Immediate Postpartum Family Planning: A Key Component of Childbirth Care

The piece was originally published on FP High Impact.


Offering modern contraception services as part of care provided during childbirth increases postpartum contraceptive use and is likely to reduce both unintended pregnancies and pregnancies that are too closely spaced.1,2 Unintended and closely spaced births are a public health concern as they are associated with increased maternal, newborn, and child morbidity and mortality.3-8 After a live birth, the recommended interval before attempting the next pregnancy is at least 24 months, based on a consultation convened by the World Health Organization (WHO), in order to reduce the risk of adverse maternal, perinatal, and infant outcomes.9 Despite this evidence, 61% of postpartum women in low- and middle-income countries have an unmet need for contraception.10

There are many reasons why women do not use effective contraception during the postpartum period, such as sociocultural and gender norms that guide postnatal practices,11,12 timing of return to menses13,14 and sexual activity,12 breastfeeding practices and misconceptions of conditions for lactational amenorrhea,11,15 and lack of access to contraceptive services (Figure 1). The COVID-19 pandemic has disrupted access to essential health services, including access to facility-based birth and immediate postpartum family planning care. A WHO survey found 68% of countries surveyed reported disruption to family planning services and 32% reported disruption to facility birth service,16 though these estimates were not specific to postpartum services.

This High Impact Practices in Family Planning (HIP) brief summarizes the evidence and provides implementation tips for proactively offering family planning as part of care during and immediately after childbirth, often referred to as the immediate postpartum period. (Offering services during the postpartum period is a common approach to addressing gaps in access to services; see, for example, the Family Planning and Immunization Integration HIP brief.)

The WHO recommends that women receive information on family planning and the health and social benefits of birth spacing during antenatal care, immediately after birth, and during postpartum and well-baby care, including immunization and growth monitoring.17 Each visit to a health professional offers a unique opportunity to screen for, counsel, and offer family planning services. Yet each opportunity requires deliberate attention to organize services, update policies and provider practices, and mobilize resources for successful implementation. Facility-based childbirth services offer an ideal platform to reach women and their partners with family planning information and services, provided women’s right to make a full and informed choice are respected. Immediate postpartum family planning is one of several proven HIPs identified by a technical advisory group of international experts. A proven practice has sufficient evidence to recommend widespread implementation as part of a comprehensive family planning strategy, provided that there is monitoring of coverage, quality, and cost as well as implementation research to strengthen impact.18 For more information about other HIPs, see

Figure 01.

Offering Family Planning Counseling and Services at the Same Time and Location as Facility-Based Childbirth Care: Theory of Change | Assumption: There are high levels of facility-based births among the target population.

Abbreviations: HMIS: health management information system; PPFP: postpartum family planning

Why is this practice important?

Providing family planning counseling as part of childbirth care raises awareness of the importance of birth spacing and postpartum contraceptive options. Women and their partners often have limited understanding about contraceptive options, return to fertility, and risks of a closely spaced or unintended pregnancy soon after childbirth.11,12,194 Providers, women, and their support networks cite concerns about contraceptive side effects, especially related to effects of hormonal contraceptives on breast milk and the child’s health as reasons to avoid contraception during the postpartum period.10,20,215 In settings where women seek care well before active labor or in communities where women are able to recuperate in a facility after birth, family planning counseling can be incorporated into care around the preparation for childbirth and/or immediately thereafter; these approaches are considered acceptable to both providers and clients. Providing information at this time can improve knowledge and attitudes regarding the use of postpartum contraception.22-26

An increasing number of women and their partners can be reached through facility-based childbirth services. Globally, 4 of 5 births take place with the assistance of a skilled birth attendant, and increasingly these births are taking place in health facilities.27 For example, in Bangladesh, deliveries in health facilities increased from 17% to 37% between 2007 and 2014. During a similar time frame, facility deliveries increased from 39% to 72% in Burkina Faso and from 43% to 64% in Kenya.28 As countries continue to strengthen facility-based childbirth care, this will be an increasingly important platform to reach women and their partners with family planning services.

Women have more contraceptive options during the immediate postpartum period. Based on a consultation convened by WHO, women can safely use contraceptive implants during the immediate postpartum period,29 in addition to many other types of contraceptives (see Box 01). Therefore, immediately after birth, women may choose from a wide variety of contraceptives including hormonal and non-hormonal, long- and short-acting, and permanent methods.30

Box 01.

Contraceptive Options During the Immediate Postpartum Period

For breastfeeding women:

  • Female sterilization
  • Male sterilization
  • Intrauterine device (IUD)
  • Implants
  • Progestogen-only pills
  • Lactational amenorrhea method (LAM)
  • Condoms

For non-breastfeeding women*:

  • Female sterilization
  • Male sterilization
  • IUD
  • Implants
  • Injectables
  • Condoms
  • Emergency contraception


*Promote advance provision of Combined Oral Contraceptives while women are in the facility with counseling to begin after 21 days. 

Source: WHO Medical Eligibility Criteria for Contraceptive Use (2015).22

What is the impact?

