SE) in India launched Between Us, a digital campaign that includes customized FP self-care information through the Nivi chatbot, a cyber educator, personalized online consultations with a provider, and an e-pharmacy integration for home-delivery of FP products. Since its launch in June 2020, the digital campaign reached over 1.2 million people with key messaging, leading to over 9,035 conversations via the Nivi chatbot, a cyber educator and 1,512 client e-consultations.
“[Moving forward] new partnerships with e-pharmacies have been set in place to reduce the number of touch points in the journey, that is, to provide consultation and purchase at one place.” – Vidhi Kalra, Assistant Manager – Digital Marketing, Social Enterprise India Project, PSI India
Targeted Client Communication in Nigeria:
To prevent COVID-19 transmission, PSI’s Adolescent 360 (A360) program had to adapt their in-person youth–targeted FP information “Love, Life and Health” (LLH) classes by digitizing their curriculum on WhatsApp where they provided customized counseling and continued linking youth located in Lagos, Osun, Ogun, and Oyo states to A360 FP clinics at no cost. Between May and June 2020, there was a 111% increase (3,335 to 7,053) in youth exposed to A360 interventions and a 130% increase (2,260 to 5,202) in youth (15-19) adopting FP for the first time within the four states.
“[The] WhatsApp group is also a platform to get information on FP, get information on skills for love and relationships, and also for skills for their overall health.” – Joy Otsanya Ede, Social and Behavior Change Specialist & Digital Communications Lead, Society for Family Health, A360 Nigeria
Health Provider-Facing Digital Adaptations
Digital Training in Kenya
In April 2020, PSI’s Delivering Equitable and Sustainable Increases in Family Planning (DESIP) program rapidly transitioned their in-person training on FP social and disability inclusion to Zoom in order to continue safely advocating for equitable access to FP for women living with disabilities. Between April and June 2020, DESIP successfully trained several sub-country staff via Zoom on social and disability inclusion who cascaded training to over 200 community health volunteers. Although stable internet connectivity poses a challenge, DESIP will continue advocacy trainings via Zoom post-COVID–19 to save time and money.
“Since the virtual training, several providers have made efforts to make changes in the facilities like having disability–friendly toilets and having ramps and wheelchairs” – Bill Okaka, Senior Manager, Technical Learning, PSI, DESIP Project, Kenya
Remaining Resilient: Maintaining Digital FP Adaptations
As we enter the second year of the pandemic, these service delivery partners will continue to implement the lessons learned from their digital FP program adaptations to ensure that the approaches are reaching new clients, rendering more on-demand, customized, and efficient programs, and strengthening the health system that they seek to support.
The examples shared during this webinar were developed in direct response to specific COVID-19 related challenges, including transportation and movement restrictions that limit individuals’ ability to seek services in facilities and social distancing which limit some of the traditional means by which individuals receive health information—including from community health workers and in community gatherings—and receive professional training.
The speakers shared the value that they have seen, coupled with some programmatic monitoring data, indicating how these digital services helped reach more people with FP information and services. However, there are limitations both to what these platforms can provide, and how much we can assess through routine monitoring data. For example, in instances where telemedicine and e-prescriptions are combined, policy restrictions may limit method selection (i.e. contraceptive pills and emergency contraception) and those wishing to use other methods may still need to visit a facility.
We are still learning about how these digital platforms may impact privacy and personal data; in some instances, it may provide a “safer space” for individuals to discuss taboo topics, but it may also expose individuals to increased risk (through use of shared phones or attempting to find private spaces for telemedicine consultations). And while certain data about visits to websites, calls to a call-in center, or orders of contraceptives may hint at the effectiveness of these approaches, we need robust data collection efforts to truly understand the impact these interventions are having on contraceptive uptake and continuation. This information is vital for future programming and to inform country and global-level guidance, including updates to the WHO digital health guidelines.
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IBP partners are using storymaps to visualize the trials and tribulations of a pandemic year in family planning.
Research for Scalable Solutions (R4S) is an implementation science project funded by the United States Agency for International Development (USAID) that aims to increase the production and use of evidence to improve voluntary family planning (FP) programs around the world. Specifically, R4S focuses on generating evidence related to self-care and client-driven approaches for FP, the cost and cost-effectiveness of implementing high-impact practices (hips), and measuring and addressing equity within FP programs. Led by FHI 360 in partnership with Evidence for Sustainable Human Development Systems in Africa (EVIHDAF), Makerere University School of Public Health (Makerere SPH) in Uganda, Population Services International (PSI), and Save the Children, R4S works with a range of country-based stakeholders to strengthen research and research utilization capacity and to support countries in their journey to self-reliance. In this blog, PSI shares experiences and lessons learned as part of R4S-funded documentation of FP program adaptations made during the COVID-19 pandemic.