E2A Newsletter, May June 2016

E2A expands postpartum family planning interventions in Cameroon to rural districts

Ten health facilities in Cameroon’s Bafia and Mbalmayo districts have joined four hospitals in the capital city of Yaoundé to offer family planning services at opportune times: counseling during antenatal care, and postpartum counseling and contraceptives after delivery, during immunizations, and in the family planning room. Interventions at all 14 hospitals and health facilities, located in Cameroon’s Central Region, are supported by E2A’s USAID West Africa mission-funded program: “Advancing Youth, Postpartum, and Community Family Planning Promotion and Service Delivery in Cameroon.”

According to the last Demographic and Health Survey conducted in Cameroon five years ago, only around 20 percent of reproductive-age women in Yaoundé and 9 percent of reproductive-age women in rural areas, like Bafia and Mbalmayo, were using a modern contraceptive method.

E2A’s program focuses on offering family planning services during immediate and extended postpartum care, up to 12 months after delivery, in order to help prevent unintended, closely spaced pregnancies, and to offer women the chance to properly nourish their breastfeeding infants and recover from pregnancy. The program is implemented through Management Sciences for Health, a core partner in the E2A consortium, in collaboration with the Ministry of Health.

In order to offer postpartum women and girls full contraceptive method choice, 82 providers from the hospitals in Yaoundé and health facilities in the two rural districts have participated in competency-based trainings on insertion of implants and intrauterine devices during the postpartum period. Trainings have also focused on ensuring voluntary informed choice of all available contraceptive methods available during counseling sessions.

Because use of contraceptives has been so limited in Cameroon, especially in rural areas, the E2A program has trained 53 community outreach workers in Bafia and Mbalmayo who mobilize communities and generate demand for services. Providers trained by the program as supervisors oversee and support all other providers and community outreach workers engaged through the program. The outreach workers are paid a small stipend to conduct informational talks to individuals and groups in the clinic catchment areas on the importance of healthy timing and spacing of pregnancy and use of family planning after delivery.

As of March 2016, 5,311 women had accepted a family planning method during interventions supported by the program. Of those, more than 68 percent accepted a contraceptive method during the immediate or extended postpartum period.

More young postpartum women are also accepting contraceptives. Of the 5,311 women and girls who accepted contraceptives as a result of program interventions, 23 percent were between the ages of 15 and 24.  Providers trained by the program offer youth-friendly family planning counseling and services to young mothers who delivered a baby in the past 12 months so they can space their children to improve their health and the health of their children.  They offer a full range of short and long-acting reversible contraceptive options and explain the benefits of spacing, especially for young mothers aged 15-24 years.

The United Nations Population Fund has plans to scale up the approach applied by E2A to five additional regions in Cameroon.

E2A events feature the Health of People and Environment (HoPE) project in the Lake Victoria Basin

Photo credit: Maren Vespia, Pathfinder International

The Health of People and Environment (HoPE) Initiative was the focus of several events this past week. Since 2012, HoPE has been working to model and scale up a promising cross-sectoral approach—known as “population, health and environment”(PHE) — to address the interrelated challenges faced by marginalized, rural communities in the Lake Victoria Basin regions of Kenya and Uganda.

Impact on family planning and maternal health

On June 20, during a presentation and interactive discussion with East African staff from the HoPE initiative, the audience learned about how the integrated PHE approach has impacted uptake and use of family planning and maternal health services among a target population of approximately 130,000.

HoPE has worked directly with community members, existing groups, and local governments in the Lake Victoria Basin to encourage improved practices in: sustainable agriculture, fisheries, and natural resource management; family planning, maternal and child health, and reproductive health service delivery and usage; and eco-friendly, alternative sustainable livelihoods. The HoPE integrated approach addresses challenges faced by rural populations, including:

  • Food insecurity
  • Weak health infrastructure and services
  • Environmental degradation
  • High maternal and child mortality
  • Vulnerability to climate change
  • High unmet need for family planning
  • Gender inequality

In terms of family planning, the project has trained 392 health workers to provide facility, outreach, and community-based family planning services including counseling and a range of short- and long-acting methods. HoPE also works with 48 different community groups and community-based health providers to increase the demand for family planning services in communities. Through the project, more than 38,000 people have started to use a family planning method for the first time. HoPE staff have found that people in project communities are more responsive to family planning messaging when it is connected to household resources, environmentally linked messaging, and income-generating activities that improve their livelihoods.

In terms of maternal health, HoPE has focused on increasing the number of skilled deliveries, especially among young women who were the least likely to seek skilled attendance. Under the project, almost 6,000 facility-based deliveries have been conducted and more than 25,000 referrals have been made by a variety of community-based groups for antenatal care and deliveries at health facilities.

