Local Ownership in Action

New insights from DRC’s expansion of community-based family planning using our sustainable approach to scale-up

Our participation in the recent Women Deliver Conference in Vancouver was exciting, partially because we got to interact with members of our global family planning and reproductive health community. We asked them what they most want to see from future contraceptive programs. Here are some of my favorite responses:

As a technical advisor for the Evidence to Action Project (E2A), USAID’s global flagship for strengthening family planning and reproductive health service delivery, I believe the key to achieving our global family planning goals and supporting the world’s hardest-to-reach women and girls is taking programs that work and scaling them up to sustainably reach more people in more places.


It’s true that scale-up is not easy. But E2A, with funding from USAID and led by Pathfinder and a consortium of partners, including scale-up leader ExpandNet, is illuminating pathways to success. Our team has significant experience and systematic scale-up approaches that have been adopted and institutionalized in multiple countries in Africa. We’re committed to sharing what we’ve learned.

So what does work? The main thing to know is that being systematic matters.

ExpandNet’s tool—Beginning With the End in Mind—provides 12 recommendations or steps for taking a pilot from the pilot stage onto the BIG stage (remember…more people, more places). Today, I’d like to focus on just one of those recommendations and highlight the importance it played in scaling up a family planning intervention from South Kivu to three additional provinces in the DRC: engage in a participatory process.


From 2008-2013, Pathfinder implemented a pilot project to respond to the urgent needs of a largely transient population living in a post-conflict area of DRC’s South Kivu Province—refugees, returnees, and internally displaced people, many of whom were survivors of rape used as a weapon of war. The project supported community health workers, retired nurses, and skilled health providers to deliver integrated community-based family planning and primary health care to some of the country’s most underserved populations.

Based on the success of the pilot, which reached over 30,000 households, USAID approached E2A to implement similar integrated services on a wider scale—expanding to 15 health areas within 15 priority rural health zones across three new provinces.

Using the Beginning with the End in Mind tool and recognizing the importance of engaging stakeholders in the process, we got down to work.

We engaged DRC’s National Reproductive Health Program, which enthusiastically assumed ownership of the scale-up process, even though it meant they had to substantially adjust their existing workplans and negotiate with other Ministry of Health programs to secure their commitment and participation.

The National Reproductive Health Program established a national Technical Advisory Group that also included representatives from DRC’s Adolescent Health Program and the Integrated Child Health Program. All three programs shared a common interest: using community-based distributors for community-based health care delivery.

Regular communication between the Technical Advisory Group and the provincial and zonal health authorities ensured integration of project activities into their operational plans. On a semi-annual basis, this multidisciplinary team conducted field visits to the provinces and health zones to observe project implementation and provide feedback, thereby playing an instrumental role in ensuring community-based family planning and basic childcare interventions were integrated and effectively delivered.

Scale-up results in 3 new provinces:

  • 231,566 new adopters of modern contraceptive methods
  • A total of 149,826 couple-years of protection

With the government taking the lead, E2A’s role largely shifted to that of facilitator. We focused on communication and exchanging up-to-date information among donor, government, and other implementing partners. And we provided leadership and targeted support in areas where gaps remained, based on the government’s requests. This included helping our in-country partners answer two important questions for the future:

What can a project in its ending phase do to pave the way toward future scale-up?

What guidance can be given to help sustain the gains we’ve made?

including excerpts from a resulting scale-up strategy, by checking out our latest technical brief: Expansion of Community-Based Family Planning in the Democratic Republic of the Congo: Using a Systematic Approach to Scale-Up