Offering modern contraception as part of childbirth services increases postpartum contraceptive use. Immediate postpartum family planning is not a new concept. The International Postpartum Program, implemented from 1966 to 1973 in 138 institutions across 21 countries and reaching 3.5 million women, demonstrated the feasibility of providing family planning services in the context of hospital-based obstetric care. In 1971, at the height of implementation, approximately 21% of obstetric patients in participating facilities obtained contraception during the immediate postpartum period, proving that family planning services could be incorporated into obstetric wards quickly and at low cost.31 The program is estimated to have averted 500,000 unwanted pregnancies over its 8 years of implementation.31

More recent experiences consistently demonstrate the potential impact of this practice. Between 2013 and 2017, the International Federation of Gynecologists and Obstetricians conducted a large multi-country collaboration with ministries of health to strengthen immediate postpartum family planning, including counseling, training, monitoring, and service delivery.32 One component was revitalizing voluntary postpartum IUDs (PPIUD) as a method for immediate postpartum family planning. In four countries—India, Nepal, Sri Lanka, and Tanzania—6,477 doctors, nurses, and midwives were trained, serving 239,033 women delivering between January 2016 and November 2017; 68% received balanced counseling on family planning and 20% chose an IUD.33 Multiple counseling sessions during the course of a pregnancy contributed to higher postpartum family planning uptake. In Sri Lanka, a pilot introduction of PPIUD in 12 major hospitals over several years led to PPIUDs being included as a method in the national family planning program in 2017.34

Training nurses and midwives in immediate PPIUD insertion was particularly successful, achieving increased PPIUD uptake with few complications, expulsions, and removals. In a major Indian hospital, PPIUD uptake increased from 2.3% to 49.0% over 2 years with 99.5% of 2,626 vaginal insertions performed by trained nurses.35 In Tanzania, midwives performed 58.5% of 2,347 PPIUD insertions.36 Overall lessons for success included emphasis on country-level and hospital-based leadership, on-the-job training, competency standards, prenatal counseling, and robust monitoring, evaluation, and feedback.32,37,38

Table 1 summarizes experience from 6 country programs, 3 of which (Afghanistan, Indonesia, and Niger) are based on unpublished data. The time frame examined in all the studies was the immediate postpartum period prior to women leaving the facility. Studies were considered if multiple contraceptive methods were offered. Taken together, old and new, these findings show that if women are provided comprehensive counseling and are proactively offered contraception from a range of choices as part of childbirth care, between 20% and 50% of women will leave the facility with a method. This is consistent with other evidence that found women were significantly more likely to be using modern contraception postpartum if they were offered family planning services at the time of delivery.39-41

Table 01.

Percentage of Women Giving Birth Leaving the Facility With a Modern Contraceptive Method, Before and After Introduction of Contraceptive Counseling and Services During Childbirth Care

Afghanistan28,29 4% (180/4179) 51% (1700/3362)
Honduras30* 10% (47/474) 33% (188/571)
Honduras31† 9% (23/251) 46% (142/308)
Indonesia32 9% (307/3373) 41% (1286/3101)
Niger33,34 0% (7/2193) 31% (686/2213)

* Hospital Escuela, the government-run hospital.
† Hospital Materno-Infantil in Tegucigalpa, the Honduran Social Security System.

How to do it: Tips from implementation experience

Invest in good documentation and monitoring to help ensure voluntarism and informed choice. Childbirth can be a stressful and challenging time for women. Clear documentation and recordkeeping, along with consistent monitoring, can help programs assess progress while ensuring clients’ rights are protected. For example, when counseling is provided during antenatal care, method choice should be indicated on the client’s record, whether it be a woman-held card or a facility chart. This documentation facilitates communication across providers who are caring for the same client and ensures continuity of care. The record should emphasize method choice or refusal, rather than whether or not counseling was provided.

Update national service delivery guidelines and clarify the role of service providers. This is particularly critical if existing guidelines reflect delayed start of progestin- only methods, like implants, which are now an option for immediate postpartum family planning use.29 Guidelines as well as job descriptions should clearly articulate that all antenatal and maternity care providers have a role in postpartum family planning, and that it is not just the responsibility of a few trained provider(s). The role of community health workers in promoting postpartum family planning can also be specified.

Include humanitarian crisis settings. Humanitarian crises are enormous and ever-growing, and the sexual and reproductive health needs of women and adolescent girls experiencing them are often greater than in stable settings.50 With clinical training, community outreach, and a wide range of contraceptive options, programs document rapid increases of immediate postpartum family planning uptake, including long-acting reversible contraceptives (LARCs). When offering implants and IUDs with balanced counseling and competent services, these methods quickly achieve popularity in unstable settings where women and families may be uprooted at a moment’s notice.51,52

Conduct formative assessments to guide social and behavior change strategies. Understanding barriers to PPFP uptake and tailoring programmatic approaches to address those barriers can improve uptake.53,54 Programs have found that when first starting PPFP services, providers can identify interested clients through counseling during antenatal care services and at birth. As services become established, and programs seek to increase uptake on a sustained basis, demand creation at the community level is needed.55 This is particularly helpful in contexts where misinformation and resistance to IUDs or LARCs is strong in the community in general.55

Consider home visits if targeting postpartum family planning adoption among first-time, young parents. Programs targeting young married women and adolescents have found value in using home visits or community group engagement.37 (See the HIP brief on Community Group Engagement.) Mothers-in-law, co-wives, and other senior women are key influencers of married adolescents. These programs documented the need to carefully test strategies for approaching and counseling young married women, as well as their partners and senior women in the household.38-40

