MSH Hosts Dialogue on Effective Health Systems for Family Planning at International Family Planning Conference, Kampala, Uganda

On November 16, 2009, MSH gathered leading family planning and reproductive health experts for a lively roundtable discussion on how to build effective, integrated health systems that provide universal access to family planning and reproductive health services. The event, “A Dialogue on Effective Health Systems for Family Planning,” capped off a busy first day of the International Family Planning Conference in Kampala, Uganda. 

Six Building Blocks of an Effective Health System
Sallie Craig Huber, MSH’s Global Lead for Results Management, began the discussion with an overview of the six building blocks of an effective health system: leadership, management, and governance; health services delivery; pharmaceutical management; human resources for health; health care financing; and, health information. 

Facilitating Political Support at All Levels
Dr. Halida Akhtar, MSH’s Global Technical Lead for Reproductive Health and Family Planning, is a reproductive health epidemiologist from Bangladesh who founded and directed a leading reproductive health research institute and directed Bangladesh’s largest reproductive health nongovernment organization (NGO). Dr. Akhtar addressed the challenges of reaching those with unmet family planning needs—those who want to space, limit, or delay births. She said that political commitment is necessary and policy strategies at national, local, and district levels are essential. 

Dr. Akhtar noted the importance of working the political system from top to bottom with all change agents in the government, starting with the Health Secretary and moving down to the local level. Civil society working in partnership with government is especially critical to success. The key message that policymakers need to hear is that family planning saves the lives of mothers and children.

Evidence-based information systems are also needed as are leadership and management programs to supervise, motivate, and mentor providers in order to build robust family planning programs. Female community health workers, in particular, need to be empowered to convince their neighbors of the importance of family planning. And the involvement of women and their stories has proven to be very effective in influencing decision makers.

Reaching Out to Communities
Dr. Fabio Castano is the Technical Director of the Extending Service Delivery (ESD) Project, which is extending family planning and reproductive health services around the world and is developing models for integrated services. Dr. Castano discussed the MSH approach of working with local partners to understand and address gaps in family planning services. 

Dr. Castano explained the importance of reaching out to communities—beyond health facilities—to gain Ministry of Health support for community-based health workers who can greatly enhance the contraceptive prevalence rate in their communities. He underscored the importance of leadership and management and of creating local champions for family planning, as well as working with religious leaders to better reach communities. He discussed the key role of NGOs in extending family planning and reproductive services in Latin America by filling in gaps when funding has been scarce to governments. 

Dr. Castano also noted that working with socially responsible corporations in the private sector can help support the case for stronger family planning. He described how the ESD project, for example, had developed family planning messages and projects to reach out to men in the workplace. 

Critical Role of Community Health Workers
Dr. Douglas Huber, a consultant with more than 30 years of experience in designing, implementing, and documenting family planning and reproductive health programs in 41 countries, discussed the challenges of delivering family planning services in conflict situations, namely in Afghanistan. He described results from a new study that showed the critical role of community health workers in increasing contraceptive rates and how they overcame myths and misconceptions about family planning methods. 

In Afghanistan, community health workers were given the same information about side effects and trained in use of condoms, injectables, and pills, resulting in a 24-37 point increase in the contraceptive prevalence rate in a challenging conflict region. Dr. Huber stated this was an extraordinary success. The Ministry of Health initiated a nationwide scale-up of the project, utilizing MSH staff already in the country, resulting in a contraceptive prevalence rate increase from 26 to 40 in just one year.

Dr. Huber described a new paradigm of talking about safety and effectiveness of contraceptives in order to overcome the fears of such use. He noted that one in eight women die in pregnancy in Afghanistan and that pregnancy is 300 times more dangerous than using pills/injectables.  

Leaders Working together to Embrace a Challenge
Dr. Abdo El Swasy, an obstetrician and gynecologist, who facilitated the launch and scale-up of MSH’s Leadership Development Program (LDP) in Aswan, Egypt, which led to a dramatic reduction in maternal mortality, described how leaders used a challenge model facilitated by MSH to visualize change that was needed for improving maternal and child health indicators—decreasing maternal mortality and ensuring safe motherhood. Once leaders embraced their challenge, together identified obstacles, and developed and implemented an action plan, maternal mortality decreased from 85/100,000 to 35/100,000.

Raising the Profile of Family Planning
Suggestions from audience members on how to improve a systems approach to family planning included the necessity of bringing in additional sectors, including agriculture, transportation, and education, to raise the level of attention to family planning as was done for HIV & AIDS. The important role of communications and social economic messages in conveying community needs to the Ministry of Health was noted. Messages should address family planning as a national crisis, as was done to elevate attention to HIV & AIDS. Most importantly, for family planning efforts to be successful, health systems need to use messages that promote the vision of a healthy future for children.

MSH is committed to supporting the emerging movement to reposition and integrate family planning and reproductive health among the core health interventions in global health. Through health systems strengthening, building leadership capacity at all levels, with a particular focus on the community, MSH is working to ensure healthier outcomes for women and children.

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