Population Council | Frontiers in Reproductive Health |Strengthening Family Planning Services through Operations Research, 23-24 April 2008, Washington, DC

Strengthening Family Planning Services Through Operations Research:
Lessons Learned and Future Directions, a forum sponsored by USAID's Bureau for Global Health, the Population Council's FRONTIERS Program, and ACCESS-FP.

Wednesday and Thursday, 23 and 24 April 2008
Rotunda Conference Room, Ronald Reagan Building
Washington, DC

This two-day forum synthesized and communicated the lessons learned from ten years of global operations research on increasing access, quality, and use of family planning (FP) services. The forum reviewed a wide range of evidence drawn from the experiences of FRONTIERS and its many partners in Africa, Asia, and Latin America and the Caribbean. The second day was co-hosted with ACCESS-FP, and focused on expanding access to and use of family planning services by postpartum women.

AGENDA

23 April
Day 1: Increasing Access, Quality, and Use of Family Planning (FP) Services, Including Meeting FP and HIV Needs

8:30–9:00 am Continental breakfast and registration

9:00–9:10 am Welcome and opening remarks Anrudh Jain, Vice President, International Programs, Population Council and Patricia Stephenson, Research, Technology, and Utilization Division, Office of Population and Reproductive Health, USAID

9:10–9:30 am USAID's strategic directions and priorities for family planning (PDF) Scott Radloff, Director, Office of Population and Reproductive Health, USAID

9:30–9:45 am Overview of FRONTIERS family planning legacy (PDF) Ian Askew, Director, FRONTIERS Program, Population Council/Kenya

9:45–11:15 am Increasing access to and use of underutilized contraceptive methods
To sustainably address increasing demand for family planning services, programs need proven strategies to increase access to a variety of methods, including new and little-known methods. The first two presentations describe approaches for increasing access to methods by enhancing providers’ and clients’ knowledge of underused methods (IUD and vasectomy) and systematically identifying clients’ unmet needs for services. The third presentation gives a system-wide view, describing the time investments and processes involved in testing, introducing, scaling up, and institutionalizing a new method (emergency contraception) within the public health systems of four South Asian countries. Chair: Judy Manning, Health Development Officer, Research, Technology, and Utilization Division, Office of Population and Reproductive Health, USAID

IUD and vasectomy (PDF) Ricardo Vernon, Associate Director, Latin America and the Caribbean, FRONTIERS Program, Population Council/Mexico

Emergency contraception (PDF) M.E. Khan, Associate Director, Asia and the Near East, FRONTIERS Program, Population Council/India

Systematic screening to increase use of family planning (PDF) James R. Foreit, Senior Program Associate, FRONTIERS Program, Population Council

Discussant: The conundrum of access to optimal method mix John Townsend, Director, Reproductive Health Program, Population Council

11:15–11:30 am Tea/coffee break

11:30 am–
1:00 Pm Improving quality of care for family planning services
Since the 1990s, family planning services have focused on quality of care as an influence on clients’ use of family planning and reproductive health services. Findings from operations research have shown that numerous approaches—including use of job aids and tools, gender-sensitive approaches, and improved facility readiness—can improve quality of care and provider satisfaction; yet the sustainability and wider impact of improved quality is not clear. Presenters in this session discuss specific approaches for improving quality and consider new ways of looking at quality of care. Chair: Isaiah N’Dong, ACQUIRE/EngenderHealth

Evaluating interventions to improve quality of FP services: Lessons from three countries (PDF) Ian Askew, Director, FRONTIERS Program, Population Council/Kenya

Strengthening and accrediting the gender sensitivity and quality of FP/RH services in Bolivia (PDF) Estela Rivero, Program Associate, FRONTIERS Program, Population Council/Mexico

Developing and scaling up a quality assessment tool in India (PDF) M.E. Khan, Associate Director, Asia and the Near East, FRONTIERS Program, Population Council/India

Discussant: Improving quality of care: Are we expecting too much? Anrudh Jain, Vice President, International Programs, Population Council

1:00–2:00 pm Lunch

2:00–3:15 pm Breakout sessions for concurrent demonstrations of FP strengthening tools (two 35-minute sessions for each)

