Flexible Fund Partners Meeting
"Community Based Family Planning Strategies and Tools for Reaching Underserved Communities"

A dialogue on where we have been and where we are going

Friday June 20, 2008

World Vision, Washington, DC

On June 20, 2008 USAID’s Office of Population and Reproductive Health’s PVO/NGO Flexible Fund and CSTS+ held a one day partner’s meeting for Flexible Fund grantees and partners to share successful and innovative community-based family planning approaches. More than 30 participants attended from 16 different organizations including EngenderHealth, Constella Futures, PSI, Woodrow Wilson, World Vision, Africa 2010, IRH, CEDPA, Save the Children, ESD, INFO Project, USAID, AED, World Learning, FHI, and PSP-One.  Community-based family planning partners presented on increasing use of family planning including via: CBD of injectables (Amanda Abbott of FHI), satellite services (Lynn Bakajiman of EngenderHealth)., and private sector strategies involving depot holders (Jeff Barnes of PSP-One). In addition, participants discussed the gaps in family planning tools and resources and recognized that additional tools and resources are needed. There was also a presentation on the new INFO Project “Elements of Family Planning Success” website. All presenters made PowerPoint presentations that may be downloaded at this site.

Purpose:

• Review successful and innovative community approaches to family planning.
• Identify tools and resources that are currently available for community-based family planning programming.
• Identify areas where additional tools would be helpful for planning, implementing or evaluating successful community based family planning programs.

Summary of Assessment of tools needed for community-based Family Planning Strategies

Meeting Agenda: (Please click on the hyperlinks to download the presentations.)

8:30-9:00:      Registration and Breakfast

9:00-9:30:      Welcome and Introductions, Leo Ryan, Project Director, CSTS+

                        Proposed Future Directions for Community-based Family Planning, Victoria Graham, Senior Technical Advisor for the Flex Fund, USAID

9:30-10:00:    Community based Distribution of Injectable Contraception Amanda Abbott, Program Officer for CRTU, Family Health International

10:00-10:15: Question and Answer Session

10:30-11:00:  Linking communities to FP and LAPM via Outreach Services Lynn Bakajiman, Director of the Acquire Project, EngenderHealth

11:00-11:15: Question and Answer Session

11:15-11:30: Coffee Break

11:30-12:00:  Private Sector Strategies for Reaching Underserved Communities Jeffrey Barnes, Deputy Director, PSP-One

12:00-12:15: Question and Answer Session

12:15-12:30: Group Discussion: Proposed Future Directions for Community-based Family Planning

12:30-1:30:    Lunch

Lunch time presentation from JHUCCP on the website “Elements of Successful Family Planning Programs”

1:30-2:30:      Group work:  Assessment to identify the types of tools we need to move community based family planning programs into the direction of incorporating CBD of injectables, satellite services, and private sector/community depot holders.

2:30-3:00:      Report back on group work

3:00:               Close meeting

Summary of Assessment of tools needed for community-based Family Planning Strategies:

In the afternoon, participants were asked to do group work to identify the types of tools we need to move community based FP programs in the direction of incorporating:

-        Community Based Distribution (CBD)

-        Outreach Services

-        Private sector/Community Depot Holders

Community-based Distribution of Injectables:

1. Where can one find the most useful resources /tools to assist implementers in CBD?

1. Media Materials Center (MMC): http://www.m-mc.org/  
2. Pop Line database: http://db.jhuccp.org/ics-wpd/popweb/
3. INFO one source is on the right side of the following website: http://www.infoforhealth.org/
4. IBP website: http://www.ibpinitiative.org/knowledge_gateway.php
5. FHI’s website has several tools on CBDs which can all be accessed at: http://www.fhi.org/en/Topics/CBD+of+DMPA.htm 
6. Flex Fund Community based resources: http://www.flexfund.org/resources/cbfp.cfm
7. The CORE Group: http://www.coregroup.org/working_groups/health.cfm
8. Pathfinder has an M & E tools for CBD workers: http://www.pathfind.org/site/PageServer?pagename=Pubs_MandE_Guides
9. JSI has a resource on how to integrate FP into a CBD program: http://www.jsi.com/JSIInternet/Publications/index.cfm
10. ESD project has a guide for practitioners: www.esdproj.org
11. AIHA: American International Health Alliance: www.aiha.com
12. The CEDPA website has tools for sale only: www.cedpa.org
13. WHO will be adapting the Decision Making Tool (DMT) for CBD programs.
14. ELCO Mapping for eligible couples – a tool for CBD agents, produced by CEDPA. This tool may be on their website. Contact Laurette if interested.