Impact at scale

On June 22, HoPE’s East African staff participated in a webinar co-hosted by the Population Reference Bureau-led PACE Project and E2A’s Community of Practice on Systematic Approaches to Scale-Up of Family Planning/Reproductive Health Best Practices. During the webinar, discussions covered how E2A/ExpandNet worked with the HoPE team to design and implement the project in ways that would be scalable to wider populations in Kenya and Uganda and across East Africa.

“To achieve the Sustainable Development Goals, projects need to be scalable,” said Laura Ghiron of ExpandNet.

To design and implement a scalable approach, the HoPE Project applied the 12 recommendations contained in the ExpandNet/WHO tool Beginning with the end in mind.  This included involvement of a wide, diverse body of local, district, and county government stakeholders and systems.

“Having had these people participate resulted in a much greater set of resource people who could expand interventions after they proved to be effective,” said Pamela Onduso of Pathfinder International in Kenya.

HoPE opted to work with existing systems and groups that would continue beyond the project’s life. The project conducted a participatory needs assessment, and engaged and empowered communities to determine what interventions would best address their needs, and to monitor and report on project interventions.

“We showed them that the trees that are cut will not come back and they need to have trees for livelihoods and also the environment,” said Dorah Taranta of Pathfinder International in Uganda. “People in the community took on tree planting and selling seedlings and they are now getting better use of their gardens.”

After the model was proven successful, the project organized scaling-up workshops in Uganda and Kenya to generate the necessary political will to scale up the approach more widely in both countries.

As a result of this strategic work, in Kenya, the two counties touched by the project have budgeted for integrated PHE activities in their five-year County Integrated Development Plans. In Uganda, the Ministry of Health has adopted HoPE’s model household concept as a focal point in its phased implementation of a new national strategy for community health extension workers.

The model applied by HoPE is now being adapted and tested outside of Kenya and Uganda in other East African Community countries, whose national governments are engaged in developing their own strategies and frameworks for PHE integration. These strategies have used evidence from HoPE, as are other recently developed policy initiatives such as Uganda’s effort to integrate family planning into its national climate change strategy.

HoPE is led by Pathfinder International with local environmental organizations in Kenya and Uganda. It is funded by USAID, MacArthur Foundation, Packard Foundation, Barr Foundation, Swift Foundation, and Winslow Foundation. To learn more about HoPE, watch this video, read this brief, or listen to the webinar.

Johannes Linn talks to E2A’s community of practice about institutional support for scale-up

On May 11, the resource team of the Community of Practice on Systematic Approaches to Scale-Up of Family Planning/Reproductive Health Best Practices heard from Johannes Linn, Senior Fellow at the Brookings Institution, about the intrinsic value of garnering institution-wide support for scaling up interventions and programs. The resource team is composed of representatives from 15 organizations charged with setting objectives for the community of practice, mobilizing the participation of colleagues in activities related to scaling up, and engaging in substantive discussions that advance learning in the area of scale-up.

“Many organizations are talking about the scaling-up agenda, but how do we generate impact at scale to achieve formidable goals like the Sustainable Development Goals?,” asked Linn of the resource team.

He said that while individuals—champions, designers, implementers—are important to the scale-up process, in order for the process to be effective and sustainable, those individuals have to be embedded in supportive institutions.

Linn told resource team members that the scale-up of development interventions needs comprehensive, institution-wide support. The institutions he referred to include government ministries and departments, private firms and social enterprises, civil society organizations, and public and private donors.

Linn said a disproportionate focus on innovation that trumps the necessary focus on garnering comprehensive institutional support leads to “pilots to nowhere.” A focus on short-term results, short budget cycles, and discontinuities in leadership also hinder the potential for scale-up of successful pilot interventions.

He said first and foremost, “we need to understand how the institution works.” Scaling up then must be incorporated fully into each organization’s mission, strategy, policy, processes, budgeting, incentives, and monitoring and evaluation systems. He said scaling up must be championed from the top and it must be homegrown.

In addition to his presentation on institutional support for scale-up, Linn, along with Larry Cooley, President of Management Systems International (MSI), was at the resource team meeting to explore collaboration between E2A’s community of practice on scale-up and a new community of practice on scale-up launched by MSI and Results for Development. The new community of practice focuses on the scale-up of development interventions and is limited to 50 to 60 members from donor agencies, foundations, think tanks, and academia. The community of practice has formed four working groups that are open to organizations outside the core membership group. The working groups are: agriculture and rural development, education, monitoring and evaluation, and fragile and conflict-affected states.

The two communities are specifically exploring collaboration related to the monitoring and evaluation working group.

To learn more about Linn’s insights on scaling up development programs, read his blog post.