Service Delivery Strengthening

Despite the impressive progress in contraceptive use in recent decades, an estimated 225 million women around the world have unmet need for family planning; 45% of these women reside in South and Central Asia and 22% in sub-Saharan Africa. Many effective and acceptable practices in family planning and reproductive health service delivery are known, but have not been implemented effectively and at scale to bring the desired impact that will benefit women, girls, and men. E2A is designed to support efforts to reduce this huge unmet need by strengthening service delivery and scaling up these proven family planning and reproductive health best practices.

The overarching strategy for E2A’s approach to service delivery strengthening is to increase access to and utilization of quality family planning and reproductive health services appropriate at each stage of the lifecycle to meet changing family planning and reproductive health needs over time and reduce unmet need for contraception. E2A activities support and strengthen diverse elements of service delivery. The three cross-cutting areas of youth, gender, and community participation are fundamental to E2A’s approach.

Starting from the foundation of country priorities, policies, and guidelines, E2A collaborates with country stakeholders to assess gaps and develop activities to strengthen family planning services. By taking into consideration elements of both demand and supply, activities are geared towards strengthening service delivery in a sustainable, comprehensive way, while also supporting the development of a long-term, enabling environment.

Examples of supply-side elements include: access to family planning offered through a variety of service-delivery approaches at facility and community level by both public and private sector; equitable services that are responsive to the needs of communities; availability of a broad mix of contraceptive methods; integration of family planning with health and non-health services; adequately equipped health facilities that are staffed by providers who have the necessary skills to provide quality services; effective management and operations; performance and quality improvement systems; and functional referral systems.

Examples of demand-side elements include: use of different models of behavior-change communication, with targeted messages appropriate to the different needs of each phase of the reproductive lifecycle; a rights-based approach to service provision; community mobilization for participation; social marketing and whole market approaches; and reduction in the cost of family planning use to the client.

Examples of enabling environment elements include: management and leadership; supportive policies and guidelines; evidence-based decision making; contraceptive security; availability of human and financial resources; community mobilization to address socio-cultural barriers to family planning; youth responsiveness; and strategies to address gender norms.

While no single activity can address all of these elements, service-delivery support can be designed within this wider context in order to maximize its contribution to impact and sustainability. By seeking out partnerships, adapting and applying tested tools and methodologies to identify gaps in service delivery, seeking in-country consensus, and providing assistance to apply best practices, E2A works to create synergies and build on experience. E2A also focuses on the documentation and dissemination of successful approaches to strengthening service delivery, further contributing to the global knowledge base of effective approaches.