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2020: An Adaptation Crash Course

Using StoryMaps to share family planning program adaptations

IBP Network partners are using StoryMaps to visualize the trials and tribulations of a pandemic year in family planning.

This post was originally published on the Research for Scaleable Solutions (R4S) blog.

We adapted how we work, how we interact, and how we do just about everything in 2020. Family planning is no exception. Across the globe, family planning programs are continually adapting to the austere circumstances of COVID-19. Lockdowns and social distancing make it difficult to continue activities as planned. Overburdened health systems suffer shortages of health workers, hospital beds, and supplies. Hesitancy to visit health facilities and lack of information among providers and clients alike are creating barriers to care. These are just a few of the challenges.

Starting in May 2020, the COVID-19 and FP/RH Task Team, co-hosted by the IBP Network, Knowledge SUCCESS, and Research for Scalable Solutions (R4S), set out to document unprecedented challenges and creative solutions in family planning during the pandemic. The task team collected information from partners about how they are adapting family planning activities via a spreadsheet and visualized these in an ArcGIS StoryMap. The map tells the story of the past year in family planning: paused activities, systems pushed to the brink. But next to each challenge, there’s the story of resilience. Programs pivoted to procure personal protective equipment (PPE) for community health workers and sent them door to door to dispel myths with tailored tools. Others adapted training content for virtual and hybrid platforms to provide instruction in self-injection and found new ways to reach target audiences online and over the phone.

In February 2021, we launched the ArcGIS StoryMap and analyzed the trends in a webinar alongside PSI, who presented the StoryMaps they used to track and visualize their programmatic adaptations to COVID-19 during the pandemic. You can read about some of the trends below. You can also explore the IBP network StoryMap and add to it via this form (available in English and French) if you have something you’d like to share. We hope you’ll find inspiration in these maps; each data point tells a story.

Click on the highlighted countries on the map to learn more about the digital adaptations. Use the links above to access the full features of the map.

What trends are we seeing in the ArcGIS StoryMaps?

Service Delivery

For COVID-19 adaptations trends in FP service delivery, PSI and other IBP Partners are seeing:

  • An increase in last-mile service delivery approaches, using unconventional strategies (motorcycles, digital tools) to bring FP services closer to clients,
  • Use of digital platforms to support and train providers on COVID-19 prevention including mental health support groups, and
  • Strategic selection of methods or provision of additional supplies to minimize travel to health facilities.

In Pakistan, Palladium trained providers on infection prevention and is integrating family planning into primary health care, including postpartum family planning.

In Zimbabwe, the Zimbabwe Association of Church-Related Hospitals (ZACH) started to provide multiple pill packs to ensure continuity of oral contraceptives among its clients.

Pathfinder and the Ministry of Health, alongside private sector partners, have launched training for central government trainers and NGO providers on self-injection of DMPA-SC that comply with COVID-19 travel and social distancing restrictions in Democratic Republic of Congo. They are:

  • facilitating small-group training sessions (5-10 participants/session),
  • providing distance training through teleconferences coupled with PATH’s online eLearning course, and
  • implementing onsite training for some facility-based providers.

Prior to the pandemic, PSI’s Adolescent360 (A360) project in Nigeria had been targeting youth aged 15-19 with FP products and services through their free ‘hub and spoke’ facility model. As COVID-19 spread, the government-initiated lockdown prevented youth from travelling to access FP clinics. Funded by the Children’s Investment Fund Foundation (CIFF), A360 adapted by transforming spoke facilities into ‘mini hubs,’ by dedicating more youth-friendly days closer to young clients’ communities. The result: PSI saw an increase in young women (15-19), married and unmarried, adopting FP for the first time.

Social and Behavior Change

IBP partners and PSI are seeing adaptations to social behavior change programming that include:

  • Rapid adoption of social media (Facebook, Twitter, Instagram) to promote FP demand creation and expand client reach,
  • Radio show and hotline FP/COVID-19 prevention integration messaging for women of reproductive age living in rural areas, and
  • Community group engagement to diffuse COVID prevention messaging alongside FP messaging.

In Mali, Conseils et Appui pour l’Education à la Base (CAEB) modified large community health fairs to provide smaller education sessions about social distancing, provision of kits (handwashing kits, hydroalcoholic gel, soap, bleach, washable masks, etc.).

Since 2015, PSI’s Social Enterprise (SE) in India has promoted FP self-care for young women through creative FP information social media campaigns. However, the COVID-19 lockdown lowered demand for FP products and services in India. Funded by the Bill and Melinda Gates Foundation, SE India rapidly accelerated their digital strategy to better target women aged 18-30 with FP self-care information through artificial intelligence and chatbots. From July-November 2020, 9035 clients have interacted with the chatbot and 1512 e-referrals have been given.