Offer the broadest range of contraceptive methods possible and make them available prior to maternity discharge. Institutions that demonstrate marked improvements in postpartum contraceptive uptake did so by expanding the method mix and by focusing on method adoption during the pre-discharge period. For example, in Honduras, the range of methods available was expanded from IUDs and female sterilization to include progestin-only oral contraceptives and condoms. The result was a fivefold increase in the percentage of postpartum women leaving the hospital with a method of their choice, from 9% in December 1990 to 47% in February 1992.45 A study in Egypt found that counseling on and advance provision of emergency contraceptive pills for LAM users in the event of a delay in transitioning from LAM to another method significantly decreased the incidence of unintended pregnancy and increased timely transition to another method.60

Consider leveraging antenatal care visits to educate clients on contraception. While the effect of including family planning counseling as part of antenatal care on increased postpartum family planning uptake is unclear, doing so may allow women to fully explore their intentions and to make an informed decision about contraception before delivery.61 Counseling earlier during a pregnancy may be particularly helpful if introducing IUD or sterilization, as women often need more time to consider and discuss these options with their partners.

Engage men. In many cultures male partners exert considerable influence on uptake and continuation of immediate postpartum family planning.62-64 Men’s involvement during and after pregnancy can reduce the occurrence of postpartum depression and improve use of maternal health services, such as skilled birth attendance and postnatal care.65 Using couples’ counseling—with women’s concurrence— during antenatal visits at a Northern Nigeria hospital increased immediate postpartum family planning uptake from 29% to 49%.66 A pilot mHealth interactive short messaging service for women and men was well received by both and confirmed men’s desire for inclusion in family planning programs. Utilizing mHealth messaging is a promising approach to enhance couples’ communication and to address men’s and women’s contraceptive knowledge gaps, anticipated side effects, and misconceptions.67 Inequitable gender norms have a powerful effect on women’s ability to make and act on decisions about birth spacing and limiting. Providing men and women the opportunity to engage in family planning discussions as part of maternity care—together or separately—can directly address these inequitable norms and create space for joint decision making for effective use of family planning.

Plan for contraceptive uptake later during the postpartum period. In Rwanda, the postpartum family planning counseling session is an opportunity to make a plan for returning to a facility for postnatal care and immunization and for obtaining a postpartum family planning method at that time. Data from one quarter in 2017 from 10 districts showed that 24% of women adopted a method pre-discharge and an additional 67% left with a plan of when to start (data unpublished). Immunization services tend to reach high coverage and provide a possible platform for linking or integrating family planning services (see related HIP brief on Family  Planning and Immunization Integration).

Ensure adequate staff, equipment, and supplies, and if possible ensure their availability 24 hours a day, 7 days a week. Needs vary considerably from country to country and from facility to facility, depending on the existing clinic space, the extent to which current staff can undertake this additional responsibility, and the availability of equipment and supplies. Ensuring systematic postpartum family planning counseling may entail making postpartum family planning– trained providers available on call at night or on weekends.45,46,68-70 In addition, conducting whole-site orientations helps ensure that even staff who have not been trained or do not possess a clinical background can support postpartum family planning.55 Make sure to pre- position supplies and organize client flow through labor, delivery, and postnatal wards to identify appropriate space for counseling. In Niger, when the schedule was revised to offer postpartum family planning services at all times rather than during the morning only, the number of women delivering who left with their method of choice increased from 44% to 55% within one month in one rural district hospital (unpublished data).47,48

Encourage facility leadership and adjust management practices based on facility size. Larger facilities may require more intensive engagement of staff than smaller facilities to achieve similar output. In the International Postpartum Family Planning Program, small facilities with motivated providers demonstrated the highest rate of postpartum contraceptive uptake. Among facilities with fewer than 10,000 patients per year, about 27% of obstetric patients opted for contraception during the immediate postpartum period. Facilities with 10,000 to 20,000 patients, however, averaged 17% postpartum contraceptive uptake, and the largest institutions (with caseloads of 20,000 or more) averaged only 13%.31 These findings are consistent with research in Guatemala that found higher rates of postpartum contraceptive uptake at lower levels of the health system.71 Problem-solving strategies, as part of leadership, management, or quality improvement approaches, help staff address barriers as they arise.47,48,72

Tools and resources

Compendium of WHO Recommendations for Postpartum Family Planning73 is a web-based tool that integrates core WHO guidance to guide women through their family planning decision-making during the first year postpartum. 

Postpartum Family Planning (PPFP) Toolkit74 provides a comprehensive collection of best practices and
evidence-based tools and documents on postpartum family planning.

Programming Strategies for Postpartum Family Planning18 is a resource for program planners and managers when designing interventions to integrate PPFP into national and subnational strategies.

Service Communication Case Study: Bangladesh: Behavioral Maintenance and Follow-Up75 is an example of a project that has successfully used social and behavior change communication via mHealth to communicate important information about pregnancy and the first year of a child’s life, including PPFP, to expecting and new mothers and their families.

