Ten Good Practices in Essential Supplies for Family Planning and Maternal Health

"The worldwide trend toward smaller families - average family size has declined by half since 1950 - is linked to advances in education and health care and increased opportunities for women. This great global success story can continue only if access to family planning continues to grow worldwide."

The strategic support to voluntary family planning through the Global Programme to Enhance Reproductive Health Commodity Security (GPRHCS) is described through examples of activities in countries participating in the programme as of 2011. The aim of this United Nations Population Fund (UNFPA) programme of reproductive health commodity security (RHCS) is to support countries in ensuring that all individuals can obtain and use affordable, quality reproductive health supplies of their choice whenever they need them. Examples are included from Burkina Faso, Ecuador, Ethiopia, Lao PDR, Madagascar, Mongolia, Mozambique, Nicaragua, Niger, Senegal, and Sierra Leone. For UNFPA, the GPRHCS is the main channel for providing technical and financial assistance for family planning.

Contents include the following:

• Reaching Underserved Communities
  • Opening doors to family planning in remote, ethnic households of Lao PDR through trained "community-based distribution agents" (CBDs) - Agents belong to the communities, speak the same language, and share social norms - described as a culturally-appropriate approach. As an evaluation measure, 324 clients had used services at district hospitals and health centres in February 2011, while 557 clients went to CBDs in February 2012. 
  • Schools for Husbands engage men in reproductive health and family planning in Niger - Following a communication campaign - an information, education and communication (IEC) campaign with peer training centred around a series of radio sketches called 'The Adventures of Foula' - created by non-governmental organisation (NGO) Animas-Sutura, the country then initiated the Schools for Husbands, which creates a place of discussion, decision making, and action for the emergence of husbands as responsible actors in their own development. To provide support, two local NGOs supervise each school. "One NGO is specialized in capacity building and community work and is in charge of the 'coach' - a leader responsible for 10 to 12 schools. The coach also assists the group in developing an action plan and monitoring its progress. To facilitate this work, UNFPA Niger and its partners have developed a monitoring journal (cahier de suivi)." The second NGO brings technical reinforcement by providing counseling and information on RH services through a local health agent, midwife, or religious leader. "Significant results have been documented: (1) behavioral change among men, from conservative attitudes to involvement and commitment of men in favor of reproductive health with better dialogue, listening and understanding of health issues observed since the husbands have joined the School for Husbands; (2) improvements in RH indicators, e.g. the RH indicator on post-natal consultations in the Bandé community in Zinder increased from 13 per cent in the first trimester of 2009 to 40 per cent in 2011; (3) results beyond initial objectives including construction of public lavatories for health centres, construction of houses for midwifes to allow better RH services, and participation of members in sensitization during vaccination campaigns and other health activities. "
  • Bancada Feminina (Women’s Caucus or Female Stand): A space to address family planning and empowerment in Mozambique - Young female coordinators are trained in human rights, sexual reproductive health, and other social areas related to women. They facilitate the meeting forums as safe places for women to discuss sensitive issues surrounding RH.
  • Bajenu Gox ‘godmothers’ offer reproductive health information to younger women in Senegal - It is based on "traditional values around the involvement of the paternal aunt in monitoring a pregnant woman and the mother-child pair, a tradition of solidarity where the older women assist the younger women with health care. This aunt is represented in the strategy by women community leaders who serve as godmothers of women in their neighborhood or village during pregnancy, childbirth and postpartum."
  • Multimedia campaign raises awareness and creates demand in Burkina Faso - Through community theatre, film, TV, and radio, this campaign reached an estimated audience of 60 percent of the population with family planning messages. The 2008-2011 multi-media campaign "promoted reproductive health information and services in all regions, especially rural areas, with films aired at community meetings, national radio broadcasts, and television coverage and community theatre. Promotional materials were widely distributed, including posters, leaflets, image boxes, and calendars." A press caravan covered four regions of the country, reaching administrative, traditional, and religious authorities and the general public with messages on reproductive health through reporters from TV, radio, and newspapers who participated in the caravan. "This programme also provided community leaders with an opportunity to directly address the public and highlight the good news that, overall, indicators of family planning were improving." In addition, advocacy meetings on family planning were facilitated by the Association of Religious and Traditional Leaders of Burkina Faso. In a similar vein, the Burkina Faso Muslim Population and Development Organization network implemented advocacy activities to gain the attention of preachers, imams, and Muslim women. New contraceptive methods users increased 26.5 percent in the second quarter of 2011 compared to the same period in 2010. In addition, "capacity development activities include training of staff at more than 200 service delivery points in forecasting and procurement, and training of district health practitioners in every region on the use of computerized logistics management information system to avoid supply stock-outs. CHANNEL software entered the final stages of rollout across all of Burkina Faso’s health regions and districts and regional and national hospitals in 2010."
• Strengthening Supply Management
  • A commitment to a stronger system for a secure supply of RH commodities in Madagascar - Computerised health supplies management was instituted for the period 2008-2012, using CD-ROMs when internet connections were not available and CHANNEL software. The Minister of Health reported improvement in medication quality and availability through improved stock management, transport, and human resource training.
  • Pharmacy curriculum teaches how to avoid shortages in family planning supplies in Mongolia - "Training in reproductive health commodity security is now part of the School of Pharmacy’s curriculum at the Health Sciences University of Mongolia (HSUM)....The percentage of service delivery points offering at least three modern methods of contraceptives increased from 93.5 per cent in 2010 to 98.2 per cent in 2011. Those offering five life-saving maternal and reproductive health medicines increased from 76.8 per cent in 2010 to 86.8 per cent in 2011."
  • Building the training capacity of the public health and pharmacy schools in Ethiopia - The School of Public Health faculty decided to develop a curriculum on RHCS that the School would use as a component of its longer diploma courses as well as short courses. Faculty from the School of Public Health and School of Pharmacy drafted the curriculum.
  • Sierra Leone improves accountability & access with civil society monitors, community advocates - The Health For All Coalition, a civil society organisation (CSO) is part of an independent monitoring and evaluation system to reduce drug theft and improve availability. The effort enhances the government’s computerised system to track and manage essential supplies and to support its Free Health Care Initiative for pregnant women and children under five. "At the same time, Community Action Groups are working to increase demand and ensure that the strengthened supply chain reaches a growing community of receptive women and families." These Community wellness Advocates are "often powerful and respected women such as traditional birth attendants and female FGM/C [female genital mutilation/cutting] initiators.... These women become agents of social change to empower communities, given additional training in a range of sexual and reproductive health and gender issues."
• Mobilising Political Will and Financial Resources
  • Evidence-based advocacy wins support for family planning at the highest levels in Ecuador - "Ecuador’s comprehensive, human rights perspective has allowed UNFPA to support government and civil society initiatives in advocacy, spokesperson preparation, improvement of reproductive health services and strengthening of informed demand."
  • Advocacy strategy for political and financial commitment to RHCS in Nicaragua - According to this document, family planning has improved with community distribution of reproductive health commodities, and maternal health has improved with increased skilled birth attendance. The process began with forming an RHCS Committee in 2005, signing an agreement between UNFPA and  the government in 2007 and, subsequently, signing of a Joint Financing Arrangement (JFA) Memorandum of Understanding by development partners and the government.
  • Leaders from 12 countries share good practices at the first UN High Level Meeting on RHCS in 2011 - "The event included four panel discussions, plenary sessions, presentation to the UNFPA Executive Board and a Call to Action that voluntary family planning, secured by a steady supply of contraceptives, is a national priority for saving women’s lives."