Integrated Family Planning and Immunization Service Delivery at Health Facility and Community Sites in Dowa and Ntchisi Districts of Malawi: A Mixed Methods Process Evaluation.

Chelsea M Cooper,Anne Schuster,Hannah Gibson,Asnakew Tsega,Hannah Hausi,Steven Shire,Hannah Tappis,Sheila Makoko,Jacqueline Wille

doi:10.3390/ijerph17124530

Abstract

The Government of Malawi’s Health Sector Strategic Plan II highlights the importance of service integration; however, in practice, this has not been fully realized. We conducted a mixed methods evaluation of efforts to systematically implement integrated family planning and immunization services in all health facilities and associated community sites in Ntchisi and Dowa districts during June 2016–September 2017. Methods included secondary analysis of service statistics (pre- and postintervention), focus group discussions with mothers and fathers of children under age one, and in-depth interviews with service providers, supervisors, and managers. Results indicate statistically significant increases in family planning users and shifts in use of family planning services from health facilities to community sites. The intervention had no effect on immunization doses administered or dropout rates. According to mothers and fathers, benefits of service integration included time savings, convenience, and improved understanding of services. Provision and use of integrated services were affected by availability of human resources and commodities, community linkages, data collection procedures and availability, sociocultural barriers, organization of services, and supervision and commitment of health surveillance assistants. The integration approach was perceived to be feasible and beneficial by clients and providers.

Highlights

A woman’s access to family planning services and consequential ability to space or limit her pregnancies has a profound effect on her and her family’s well-being [1]
Study results are presented around the effect of service integration on service utilization and on experience of care, as well as the contextual factors that affected implementation of service integration
We did not expect that the intervention would affect uptake of DPT1, which can be used as a proxy for immunization access

Summary

Introduction

A woman’s access to family planning services and consequential ability to space or limit her pregnancies has a profound effect on her and her family’s well-being [1]. Malawi’s modern contraceptive prevalence among women of reproductive age was 45% in 2015–2016 and 30% among women at six months postpartum [2,3]. Though the country’s contraceptive prevalence rate has steadily increased over the past two decades, unmet need for family planning among married women in the Central. Region, where this study was conducted, was 16% in 2016, and the total fertility rate in the region (4.4). Remained higher than the total wanted fertility rate (3.4), indicating a need to identify new avenues to reach women with counseling and services [2]. Public Health 2020, 17, 4530; doi:10.3390/ijerph17124530 www.mdpi.com/journal/ijerph

Methods

Discussion

Conclusion