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  1. Abdulkadir Z, Grema BA, Michael GC, Omeiza Effect of antenatal couple counselling on postpartum uptake of contraception among antenatal clients and their spouses attending antenatal clinic of a northern Nigeria tertiary hospital: a randomized controlled trial. West Afr J Med. 2020;37(6):695-702.
  2. Harrington EK, McCoy EE, Drake AL, et al. Engaging men in an mHealth approach to support postpartum family planning among couples in Kenya: a qualitative study. Reprod Health. 2019;16(1):17.
  1. Lathrop E, Telemaque Y, Goedken P, Andes K, Jamieson DJ, Cwiak Postpartum contraceptive needs in northern Haiti. Int J Gynaecol Obstet. 2011;112(3):239-242. ijgo.2010.09.012
  2. Telemaque Y LE, Leconte C, Kimonian K, Kuhn C, Nickerson N. Postpartum family planning in northern Haiti: evaluation of a pilot Unpublished; 2017.
  3. Maternal and Child Survival Program (MCHIP), Population Services International (PSI). PPIUD Services: Start-Up to Scale-Up Regional Meeting, Burkina Faso, February 3-5, 2014: Meeting MCHIP; 2014. Accessed October 5, 2022. https://
  4. Kestler E, Orozco MdR, Palma S, Flores Initiation of effective postpartum contraceptive use in public hospitals in Guatemala. Rev Panam Salud Publica. 2011;29(2):103-107.
  1. Chitashvili T, Holschneider S, Clark Improving Quality of Postpartum Family Planning in Low- Resource Settings: A Framework for Policy Makers, Managers, and Medical Care Providers. University Research Co., LLC; 2016. Accessed October 5, 2022. improving_quality_of_ppfp_apr_2016.pdf
  2. Guide women through their postpartum family planning options. World Health Accessed October 5, 2022. https://postpartumfp.srhr. org/
  3. Postpartum family planning (PPFP) Maternal and Child Health Integrated Program. Accessed October 5, 2022. ppfp
  4. Bangladesh: behavioral maintenance and follow-up. Service communication implementation Health Communication Capacity Collaborative. Accessed October 5, 2022. https://sbccimplementationkits. org/service-communication/case-studies/case-study-behavioral-maintenance-and-follow-up-in- bangladesh/
Suggested Citation

High Impact Practices in Family Planning (HIPs). Immediate postpartum family planning: a key component of childbirth care. Washington, DC: HIP Partnership; 2022 May. Available from: https://www.  family-planning/


This brief was written by Elaine Charurat, Douglas Huber, Eva Lathrop, Trish MacDonald, Suzanne Mukakabanda, Rachel Yodi, and Linnea Zimmerman. It was updated from a previous version, available here. This brief was reviewed and approved by the HIP Technical Advisory Group. In addition, the following individuals and organizations provided critical review and helpful comments: Afeefa Abdur-Rhaman, Ribka Amsalu, Bethany Arnold, Michal Avni, Maggwa Baker, Neeta Bhatnagar, Rosanna Buck, Megan Christofield, Arzum Ciloglu, Kim Cole, Temple Cooley, Chelsea Cooper, Carmela Cordero, Ana Cuzin, Peggy D’Adamo, Aachal Devi, Ellen Eiseman, Mario Festin, Coley Gray, Karen Hardee, Nuriye Hodoglugil, Caroline Jacoby, Emily Keyes, Joan Kraft, Cate Lane, Samantha Lint, Ricky Lu, Sara Malakoff, Shawn Malarcher, Janet Meyers, Erin Mielke, Pierre Moon, Dani Murphy, Winnie Mwebesa, Maureen Norton, Gael O’Sullivan, Saiqa Panjsheri, Alice Payne Merritt, Anne Pfitzer, May Post, Shannon Priyor, Heidi Quinn, Setara Rahman, Laura Raney, Elizabeth Sasser, Ritu Schroff, Caitlin Shannon, Willy Shasha, Jim Shelton, John Stanback, Sara Stratton, Caitlin Thistle, Carroll Vasquez, Michelle Weinberger, Jessica Williamson, and Melanie Yahner.

The World Health Organization/Department of Reproductive Health and Research has contributed to the development of the technical content of HIP briefs, which are viewed as summaries of evidence and field experience. It is intended that these briefs be used in conjunction with WHO Family Planning Tools and Guidelines:

The HIP Partnership is a diverse and results-oriented partnership encompassing a wide range of stakeholders and experts. As such, the information in HIP materials does not necessarily reflect the views of each co-sponsor or partner organization.

To engage with the HIPs please go to: https://www.

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Supporting documents

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The Consumer as CEO

For over 50 years, PSI’s social businesses have worked globally to generate demand, design health solutions with our consumers, and work with local partners to bring quality and affordable healthcare products and services to the market. Now consolidating under VIYA, PSI’s first sexual health and wellness brand and social business, our portfolio represents the evolution from traditionally donorfunded projects towards a stronger focus on sustainability for health impact over the long term. Across 26 countries, the VIYA model takes a locally rooted, globally connected approach. We have local staff, partners and providers with a deep understanding of the markets we work in. In 2022, we partnered with over 47,000 pharmacies and 10,000 providers to reach 11 million consumers with products and services, delivering 137 million products. VIYA delivers lasting health impact across the reproductive health continuum, from menstruation to menopause. Consumer insights drive our work from start to finish. Their voices, from product exploration to design, launch, and sales, ensure that products not only meet consumers’ needs but exceed their expectations. The consumer is our CEO. 

