Improving access to quality family planning services in Nepal and Sri Lanka: insights from a South-South learning exchange

Abstract

Nepal and Sri Lanka ministries of health shared best practices and learnings, in a South-South learning exchange (SSLE) to improve access to quality and rights-based family planning services. The SSLE between the two countries followed a five-step methodology designed by the WHO, under the Family Planning Accelerator project. SSLE between the two countries started in January 2020 and is still continuing. Both countries started implementation of the learnings (step 4) at the time of preparing this manuscript (December 2021). An independent consultant from Sri Lanka carried out an evaluation, to inform future SSLEs. The evaluation included a desk review on SSLE and family planning in both countries and key informant interviews with Sri Lanka Ministries Health, WHO CO, external partners. A final evaluation of the outcomes/impact is planned in December 2022. The SSLE resulted in a systematic cross-country transfer of knowledge and implementation of the learnings. Sri Lanka implemented a web-based system for logistics management of family planning commodities and Nepal commenced implementing integrated family planning services in a decentralised environment using a lifecycle approach to improve postpartum family planning uptake. The success of this SSLE is attributed to the rigorous methodology, country-led designing of the learning agenda and process, extensive communication amongst the teams, a focus on outcomes, commitment and leadership by ministries of health in both countries. Learning and technical assistance needs of countries can be met by SSLE if national contexts, availability of resources are considered.

Scoping review on the use of South-South learning exchange to scale up evidence-based practices in family planning

“…Health providers from Benin, Chad, Cote d’Ivoire, Niger and Senegal were trained in Guinea on PPFP/PPIUD (postpartum intrauterine device) to facilitate scaling up these services at the facility level in their respective countries 7. The reciprocal exchange between Nepal and Sri Lanka focused on Nepal learning about the integration of FP counselling and services using a life course approach to improve PPFP uptake and Sri Lanka learning about establishing a web-based e-logistics management information system (eLMIS) for contraceptives to enable district and central levels commodity security 8–10. Niger shared its experiences and learnings on Schools of Husbands, established to promote women’s access to RH information and services with other African countries (Burkina Faso, Cameroon, Cote d’Ivoire, Guinea, Mali, Mauritania, Senegal, Sierra Leone, Togo) (18d).…”

“…Six studies reported using more than one method to conduct SSLE (7, 8, 9, 10, 22b, 24a). Of these, three studies used a study tour with expert visits (7, 22b, 24a) and three studies reported using reciprocal and virtual exchanges 8–10. In Chad and Niger, following the study tour, Indonesian Muslim leaders were invited to facilitate the workshop on FP and Islam (24a).…”

“…In another study, following the study tour, the trainers visited the participants in their hospitals to monitor the new skills and services and help providers address challenges and manage service delivery 7. WHO supported reciprocal virtual learning exchanges between Nepal-Sri Lanka and Nigeria-Uganda 8–10. The most common combination for conducting an SSLE is when participants from a knowledge-seeking country conduct a study tour, followed by a visit of an FP expert to their country to follow-up on the learnings.…”

“…Three indicators to monitor PPFP uptake were proposed for inclusion in Demographic Health Survey and National Health Facility Survey in Nepal. The Ministry of Health had allocated funds to all provinces to initiate and strengthen PPFP in hospitals 9 10. Sri Lanka had introduced a dedicated page on the reporting system of contraceptive commodities in its District Health Information Software 2 9 10…”

“…A book developed by UNFPA Indonesia and BKKBN on ‘FP, RH and gender: Islamic perspective’ was translated into Nepali language and is used by MRLs for community level orientation (22b, 24a). Nepal developed a PPFP advocacy tool that was used to conduct policy dialogue with policy-makers and programme managers in two provinces 9 10…”