A Spotlight on Research for Scalable Solutions (R4S)

Tell us about the R4S project and why it is relevant to self-care.

R4S LogoResearch for Scalable Solutions is a five-year USAID-funded global implementation science project led by FHI 360, with partners Population Services International, Evidence for Sustainable Human Development Systems in Africa, Makerere University School of Public Health in Uganda, and Save the Children. The project is conducting implementation science research to answer priority family planning (FP) questions that will strengthen programs and policies on self-care, High Impact Practices (HIPs) and equity. Related to self-care, R4S is exploring several areas. We seek to deepen our understanding of what self-care means to different people by implementing two multi-country research activities that examine attitudes and behaviors related to FP self-care among potential end-users and healthcare providers. In one activity, we developed and deployed a module on self-care within the Performance Monitoring and Accountability (PMA) surveys in Kenya and Nigeria. Data collection is complete, and we are looking forward to sharing results in a few months. Results will document commonalities and differences related to defining and operationalizing FP self-care and will contribute to global thinking about sexual and reproductive health and FP self-care indicators. We are also conducting research to generate and apply evidence about how digital technologies can support FP self-care, by increasing knowledge, self-efficacy, and/or FP uptake and continuation in the context of informed choice. We are also examining other important dimensions of self-care including reproductive empowerment, increasing access to emergency contraceptive pills, and opportunities to integrate FP into other self-care platforms such HIV community care models. 

As lead on R4S, has FHI360 contributed to identifying evidence needs, building the evidence base, and creating evidence and knowledge products for self-care? 

FHI 360 has a long history with the SCTG, of which we’re very proud! Our colleague, Dr. Holly Burke, was a member of the inaugural Steering Committee member and now our colleague Aissatou Thioye is a current member of the Coalition Steering Committee. Across our organization, we have staff involved in all SCTG working groups, contributing to many of the workstreams. We also have staff involved with national selfcare working groups in Kenya, Niger, Nigeria, Senegal and Uganda, helping to forge the links between the global and local levels. We have really enjoyed contributing to multiple initiatives and products that the SCTG Evidence & Learning Working Group (ELWG) has spearheaded. These include participation in the costing and financing, evidence mapping and prioritization (EMP), and measurement workstreams, and contributions to various products such as the quality of care (QoC) framework and the digital self-care framework. For the QoC framework, we were able to bring our experiences supporting quality assurance/quality improvement efforts across family planning programs in general, and specifically related to self-care interventions such as self-injection of DMPA and provision of contraceptives through drug shops. Working on the digital self-care framework was a great opportunity to similarly bring our rich experience designing, implementing, and evaluating digital FP tools while thinking ahead to the research that we are undertaking under R4S.

How has the collaboration with ELWG informed the self-care work under R4S? 

We’ve had the opportunity to collaborate with partners within the workstreams to hone our individual activities, making sure they are compatible and relevant, and to identify gaps that the SCTG can fill. A fitting example is our participation in the evidence mapping and prioritization (EMP) workstream. R4S supported country government and family planning (FP) stakeholders in six countries to develop FP research and learning agendas that included questions about family planning self-care. We learned a lot through this process that we were able to contribute to the workstream, which is undertaking development of a global sexual and reproductive health and rights (SRHR) self-care research and learning agenda (RLA). In the April ELWG meeting, we worked with the EMP workstream to share takeaways from the R4Ssupported country-owned research and learning agendas, highlight how Uganda is connecting their RLA with the Monitoring and Evaluation Plan for the National SelfCare Guidelines, and discuss the approach for the global self-care RLA for SRHR. An interactive session with participants was then held to discuss the value of both global and country-specific self-care RLAs. It was a very nice opportunity to paint a picture of how all of us, as self-care stakeholders and supporters, can collaborate to identify evidence needs and shape responsive research agendas. 

How will R4S’s RLAs help to institutionalize self-care health policy and/or programs to promote access to universal health coverage (UHC) in the six countries where it is being implemented? 

Stakeholders in the six countries—Côte d’Ivoire, Malawi, Mozambique, Nepal, Niger, and Uganda—articulated a range of compelling questions related to self-care, covering aspects of: acceptability (i.e., who wants self-care, and what specifically do they want); service delivery (i.e., how can providers be trained, how can waste be properly disposed outside of facilities); and the enabling environment (i.e., how to best connect self-care users to the broader health system, and how to ensure self-care supports equitable access to and use of FP/RH services). Now, those stakeholders are engaged in operationalizing the RLAs, by sharing them with audiences who will either conduct or fund research, incorporating them into broader strategic documents, and developing tracking systems to collect and share relevant evidence as it becomes available. Several countries have already used the RLAs to strengthen costed implementation plans, inform FP2030 commitments, integrate into broader health research agendas, and bolster national self-care guidelines. R4S will continue to support governments to answer RLA questions, share data and—most importantly—apply results, and we are confident that in doing so self-care policies and programs will expand and contribute to improved health outcomes.