In 2019, our human-centered design work in East Africa explored ways that our work could support and accompany young women as they navigate the various choices required for a healthy, enjoyable sexual and reproductive life. Harnessing insights from consumers, VIYA is revolutionizing women’s health by addressing the confusion, stigma, and unreliability surrounding sexual wellness. Across five markets – Guatemala, Kenya, South Africa, Uganda and Pakistan – VIYA utilizes technology to provide women with convenient, discreet, and enjoyable tools for making informed choices about their bodies. The platform offers a wealth of high-quality sexual wellness information, covering topics from periods to pleasure in an accessible and relatable manner. Additionally, VIYA fosters a supportive community where users can share experiences and receive guidance from counselors. In 2023, VIYA will begin offering a diverse range of sexual wellness products and connect users with trusted healthcare providers, ensuring comprehensive care tailored to individual needs.  

Digitalizing contraceptive counseling to reach rural women and girls in Ethiopia

By: Fana Abay, Marketing and Communications Director, PSI Ethiopia 

In rural Ethiopia, women and girls often face significant barriers in accessing healthcare facilities, which can be located hours away. Moreover, there is a prevailing stigma surrounding the use of contraception, with concerns about potential infertility or the perception of promiscuity. To address these challenges, the Smart Start initiative has emerged, linking financial well-being with family planning through clear and relatable messaging that addresses the immediate needs of young couples—planning for the lives and families they envision. Smart Start takes a community-based approach, utilizing a network of dedicated Navigators who engage with women in their localities. These Navigators provide counseling and refer interested clients to Health Extension Workers or healthcare providers within Marie Stopes International-operated clinics for comprehensive contraceptive counseling and services.  

In a significant development, PSI Ethiopia has digitized the proven counseling messaging of Smart Start, expanding its reach to more adolescent girls, young women, and couples. This approach aligns with the priorities set by the Ethiopian Ministry of Health (MOH) and is made possible through funding from Global Affairs Canada. The interactive and engaging digital messaging has revolutionized counseling services, enabling clients to make informed and confident decisions regarding both their finances and contraceptive choices. 

Clients who received counseling with the digital Smart Start tool reported a higher understanding of their options and were more likely to choose contraception (74 percent) compared to those counseled with the manual version of Smart Start (64 percent). Navigators also found the digital tool more effective in connecting with clients, leading to higher ratings for the quality of their counseling. 

By December 2023, PSI Ethiopia, working in close collaboration with the MOH, aims to reach over 50 thousand new clients by leveraging the digital counseling tool offered by Smart Start. This innovative approach allows for greater accessibility and effectiveness in providing sexual and reproductive health services, contributing to improved reproductive health outcomes for women and couples across the country. 

Building community health worker capacity to deliver malaria care

By: Christopher Lourenço, Deputy Director, Malaria, PSI Global 

Community health workers (CHWs) are critical lifelines in their communities. Ensuring they have the training, support, and equipment they need is essential to keep their communities safe from malaria, especially in the hardest to reach contexts. 

For example, in Mali, access to formal health services remains challenging, with four in ten people living several miles from the nearest health center, all without reliable transportation or access. In 2009, the Ministry of Health adopted a community health strategy to reach this population. The U.S. President’s Malaria Initiative (PMI) Impact Malaria project, funded by USAID and led by PSI, supports the Ministry with CHW training and supervision to localize health services.  

In 2022, 328 thousand malaria cases were recorded by CHWs); 6.5 thousand severe malaria cases were referred to health centers, according to the national health information system. 

During that time, the PMI Impact Malaria project (IM) designed and supported two rounds of supportive supervision of 123 CHWs in their workplaces in the IM-supported regions of Kayes and Koulikoro. This included developing and digitizing a standardized supervision checklist; and developing a methodology for selecting which CHWs to visit. Once a long list of CHW sites had been determined as accessible to supervisors for a day trip (including security reasons), the supervisors telephoned the CHWs to check when they would be available to receive a visit [as being a CHW is not a full-time job, and certain times of the year they are busy with agricultural work (planting, harvesting) or supporting  health campaigns like mosquito net distribution].  

Supervisors directly observed how CHWs performed malaria rapid diagnostic tests (RDTs) and administered artemisinin-based combination therapy (ACT). They recorded CHW performance using the digitized checklist, interviewed community members, reviewed records, and provided on-the-spot coaching. They also interviewed the CHWs and tried to resolve challenges they expressed, including with resupply of commodities or equipment immediately or soon afterwards.  

Beyond the observed interactions with patients, supervisors heard from community members that they were pleased that CHWs were able to provide essential malaria services in the community. And the data shows the impact. 

In IM-supported areas of Mali, 36% of CHWs in the first round were competent in performing the RDT, which rose to 53% in the second. 24% of CHWs in the first round compared to 38% in the second were competent in the treatment of fever cases and pre-referral counseling. Between both rounds, availability of ACT increased from 80 percent to 90 percent. 

Supportive supervision with interviews and observations at sites improved the basic competencies of CHWs between the first and second rounds, and additional rounds will help to understand the longer-term programmatic benefits.

Taking a market-based approach to scale sanitation in Ethiopia

By: Dr. Dorothy Balaba, Country Representative, PSI Ethiopia  

In Ethiopia, PSI leads the implementation of USAID Transform WASH (T/WASH) activity with consortium partners, SNV and IRC WASH. Contrary to traditional models that rely on distribution of free or heavily subsidized sanitation products, T/WASH utilizes a market-based sanitation approach. This approach creates sustainable and affordable solutions, by integrating market forces and supporting businesses to grow, while creating demand at the household level. 