Balanced counseling strategy (BCS) and BCS+
The balanced counseling strategy (BCS) was developed by the Population Council to improve client–provider interaction in family planning provision. The process, tested and refined in several countries, involves a set of steps to determine the method that best suits the client according to her/his preferences and reproductive health intentions. The approach is practical, low-cost, and easy to adapt to local contexts. (more) Laura Raney, Program Associate, FRONTIERS Program, Population Council; Wilson Liambila, Program Associate, FRONTIERS Program, Population Council/Kenya; Mantshi Menziwa, Program Associate, FRONTIERS Program, Population Council/South Africa; Linda Bruce, Independent Consultant

Systematic screening
FRONTIERS has developed a training manual to provide guidance for program managers, supervisors, and providers who wish to integrate systematic screening into their health services. Systematic screening is a simple strategy to increase the number of services received at a single client visit. Designated a best practice by USAID, systematic screening can ultimately improve women’s health by efficiently addressing multiple unmet needs for reproductive and other health services. (more) James R. Foreit, Senior Program Associate, FRONTIERS Program, Population Council; Ricardo Vernon, Associate Director, Latin America and the Caribbean, FRONTIERS Program, Population Council/Mexico

Emergency contraception programming guidance tool
Research by the Population Council and ECafrique (the African Consortium for Emergency Contraception), has led to the inclusion of EC in national family planning and post-rape strategies in Africa, Asia, and Latin America. FRONTIERS has synthesized the experience of programs around the world that have successfully introduced EC into their method mix. Researchers in Africa, Asia, and Latin America have collected materials and toolkits on EC in each region on introducing, providing, and scaling up EC services. This information is the basis of a global implementation guidance tool intended for program managers and service providers that FRONTIERS is preparing. (more) M.E. Khan, Associate Director, Asia and the Near East, FRONTIERS Program, Population Council/India; Sharif Hossain, Program Officer, FRONTIERS Program, Population Council/Bangladesh

Health facility assessments
The Frontiers Integration Assessment is a methodology to make inferences about the supply-side factors influencing the delivery of family planning and other sexual and reproductive health services. It has proven useful in the measurement and evaluation of the linkage of these services to collect information on:

availability of services;

level of integration between services;

readiness of service-delivery staff and facilities to provide linked, quality services to clients;

actual services received and quality of care received by clients;

costs and service fees;

impact that the provision of services has on client satisfaction and behavior; and

correspondence between the services provided and clients’ needs.

FRONTIERS is preparing a handbook to help implement facility assessments to guide, measure, evaluate, or test the integration or linkage of family planning and other reproductive health services. The materials presented in this handbook were developed and validated in the course of implementing FRONTIERS projects that tested how the feasibility, effectiveness, efficiency, and quality of care were affected by the linkage of family planning and other sexual and reproductive health services.
Estela Rivero, Program Associate, FRONTIERS Program, Population Council/Mexico; Saumya RamaRao, Senior Program Associate, FRONTIERS Program, Population Council

3:15–3:30 pm Tea/coffee break

3:30–5:00 pm Linking family planning and HIV services
Integrating family planning programs with services to prevent, detect, and treat HIV can enhance the comprehensiveness of services; in high-HIV areas, integration is essential to meet clients’ rights to care. Studies have clearly shown that integrating services is feasible in many high-HIV settings. Evidence also shows that integration can improve quality of care, despite chronic systemic challenges such as staff shortages and infrastructure problems. Presenters describe several interventions in sub-Saharan Africa to integrate family planning with HIV counseling and testing, maternal and postnatal care, and interventions to meet the needs of young people who are living with HIV.
Chair: Mary Ann Abeyta-Behnke, Senior RH/FP and HIV/AIDS Integration Advisor, Service Delivery Improvement Division, Office of Population and Reproductive Health, USAID

Reducing unwanted pregnancies and HIV transmission through linking counseling and testing with FP services (PDF) Mantshi Menziwa, Program Associate, FRONTIERS Program, Population Council/South Africa

Meeting the FP needs of HIV-positive youth (PDF) Harriet Birungi, Program Associate, FRONTIERS Program, Population Council/Kenya

Linking FP with PMTCT and postpartum HIV care (PDF) Charlotte Warren, Program Associate, FRONTIERS Program, Population Council/Kenya

Discussant Janet Fleischman, Chair, Gender Committee, HIV/AIDS Task Force, Center for Strategic and International Studies

