How the Family Planning Sustainability Checklist Helped Identify FP Challenges in Ethiopia
Last fall, Sharon Arscott-Mills of ICF International wrote a guest blog post announcing the new Family Planning Sustainability Checklist, a tool that helps project designers, implementers, and evaluators ensure long-term sustainability for their community-based family planning programs. Now Adrienne Allison describes World Vision’s recent use of this tool in the field.
World Vision (WV) used the excellent Family Planning Sustainability Checklist during a family planning workshop for WV staff and Ministry of Health (MOH) representatives in Hawassa, Ethiopia, in February 2013. We spent the first day of the workshop exploring beliefs, attitudes, and experiences with family planning; reviewing Ethiopia’s family planning policies and guidelines; and examining the data on healthy timing and spacing of pregnancies (HTSP). The discussion of HTSP proved to be the catalyst to winning the hearts and minds of the participants, who had heard about family planning for years but had never understood how using family planning to time and space births improves maternal and child health. The second day we assessed our expectations of the circumstances we would find on a visit to Abaya, a village 100 km south of Hawassa, by rating each statement in the Checklist as “true,” “mostly true,” or “not true.” The checklist guided us to ask questions we had not considered before.
We formed five teams and then divided the team on Community Mobilization in two for focus group discussions—one for men and the other for women. Our findings in Abaya were so divergent, we recommend this be routinely done to reveal more about community knowledge and understanding. We learned that the men knew they would not be able to pass on to their sons the amount of land they themselves had inherited from their fathers. They lamented the fact that many sons had already migrated to urban areas to find employment. They seemed not to have considered the possibility of having fewer sons so they could give more land and education to the sons they did have. However, because they were farmers, they soon recognized the parallels between spacing plantings and spacing pregnancies for healthiest outcomes.
Men in Abaya had limited knowledge of modern contraception. Women, on the other hand, said they relied on injectable contraceptives provided at the health post some distance away. They preferred the privacy of leaving the village to get contraceptives to having services publicly brought to them in their homes. Women wanted to protect themselves from pregnancy, not to limit births, but to avoid the debilitation of frequent pregnancies that would impede their capacity to work long hours in the field.
The Family Planning Sustainability Checklist is available in two formats. In Annex 1 – Healthcare Providers, questions are organized according to five cadres of providers: district health management team, clinic-based health workers, community health workers, private sector, and community mobilization. In Annex 2 – Program Elements, questions relate to six essential elements: reliable supply of contraceptive methods, training, maintaining a network of quality service delivery providers, supervision, demand creation, and reporting and integration of community-based family planning program data. Workshop participants selected Annex 1 – Checklist for Healthcare Providers as the more logical approach to conducting field interviews. It also helped the participants map the flow of resources from the district level down to health workers, and, conversely, understand how information on contraceptive use needed to flow up to the district level to assure supplies and avert stockouts.
The Checklist assisted the WV team with pinpointing family planning activities they could integrate immediately within their ongoing health and nutrition programs. It also helped them identify the broader program components to use in redesigning their community development programs over the next few months. Though we found the introduction, overview, and instructions for using the Checklist a little too dense to read closely, Annex 3 – The Action Plan Template helped us plan our action steps. Overall, the Checklist is a user-friendly tool that is easily adapted for multiple types of FP programs. We hope to use it in national level workshops throughout East Africa.
For more information about HTSP, please visit the Healthy Timing and Spacing of Pregnancies Toolkit. To learn more about community-based family planning, check out the Community-Based Family Planning Toolkit.