During the last six years, T/WASH has worked alongside the private sector and government (Ethiopia’s Ministry of Health, Ministry of Water and Energy, and Ministry of Labor and Skills), among other stakeholders, to increase household access to affordable, quality sanitation products and services. For example, more than 158 thousand households have invested in upgraded sanitation solutions with rapid expansion to come as the initiative scales and market growth accelerates. 

T/WASH has successfully trained more than 500 small businesses, including community masons and other construction-related enterprises, with technical know-how in sanitation product installation, operational capacities, and marketing and sales skills needed to run successful, growing businesses. The Ethiopian government is now scaling the approach to all districts through various national, regional, and local institutions with requisite expertise. T/WASH has also worked the One WASH National Program, Ministry of Health, Ministry of Water and Energy, and Ministry of Labor and Skills to examine policies that influence increased household uptake of basic WASH services, such as targeted sanitation subsidies, tax reduction to increase affordability, and increased access to loan capital for business seeking to expand and households needing help to improve their facilities. 

To share the journey to market-based sanitation, representatives of the Ethiopian Ministry of Health and the USAID Transform WASH team took to the stage at the UN Water Conference in 2023.

“Rather than relying on traditional aid models that often distribute free or heavily subsidized sanitation products, market-based sanitation creates sustainable and affordable solutions, integrating market forces and supporting businesses to grow.”  

— Michael Negash, Deputy Chief Party of T/WASH 

Promoting self-managed care like Self-testing and Self-Sampling

By: Dr Karin Hatzold, Associate Director HIV/TB/Hepatitis

Building upon the success and insights gained from our work with HIV self-testing (HIVST), PSI is actively applying this approach to better integrate self-care, more broadly, in the health system beginning with Hepatitis C and COVID-19. Self-testing has emerged as a powerful tool to increase access to integrated, differentiated, and decentralized health services, accelerating prevention, care, and treatment for various diseases, while also increasing health system resilience against COVID-19.

Here’s how we got there.

Seven years ago, the landscape of HIV self-testing lacked global guidelines, and only the U.S., the UK and France had policies in place that allowed for HIV self-testing. High disease burdened countries in low-and-middle-income-countries (LMICs) lacked evidence and guidance for HIVST despite major gaps in HIV diagnosis.

However, through the groundbreaking research from the Unitaid-funded HIV Self-Testing Africa (STAR) initiative led by PSI, we demonstrated that HIVST is not only safe and acceptable but also cost-effective for reaching populations at high risk with limited access to conventional HIV testing. This research played a pivotal role in informing the normative guidelines of the World Health Organization (WHO) and shaping policies at the country level. As a result, more than 108 countries globally now have reported HIVST policies, with an increasing number of countries implementing and scaling up HIVST to complement and  partially replace conventional testing services. This became especially significant as nations tried to sustain HIV services amidst the disruptions caused by the COVID-19 pandemic.

By leveraging our expertise, PSI is conducting research to identify specific areas and populations where the adoption of Hepatitis C and COVID-19 self-testing could significantly enhance testing uptake and coverage. This research serves as the foundation for developing targeted strategies and interventions to expand access to self-testing, ensure that individuals have convenient and timely options for testing for these diseases, and are linked to care, treatment and prevention services through differentiated test and treat approaches.

Using peer coaches to counter HIV stigma in South Africa

By: Shawn Malone, Project Director, HIV/AIDS Gates Project in South Africa, PSI Global

In South Africa, where the HIV response has lagged in reaching men, PSI’s Coach Mpilo model has transformed the role of an HIV counselor or case manager into that of a coach and mentor who provides empathetic guidance and support based on his own experience of living with HIV. Coaches are men who are not just stable on treatment but also living proudly and openly with HIV. Situated within the community and collaborating closely with clinic staff, they identify and connect with men struggling with barriers to treatment and support them in overcoming those barriers, whether that means navigating the clinic or disclosing their HIV status to their loved ones.

PSI and Matchboxology first piloted the model in 2020 with implementing partners BroadReach Healthcare and Right to Care as well as the Department of Health in three districts of South Africa. Since then, the model has been rolled out by eight implementing partners in South Africa, employing more than 300 coaches and reaching tens of thousands of men living with HIV. To date, the model has linked 98 percent of clients to care and retained 94 percent of them, in sharp contrast to the estimated 70 percent of men with HIV in South Africa who are currently on treatment.

Given the success of the program, South Africa’s Department of Health and the United States President’s Emergency Plan for AIDS Relief (PEPFAR) have each embraced the Coach Mpilo model in their health strategy and are embedding it in their strategies and programs. 

“The men we spoke to [while I was traveling to South Africa for a PrEP project with Maverick Collective by PSI] were not only decidedly open to the idea of taking a daily pill…many were willing to spread the word and encourage friends to get on PrEP too. We were able to uncover and support this new way forward because we had flexible funding to focus on truly understanding the community and the root barriers to PrEP adoption. This is the philanthropic funding model we need to effectively fight the HIV epidemic, and it’s beneficial for all sorts of social challenges.”