5:00–5:15 pm Summary of key points Ian Askew, Director, FRONTIERS Program, Population Council/Kenya

24 April
Day 2: Strengthening Postpartum Family Planning: Current Knowledge and Future Directions

8.30–9.00 am Continental breakfast and registration

9:00–9:30 am Welcome and opening remarks: Why postpartum family planning is so important (PDF) Ian Askew, Director, FRONTIERS Program, Population Council/Kenya and Catharine McKaig, Director, ACCESS-FP/Jhpiego

9:30–11:00 am Clinic-based services: Providing FP information and services during antenatal and postpartum visits
Antenatal and postpartum care visits represent important contact points between clients and the health care system—opportunities to provide women with needed, or desired, information and services related to family planning, fertility return, and child care. While antenatal care is relatively well attended, research is inconclusive on the impact of family planning information provided at this time. Also, though women often need family planning services after delivery, they frequently fail to seek or receive them, and uncertainty about postpartum return to fertility (both among providers and clients) leads to a high risk of unplanned pregnancies. The two presentations in this session describe ways of increasing access to family planning information and services throughout the maternal cycle.
Chair: Patricia Stephenson, Research, Technology, and Utilization Division, Office of Population and Reproductive Health, USAID

Providing FP information and services during postpartum visits: Lessons from Africa, Asia, and Latin America and the Caribbean (PDF) Ricardo Vernon, Associate Director, Latin America and the Caribbean, FRONTIERS Program, Population Council/Mexico

Providing FP information during ANC: Lessons from Africa, Asia, and Latin America and the Caribbean (PDF) Estela Rivero, Program Associate, FRONTIERS Program, Population Council/Mexico; Harriet Birungi, Program Associate, FRONTIERS Program, Population Council/Kenya

Discussant Koki Agarwal, Director, ACCESS/Jhpiego

11:00–11:30 am Tea/coffee break

11:30 am–
12:30 pm Community-based services
Integrating family planning services within communities and community-based health services is a vital and underexplored way of enhancing health care in isolated communities. Research projects show that context-specific, culturally appropriate services can provide important access to essential care in such settings. The three presentations in this session give an overview of a range of feasible approaches. These include the use of culturally appropriate messages (such as spacing births rather than limiting them), ways of involving men (through leaflets and pamphlets given to wives), opportunities to mobilize community midwives, and addressing policy guidelines for community care. Chair: Patricia MacDonald, Service Delivery Improvement Division, Office of Population and Reproductive Health, USAID

Healthy timing and spacing of pregnancies: Experiences from India and Egypt (PDF) Nahla Tawab, Program Associate, FRONTIERS Program, Population Council/Egypt

Taking skilled services to the people: The community midwives approach in Kenya (PDF) Annie Mwangi, Program Officer, FRONTIERS Program, Population Council/Kenya

Community-based postpartum FP: Integration with MNH programs in Nigeria and Bangladesh (PDF) Robin Anthony Kouyaté, ACCESS-FP

Discussant May Post, Extending Service Delivery/Pathfinder

12:30–1:30 pm Lunch

1:30–3:00 pm Contraceptive methods during the postpartum period
Many women want to delay pregnancy following a delivery, and numerous options are appropriate during the postpartum period. Yet there are many system- and method-related caveats—including lack of contraceptive knowledge among maternal care providers, limited facility readiness, and caveats related to the use specific methods—including lactational amenorrhea and hormonal methods—at specific times. Three presenters give an overview of general considerations for providing postpartum family planning and discuss the specific advantages, limitations, and possible ways of improving appropriate uptake of contraception. Chair: Mihira Karra, Research, Technology, and Utilization Division, Office of Population and Reproductive Health, USAID

IUD and sterilization (PDF) John Pile and Roy Jacobstein, ACQUIRE/EngenderHealth

Hormonal methods (PDF) Holly Blanchard, Clinical Advisor for ACCESS-FP/ACNM

LAM and bridging to other methods (PDF)
Marcos Arevalo, Director of Biomedical Research, Institute for Reproductive Health, Georgetown University

3:00–3:15 pm Summary of key points Catharine McKaig, Director, ACCESS-FP/Jhpiego

3:15–3:30 pm Concluding remarks Ian Askew, Director, FRONTIERS Program, Population Council/Kenya