Key factors to facilitate locally driven family planning programming: a qualitative analysis of urban stakeholder perspectives in Africa and Asia

Abstract

Background There has been greater recognition of the importance of country ownership in global health and development. However, operationalising country ownership to ensure the scale up and sustainability of proven interventions remains elusive at best. To address this challenge, we undertook a thematic analysis of interviews collected from representatives of local governments, public health systems, and communities in poor urban areas of East Africa, Francophone West Africa, India, and Nigeria, supported by The Challenge Initiative (TCI), aiming to rapidly and sustainably scale up evidence-based reproductive health and family planning solutions. Methods The main objective of this study was to explore critical elements needed for implementing and scaling evidence-based family planning interventions. The research team conducted thematic analysis of 96 stories collected using the Most Significant Change (MSC) technique between July 2018 and September 2019. After generating 55 unique codes, the codes were grouped into related themes, using TCI’s model as a general analytical framework. Results Five key themes emerged: (1) strengthening local capacity and improving broader health systems, (2) shifting mindsets of government and community toward local ownership, (3) institutionalising the interventions within existing government structures, (4) improving data demand and use for better planning of health services, and (5) enhancing coordination of partners. Conclusion While some themes feature more prominently in a particular region than others, taken together they represent what stakeholders perceive to be essential elements for scaling up locally-driven health programmes in urban areas in Africa and Asia.

Mobilizing stakeholders for implant removals in Burkina Faso using landscape assessment data

“…Amassing and disseminating data revealing poor facility readiness and low provider competence in conjunction with early engagement of key policy players at the MOH fueled FP stakeholder buy-in during the workshops; participatory approaches ensured inclusion of all stakeholders and motivated them to commit to roadmap actions. Supporting development of a culture for data demand and use, including use for advocacy purposes, encourages timely and accurate data collection, leading to improved design of FP interventions in target populations [ 41 ]. Following a model of data-driven stakeholder engagement like this one can promote more systematic and meaningful stakeholder involvement, and integration of contributions by key players into a broader strategy for quality improvement.…”

“…Additionally, clear communication of priorities and involving stakeholders in consultations at early stages can avoid tokenistic involvement or problems resulting from involving stakeholders too late in the process [37][38][39][40]. When working to secure stakeholder commitments, it is crucial to be sensitive to local organizations that are often most actively involved in providing care, but may concerned about top-down influences over their activities [37,41]. In a systematic review of interventions in sub-Saharan Africa, local ownership and mobilization were frequently identified by included studies as crucial to sustainability of interventions, both early on and after intervention implementation [42].…”

Improving State Government's Responsiveness to Family Planning Interventions in Nigeria Using an Innovative Reflection and Action Tool

“… 1 Health outcomes of urban women living in poverty are considerably worse than those of their wealthier urban counterparts and, in some cases, of rural women. 2 – 5 Although women in urban areas have fewer children (4.5 children per woman) compared to those in rural areas (5.9 children per woman), the fertility rate is impacted by education and wealth quintile in Nigeria. For example, urban poor women in Nigeria often experience similar fertility rates as women in rural areas.…”

“…17 Both the Paris Declaration and the Accra Agenda included recommendations that technical assistance (TA) providers make capacity-building a fundamental feature of TA to enable countries to operate their health systems effectively and autonomously in the future, 18 while the Busan Declaration placed explicit emphasis on learning as 1 of the core aspects of enhanced capacity. 17 Local government ownership and capacity strengthening that is tailored to local needs is at the heart of The Challenge Initiative (TCI)'s "business unusual" approach, as outlined in Mwaikambo et al 2 TCI is an urban FP/RH program with a goal of achieving greater local government self-reliance to scale up evidence-based FP and adolescent and youth sexual and reproductive health (AYSRH) interventions, leading to sustained improvements in FP service delivery and increased use of modern contraception, especially among the urban poor. Funded by the Bill & Melinda Gates Foundation, Bayer AG, Comic Relief, and others, TCI provides coaching and technical and financial assistance to state governments to enable them to lead implementation of evidence-based FP and AYSRH interventions and ultimately sustain the positive outcomes of a government-driven FP/RH program.…”