– Anu Khosla, Member, Maverick Collective by PSI

simplifying consumers’ journey to care in Vietnam

By: Hoa Nguyen, Country Director, PSI Vietnam

In late 2022, with funding from the Patrick J. McGovern Foundation, PSI and Babylon partnered to pilot AIOI in Vietnam. By combining Babylon’s AI symptom checker with PSI’s health provider locator tool, this digital health solution analyzes symptoms, recommends the appropriate level of care, and points them to health providers in their local area. The main goal is to support people in low-income communities to make informed decisions about their health and efficiently navigate the healthcare system, while reducing the burden on the healthcare workforce. The free 24/7 service saves people time and subsequent loss of income from taking time off work and from having to pay unnecessary out-of-pocket expenses. Under our global partnership with Meta, PSI launched a digital campaign to put this innovative product in the hands of people in Vietnam. By the end of June 2023 (in the nine months since product launch), 210 thousand people accessed the AIOI platform; 2.4 thousand people created personal accounts on the AIOI website, 4.8 thousand triages to Symptom Checker and linked 2.2 thousand people to health facilities.   

Babylon’s AI symptom checker and PSI’s health provider locator tool captures real-time, quality data that supports health systems to plan, monitor and respond to consumer and provider needs. But for this data to be effective and useable, it needs to be available across the health system. Fast Healthcare Interoperability Resources (FHIR) standard provides a common, open standard that enables this data exchange.
PSI’s first consumer-facing implementation of FHIR was launched in September 2022 as part of the Babylon Symptom Checker project in Vietnam, enabling rapid alignment between PSI and Babylon’s FHIR-enabled client records systems. PSI already has several other consumer health FHIR implementations under active development in 2023, including PSI’s collaboration with the Kenya MOH to launch a FHIR-enabled WhatsApp national health line for COVID-19 health information. PSI will also look to adopt and scale health workforce-facing FHIR-enabled tools, such as OpenSRP2, which will be piloted in an SRH-HIV prevention project in eSwatini in partnership with Ona by the end of 2023.

— Martin Dale, Director, Digital Health and Monitoring, PSI

Engaging the private sector for disease surveillance in Myanmar

By: Dr. Zayar Kyaw, Head of Health Security & Innovation, PSI Myanmar

Under a three-year investment from the Indo-Pacific Center for Health Security under Australia’s Department for Foreign Affairs and Trade (DFAT), PSI is enhancing disease outbreak surveillance and public health emergency preparedness and response capacities in Myanmar, Cambodia, Laos, and Vietnam. When PSI conducted a review of existing disease surveillance systems in Myanmar, it identified several gaps: although the Ministry of Health had systems in place for HIV, tuberculosis, malaria and other communicable diseases, they were fragmented, with different reporting formats and reliance on paper-based reporting. In addition, private sector case surveillance data were not routinely captured, yet private clinics and pharmacies are the dominant health service delivery channel in the country. This hindered effective disease prevention and control efforts.

Building on our extensive private sector malaria surveillance work under the BMGF-funded GEMS project in the Greater Mekong Subregion, PSI implemented a case-based disease notification system using social media channels to overcome the limitations of paper-based and custom-built mobile reporting tools. These chatbots, accessible through popular social media platforms like Facebook Messenger and Viber, proved to be user-friendly and required minimal training, maintenance, and troubleshooting. The system was implemented in more than 550 clinics of the Sun Quality Health social franchise network as well as nearly 470 pharmacies. The captured information flows to a DHIS2 database used for real-time monitoring and analysis, enabling rapid detection of potential outbreaks. Local health authorities receive instant automated SMS notifications, enabling them to promptly perform case investigation and outbreak response.

In 2022, private clinics reported 1,440 malaria cases through the social media chatbots, while community mobilizers working with 475 private providers and community-based malaria volunteers reported more than 5,500 cases, leading to the detection of two local malaria outbreaks. Local health authorities were instantly notified, allowing them to take action to contain these surges in malaria transmission. During the same time, pharmacies referred 1,630 presumptive tuberculosis cases for confirmatory testing – a third of which were diagnosed as tuberculosis and enrolled into treatment programs.

Training health workers in Angola

By: Anya Fedorova, Country Representative, PSI Angola  

The shortage of skilled health workers is widely acknowledged as a significant barrier to achieving Universal Health Coverage. To address this challenge, PSI supported ministries of health to develop a digital ecosystem that brings together stewardship, learning, and performance management (SLPM). The ecosystem enhances training, data-driven decision-making, and the efficiency of healthcare delivery.

Here’s what it looks like in practice.

In July 2020, PSI Angola, alongside the Angolan digital innovation company Appy People, launched Kassai, an eLearning platform that targets public sector health workers in Angola. Through funding from USAID and the President’s Malaria Initiatve (PMI), Kassai features 16 courses in malaria, family planning, and maternal and child health – with plans to expand learning topic areas through funding from ExxonMobil Foundation and private sector companies. A partnership with UNITEL, the largest telecommunication provider in Angola, provides all public health providers in Angola free internet access to use Kassai.

Kassai’s analytics system to follow learners’ success rate and to adjust the course content to learners’ performance and needs. Kassai analytics are integrated with DHIS2 – the Health Management Information System (HMIS) of Angolan MOH, to be able to link learners’ knowledge and performance with the health outcomes in the health facilities.  The analytics track learners’ performance by course and gives visibility by health provider, health facility, municipality, and province. Each course has pre-and post-evaluation tests to track progress of learning, too.

