Family Planning Module: 2. Family Planning Service Delivery and Programme Management

Door-to-door service delivery

A door-to-door service providing family planning packages at household level is carried out by Health Extension Practitioners. The service includes education, counselling and the provision of contraceptive methods, such as oral pills, condoms and injectables. This approach started with the establishment of the Health Extension Programme and has been cost-effective, and the preferred way to reach the majority of people in their homes.

Facility-based service delivery

A facility-based service delivery approach provides family planning services in Ethiopia through public health centres and hospitals. The major advantage of using this approach is that it can provide medically complex methods, such as IUCDs, hormonal implants and sterilisation. This approach works well for those living close to any of these health facilities.

Community-based distribution (CBD)

In areas that do not have any type of health facility nearby, family planning services may be made available through community-based distribution or CBD programmes. In this approach, CBD workers, usually village women, are trained to educate their neighbours about family planning and to distribute certain contraceptives.

In their training, the CBD workers learn the basic concepts of family planning, how each method must be used, what the precautions and side effects are for each method, and how to keep simple records and report the information to their supervisors. CBD programmes usually distribute condoms; some also provide pills and spermicides. In Ethiopia, this programme has now been replaced by the Health Extension Programme.

Commercial retail sales

In both urban and rural areas, if people are willing to obtain contraceptives from sources outside the healthcare system, commercial retail sales (sometimes called social marketing) can make some contraceptive methods very accessible. In these approaches, contraceptives, such as oral contraceptive pills, condoms and injectables, are sold at reduced, subsidised prices in pharmacies, from market stalls, and so on.

A good example of this is DKT-Ethiopia. When a commercial retail sales approach is used, the retailers are often the customers’ only source of information about the products. These retailers should be given training in basic information about the products, and how to refer people who have problems with a contraceptive.

Other delivery methods

A number of other service delivery methods have been used. Some companies provide family planning services during certain hours at the workplace. Although generally at a higher cost, family planning services are often available from private for-profit healthcare providers. Other approaches involve training paramedics, pharmacists, traditional birth attendants, midwives, traditional healers and outreach workers to provide family planning services.

Strategic (long-term) plans

A strategic plan is a well-developed document that determines what an organisation intends to be in the future, and how it will get there. It is the process by which the organisation assesses its current situation and decides how to scale up to achieve its vision. Strategic planning is the way in which it directs its efforts and resources towards what is truly important for the sector. Strategic planning is carried out at all levels.

Annual (work) plans

Work plans (also known as operational plans) are distinguished from long-term plans in that they show how the broader objectives, priorities and targets of the strategic plan will be translated into practical activities, which will then be carried out over a much shorter time period (anywhere from a week to a year). However, there should be complete harmony between the strategic objectives and the annual targets.

Cascading objectives

Definitions of objectives and targets

Although there are many definitions for objectives and targets, for the purposes of this discussion and the examples shown here, the distinction between objectives and targets is defined as follows.

An objective shows the anticipated results of the work conducted at one or more service delivery sites, and reflects the impact or changes that are expected in the population covered by this programme. Objectives should be SMART (see Box 2.2). and refer to the measurable results that are expected in a designated population within a specified period of time Usually there will be several objectives relating to one programme goal.

Targets

Targets restate programme objectives for service delivery workers in numerical terms. They state the expected results and/or the intended activities of each service delivery component of the programme over a short time period, such as a quarter (three months), one month, or a week. Look at Box 2.3 for some examples of set targets. Keep in mind that targets serve three major purposes:

• Planning a programme.
• Motivating staff towards achievement.
• Guiding the monitoring and evaluation process.

Developing monthly work plans

Monthly work plans should be developed and used at all levels of a programme or organisation. They are particularly useful for Health Extension Practitioners and supervisors. The activities in work plans are based on the annual plan, which has been developed at woreda level, but also includes more detailed information on activities, such as which villages and households are to be visited, the timing of these visits, and the dates of the supervisory visits, holidays, self-assessment sessions and training.

Summarising activities in a Gantt chart

Once the work plan is completed, it is important to draw up a summary chart. This provides an important reference which can be used by all staff members, and communicates in a concise way what the project will do and when it will do it. This summary is called a Gantt chart and you can see an example in Table 2.1.