2. What are the most important gaps in resources that need to be addressed? There is a need for the following:

1. A searchable database comprised of CAs working on CBD of FP and links to their various tools.
2. A template for taking local-level experiences that could be shared with others and having resources for translating from the local level to the broader global perspective. This will allow innovative strategies to be shared with others.
3. A tool for ensuring follow-up with CBD referrals. Because the clinics are only loosely involved, they are not partners and therefore do not have incentive to keep track of the referrals.  This will ensure that the number of referrals who actually receive services is increased.
4. Forms for CBD workers that capture the information that the program needs. CEDPA reports that they have good forms that can even be used with illiterate agents. FHI also has these types of forms. But neither group has published their forms. It would be useful to have a comprehensive list of items to include on a form and then each program could adapt from the full compliment and choose just what they need. Some of the items could be fixed and some could be adaptable.
5. A tool for improving the quality of counseling that CBD agents provide, especially around the topic of side effects. IEC materials specifically on side effects. The balanced counseling strategy is a good counseling tool, but does not include discussion of side effects. Especially an IEC tool that can help to differentiate between side effects and warning signs of complications.
6. A take-home pamphlet so that women can be reminded of what to expect while using DMPA. These tools should be in pictorial form. Laurette of CEDPA will look for the name of a group she met at GHC that can translate messages into pictorial form.
7. Tools for scaling up CBD programs.
8. Tools for creating links between mobile clinics and CBD programs and community pharmacists and depot holders – for all possible sources.
9. Materials that can guide the agents in facilitating male involvement.
10. Tools for disclosure of DMPA use between partners.
11. What about including other methods in CBD programs such as diaphragms and cervical caps?
12. A tool for differentiating between different consumers and what services are appropriate for each.
13. What are the indicators that social norms have changed, in other words if there is an enabling environment. So it’s not just a person going in and providing CBD, but what kinds of community mobilization has to take place.

3. Recommendations:

1. Have CAs link to each other’s websites in a context specific way.
2. Create a website that is a clearing house for all websites with tools for CBD of FP programs.
3. Provide guidance on case-study and evaluation, questions to think about for scaling up. Pathfinder has a paper on how to do a case study, but we need more examples. It would be useful to have an example of a case-study on CBD.
4. It could be useful to survey CBD agents about what they need to provide to clients.

Outreach Services:

1.      Where can one find the most useful resources /tools to assist implementers in outreach services?

a.      Material available on refugee mobile services and VCT mobile services

b.      Material available on Injection Safety and/or Infection Prevention

c.      Service Delivery Guidelines: Mobile Clinics (S.Thapa, 1999)

d.      WHO Guidelines on Female and Male Sterilization (1992)

e.      Pathfinder: Ethiopia Health Extension Program 2003-2007

f.       Marie Stopes

g.      International Planned Parenthood Federation

h.     Immunization Outreach services

i.       M. Seidman- OR Studies 1990.

j.       Save the Children: Adolescent Reproductive Toolkit Pending

2.      What are the most important gaps in resources that need to be addressed? There is a need for the following:

a.      No systematic manual or strategy on how to set up either mobile or facility outreach services

b.     The resources that are available are reference material but currently, no tool exists for outreach services

c.      What does the model/intervention even look like?

d.     The resources we have are outdated

e.      A tool needs to be created that links the delivery of services with the community: increasing demand, supply, supervision, etc.

f.      A tool needs to lay out the different components with contextual case studies that cover different environmental and political situations

g.     Within this tool, we need to know what the cost issues will be and how to scale up the practice once success is proven

h.     We need data on who we have reached with current and previous outreach services

3. Recommendations:

a.      Specifically define outreach services: facility vs. mobile

b.     Create a tool that takes a holistic approach: consider issues at the facility to community level

c.      A tool to manage the quality and continuation of care received through outreach services.

d.     Creation of a holistic M&E system which captures data from the facility level to outreach

e.      We should be careful to not only think of outreach services meaning access to long acting and permanent methods but also short acting methods as well and vice versa in terms of facility level services. It’s about choice.

f.      Public/Private partnership for mobile and facility outreach.

Private Sector:

1.      Where can one find the most useful resources /tools to assist implementers in implementing a private sector approach?

a.      Tools are needed along with documentation of successful models

2.      What are the most important gaps in resources that need to be addressed? There is a need for the following:

a.      Research on safety of OTC hormonals

b.     Impact of training depot holders

c.      Research on best training for busy depot holders

d.     Demand creation

3.      Recommendations:

a.      Add depo to social marketing programs

b.     Change the Rules!

-        Allow sales of hormonal contraceptives in depots/drug shops

-        Allow/facilitate training of shop staff

-        Allow pharmacies to own depots