To promote access to sexual and reproductive health services, particularly among adolescents and youth, and render the gendered impacts of COVID-19 more visible to community members and policymakers alike, Myanmar Partners in Policy and Research (MPPR) integrated information dissemination with material support, including the distribution of dignity kits containing health and hygiene supplies. They provided training to community-based organizations, community champions, and volunteers in the public health and social service sectors.

In Francophone West Africa, Breakthrough ACTION developed radio spots promoting confidence in FP methods and services, including calls to action to:

  • promote couple communication about FP,
  • obtain an extra supply of a chosen FP method if possible,
  • prepare for a conversation with a provider about FP method choices, and
  • call existing hotlines that have information on FP methods.

A study from Breakthrough RESEARCH showed that exposure to the campaign is significantly associated with higher self-efficacy to speak to one’s partner about family planning and greater intention to get information about family planning from a nearby health center.

Advocacy

For adaptation trends in advocacy for family planning, IBP partners and PSI are experiencing new government partnerships, technical working group leadership opportunities and FP taskforce developments.

In Nigeria, the Balanced Stewardship Development Association (BALSDA) is developing knowledge products to engage policymakers, service providers, and community gatekeepers.

HP+ is coordinating Family Planning Committee meetings in Madagascar to address declining use of family planning services since the beginning of the pandemic and to ensure the supply chain for contraceptives.

IntraHealth International is providing technical assistance to the Burkinabe government for the adaptation of the WHO Essential services guide into a national services continuity plan. They are drafting six technical briefs to operationalize the national continuity plan at sub-national and facility level and have shared these with the West African Health Organization and other regional platforms to facilitate similar work in other countries across Francophone West Africa.

Using StoryMap Insights

After the webinar presentations, participants engaged in a rich discussion. Several questions emerged about the measurement of adaptations – highlighting the importance of sharing indicators and what does not work alongside what does. The IBP StoryMap includes indicators when those were shared and the next iteration of the map will include whether partners plan to continue the adaptation or not and link out to formal evaluations, when these are available. Several participants noted interest in creating a similar map for adaptations in reproductive health.

These are just a few of the adaptations and activities highlighted in the ArcGIS StoryMaps. We intend to use this as a living tool to reflect the resilience and commitment among the family planning community and continue to collect new entries via a Google form (available in English and French). We also hope that it will foster direct peer-peer learning and exchange. Contact information has been shared for each entry, so reach out for more information to support adaptation and replication of best practices.

IBP COVID-19 and FP/RH Task Team Interactive Map
Sarah Brittingham

Technical Officer, Research for Scalable Solutions, FHI 360

Sarah Brittingham serves as a technical officer in the research utilization unit at FHI 360. Her current portfolio is centered around expanding access to family planning and sexual and reproductive health information and services through digital technologies and self-care. Before focusing her career on family planning and reproductive health, Sarah managed an intercountry adoption agency, served as a home visitor to new mothers, and taught sex ed to youth. She earned her MPH at the University of North Carolina at Chapel Hill and her MA in Development Studies at the International Institute of Social Studies in The Hague, the Netherlands.

Ameya Sanyal

Fellow, FHI 360

Ameya is an undergraduate student at Duke University studying Global Health and Psychology. Her research interests lie in improving adolescent mental and sexual reproductive health care. This past summer, she worked for FHI 360 as a 2020 Stanback Research Utilization Fellow. Beyond this fellowship, Ameya has interned with the National Library of Medicine and a sexual and reproductive health non-profit.

Lola Flomen

Technical Learning Consultant, PSI

Lola Flomen is a Technical Learning Consultant for PSI working on a range of research utilisation projects in their Sexual & Reproductive Health and Digital, Health & Monitoring Departments. She received her B.A. in Global Public Health from the George Washington University.

Nandita Thatte

IBP Network Lead, World Health Organization

Nandita Thatte leads the IBP Network housed at the World Health Organization in the Department of Sexual and Reproductive Health and Research. Her current portfolio includes institutionalizing the role of IBP to support the dissemination and use of evidence-based interventions and guidelines, to strengthen the linkages between IBP field-based partners and WHO researchers to inform implementation research agendas and foster collaboration among the 80+ IBP member organizations. Prior to joining WHO, Nandita was a Senior Advisor in the Office of Population and Reproductive Health at USAID where she designed, managed, and evaluated programs in West Africa, Haiti and Mozambique. Nandita has a MPH from the Johns Hopkins School of Public Health and a DrPH in Prevention and Community Health from the George Washington University School of Public Health.

Kristen Little, PhD

Sr. Strategic Research Advisor, PSI

Kristen Little, PhD, is a Sr. Strategic Research Advisor at Population Services International (PSI) and lead of PSI's work on the Research for Scalable Solutions project.

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