A Gantt chart typically includes the following components:

• A column that lists major activities.
• Columns that mark a fixed period of time (days, weeks, months, years), showing when the activities will occur.
• A column that lists the person or people responsible for completing the activity.

Monitoring

Monitoring is a process by which priority data and/or information is routinely collected, analysed, used and disseminated to see progress towards the achievement of planned targets. This helps the managers take timely corrective actions in order to improve performance. It includes monitoring of inputs, outputs, outcomes and impacts of health programmes, including family planning. The most common form of monitoring is often based on input and output indicators using routinely collected service data. Monitoring of outcomes and impacts, on the other hand, requires the collection of target population level data, and for this reason is done at a higher level and for fewer selected priority areas only.

Monitoring consists of these components:

Routine data collection and aggregation (combining data from different sources) is the means by which routine service data is collected, aggregated, analysed and made ready for further performance monitoring.

Performance monitoring is the continuous tracking of required information on conducted activities and its indicators of success, in order to identify achievement gaps and lessons learnt. At all levels, performance monitoring will be based on the developed annual plan. The routine data collection and aggregation process provides a summary of performance data. Based on agreed Health Management Information Systems (HMIS) performance indicators, the performance monitoring committee will review the adequacy of achievements against the annual targets on a regular basis.

At all levels, performance monitoring will be conducted regularly on a weekly, monthly, quarterly and annual basis, supplemented by semi-annual and annual review meetings. With regard to family planning, you need to know what has to be monitored and how — you can refer to national HMIS technical guidelines.

In Box 2.4 you will find generic performance indicators of family planning. These may be different in your locality, but you can compare these with your own.

Supportive supervision (SS) is a process of guiding, helping, training and encouraging staff to improve their performance in order to provide high-quality health services through the use of integrated SS tools. A supervision session will include review of programme implementation at kebele level.

Evaluation

Programme evaluation is the systematic process of data collection, analysis and interpretation of activities and the effects of a programme, or any of its components. Programme evaluations may be either process evaluation, which examines the appropriate execution of programme components, or outcome evaluation, which examines the benefits of implementing an intervention or any of its components.

Record keeping and reporting

Record keeping and reporting is one way that an organisation can keep track of patterns of contraceptive use amongst its clients. Keeping records and preparing and analysing reports are effective ways to determine clients’ needs and their use patterns, without doing a formal programme evaluation. Good examples of this are stock on hand (by method and brand), and consumption/distribution (by method and brand), both of which can be easily collected and analysed on a routine basis. This information can be collected by using simple HMIS records, forms and reports (for details, refer to National HMIS technical guidelines).

Types of recording forms

Inventory control card (ICC): This form should be kept at all storage facilities that manage a significant number of inventory items. The purpose of the ICC is to have an up-to-date and continuous record, in one location, of all transactions for each item in the inventory (refer to HMIS forms).

Daily activity register (DAR): The register is designed to be used when contraceptives are dispensed to family planning clients. It provides a daily log of the number of client visits, subdivided by the types and quantities of contraceptives dispensed to each client on a monthly basis. When a new month begins, service providers should begin a new DAR. The DAR should be totalled on a monthly and quarterly basis (refer to HMIS forms).

Quarterly report/requisition: This form serves several purposes. It provides summary information from the DAR and ICC concerning the number and types of clients served, and quantities of each type of contraceptive received and dispensed over a three-month period (refer to HMIS forms).

Inventory control system

The average monthly consumption (AMC) is equivalent to one month’s supply. It is usually the monthly average of the quantity of that product that has been dispensed to users during the past three or six months. Information on the quantities dispensed is taken from the DAR or summary reports of dispensed-to-user data (see Figure 2.1).

Figure 2.1  Worksheet for calculating average monthly consumption (AMC)

Assessing your supply status

To make sure your supplies are adequate, do the following calculation for each of your contraceptive products:

This calculation will tell you how long your current supply will last if consumption stays at the current rate. If the months of supply in your stocks are less than the time remaining before your next delivery of supplies, then you may need to arrange for an emergency delivery (see Table 2.2).