By the end of 2022, there were 6,600 unique users on the Kassai platform and 31,000 course enrollments. PSI Angola’s partnership with UNITEL, the largest telecommunication provider in Angola, allows for free internet access to learn on the Kassai for all public health providers in Angola. Building on its success for malaria training, Kassai now also provides courses in family planning, COVID-19, and maternal and child health. This reduces training silos and provides cross-cutting benefits beyond a single disease.

Implementing the SLPM digital ecosystem brings numerous benefits to health systems. It allows for more strategic and efficient workforce training and performance management, enabling ministries of health to track changes in health workers’ knowledge, quality of care, service utilization, and health outcomes in real time. The ecosystem also supports better stewardship of mixed health systems by facilitating engagement with the private sector, aligning training programs and standards of care, and integrating private sector data into national HMIS. Furthermore, it enables the integration of community health workers into the broader health system, maximizing their impact and contribution to improving health outcomes and strengthening primary healthcare.



PSI does not tolerate retaliation or adverse employment action of any kind against anyone who in good faith reports a suspected violation or misconduct under this policy, provides information to an external investigator, a law enforcement official or agency, or assists in the investigation of a suspected violation, even if a subsequent investigation determines that no violation occurred, provided the employee report is made in good faith and with reasonable belief in its accuracy.


Global Code of Business Conduct And Ethics

PSI’s code sets out our basic expectations for conduct that is legal, honest, fair, transparent, ethical, honorable, and respectful. It is designed to guide the conduct of all PSI employees—regardless of location, function, or position—on ethical issues they face during the normal course of business. We also expect that our vendors, suppliers, and contractors will work ethically and honestly.


The Future of Work

With overarching commitments to flexibility in our work, and greater wellbeing for our employees, we want to ensure PSI is positioned for success with a global and holistic view of talent. Under our new “work from (almost) anywhere,” or “WFAA” philosophy, we are making the necessary investments to be an employer of record in more than half of U.S. states, and consider the U.S. as one single labor market for salary purposes. Globally, we recognize the need to compete for talent everywhere; we maintain a talent center in Nairobi and a mini-hub in Abidjan. PSI also already works with our Dutch-based European partner, PSI Europe, and we’re creating a virtual talent center in the UK.


Meaningful Youth Engagement

PSI is firmly committed to the meaningful engagement of young people in our work. As signatories of the Global Consensus Statement on Meaningful Adolescent & Youth Engagement, PSI affirms that young people have a fundamental right to actively and meaningfully engage in all matters that affect their lives. PSI’s commitments aim to serve and partner with diverse young people from 10-24 years, and we have prioritized ethics and integrity in our approach. Read more about our commitments to the three core principles of respect, justice and Do No Harm in the Commitment to Ethics in Youth-Powered Design. And read more about how we are bringing our words to action in our ICPD+25 commitment, Elevating Youth Voices, Building Youth Skills for Health Design.


Zero Tolerance for Modern-Day Slavery and Human Trafficking

PSI works to ensure that its operations and supply chains are free from slavery and human trafficking. Read more about this commitment in our policy statement, endorsed by the PSI Board of Directors.



Since 2017, PSI has been a signatory to the United Nations Global Compact, a commitment to align strategies and operations with universal principles of human rights, labor, environment and anti-corruption. Read about PSI’s commitment to the UN Global Compact here.


Environmental Sustainability

The health of PSI’s consumers is inextricably linked to the health of our planet. That’s why we’ve joined the Climate Accountability in Development as part of our commitment to reducing our greenhouse gas emissions by 30 percent by 2030. Read about our commitment to environmental sustainability.


Affirmative Action and Equal Employment Opportunity

PSI does not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, protected veteran status or any other classification protected by applicable federal, state or local law. Read our full affirmative action and equal employment opportunity policy here.


Zero Tolerance for Discrimination and Harassment

PSI is committed to establishing and maintaining a work environment that fosters harmonious, productive working relationships and encourages mutual respect among team members. Read our policy against discrimination and harassment here.

PSI is committed to serving all health consumers with respect, and strives for the highest standards of ethical behavior. PSI is dedicated to complying with the letter and spirit of all laws, regulations and contractual obligations to which it is subject, and to ensuring that all funds with which it is entrusted are used to achieve maximum impact on its programs. PSI provides exceptionally strong financial, operational and program management systems to ensure rigorous internal controls are in place to prevent and detect fraud, waste and abuse and ensure compliance with the highest standards. Essential to this commitment is protecting the safety and well-being of our program consumers, including the most vulnerable, such as women and children. PSI maintains zero tolerance for child abuse, sexual abuse, or exploitative acts or threats by our employees, consultants, volunteers or anyone associated with the delivery of our programs and services, and takes seriously all complaints of misconduct brought to our attention.


Diversity and Inclusion

PSI affirms its commitment to diversity and believes that when people feel respected and included they can be more honest, collaborative and successful. We believe that everyone deserves respect and equal treatment regardless of gender, race, ethnicity, age, disability, sexual orientation, gender identity, cultural background or religious beliefs. Read our commitment to diversity and inclusion here. Plus, we’ve signed the CREED Pledge for Racial and Ethnic Equity. Learn more.


Gender Equality

PSI affirms gender equality is a universal human right and the achievement of it is essential to PSI’s mission. Read about our commitment to gender equality here.


01 #PeoplePowered

02 Breaking Taboos

03 Moving Care Closer to Consumers

04 Innovating on Investments

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