Insights from the 2021 Learning Circles Asia Cohort

What Works and What Doesn’t for Ensuring Continuity of Essential FP/RH Services During Emergencies

WHAT’S WORKING WELL

Participants used the knowledge management techniques “Appreciative Inquiry” and “1-2-4-All” to reflect on exceptional project experiences that ensured continuity of essential FP/RH services during an emergency, including the conditions that made the experience possible.

Click the icons below to explore the participants’ responses about common factors that contributed to ensuring continuity of essential FP/RH services during emergencies, particularly during the COVID-19 pandemic.

WHAT COULD BE IMPROVED

To address challenges or setbacks in ensuring continuity of essential FP/RH services during emergencies, we used the peer-to-peer knowledge management approach “Troika Consulting.” In groups of three or four, participants took turns describing a challenge that they are currently experiencing in their projects and programs, while their fellow group members offered advice and solutions.

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In November-December 2021, family planning and reproductive health (FP/RH) workforce members based in Asia convened virtually for the third Knowledge SUCCESS Learning Circles cohort. Through weekly Zoom sessions and WhatsApp chats, participants shared personal experiences around what’s working and what isn’t working in their countries. The topic focus was ensuring continuity of essential FP/RH services during emergencies.

Participants considered two guiding frameworks to structure their discussions on Essential FP/RH Services During Emergencies.

Minimum Initial Service Package (MISP) for Sexual and Reproductive Health

WHO’s definition of emergency

Hover over the boxes below

To ground the discussions and clarify that emergencies can encompass natural disasters, human-made disasters, crises, or pandemics, participants reviewed WHO’s definition of emergency:

Participants also reviewed the role of the Minimum Initial Service Package (MISP) for Sexual and Reproductive Health (SRH), developed by the Interagency Working Group (IAWG) on Reproductive Health in Crises. The MISP is a set of priority SRH activities to be implemented at the onset of an emergency, with Objectives 5 and 6 of the MISP holding particular relevance for the Learning Circles discussion:

Hover over the pins to learn more about each participant

28 FP/RH workforce members from 8 countries in Asia (Bangladesh, Cambodia, India, Indonesia, Myanmar, Nepal, Pakistan and Philippines)

MEET THE PARTICIPANTS

Learn more about Learning Circles

Arefa Hossain Antora Bangladesh Manager Urban Family Planning Services, Pathfinder International

ACTION PLANNING: COMMITMENT STATEMENTS

Participants developed commitment statements to express immediate action steps, which are practical and realistic, that they will strive to take in order to address their individual challenges related to ensuring continuity of essential FP/RH services during emergencies.

PARTICIPANT FEEDBACK

GUIDING FRAMEWORKS

Hover over the avatars to see some of the key benefits that participants gained from the Learning Circles experience.

“...Learning Circles widened my horizon, expanded my network and gave me innovative ideas.”

“I learned about new tools.”

“[I liked the] Interaction with other countries and [I] learned new experiences and new facilitation skills. The methodology was fantastic to keep us engaged.”

“It was an effective discussion with different stakeholders and [I] got new ideas [on how] to implement my field of work.”

“I can hear and learn the success stories and difficulties from other countries in the SRH programme and [I also] get suggestions.”

“I wanted to know about different good practices in family planning in the South Asian regionand Learning Circles provided that successfully. I am also grateful to the organizers that they shared platforms like FP insight where like-minded people can sign up and interact with other FP enthusiasts across the world.”

“The Learning Circles helped to develop a network within our region. I may consult with someone [in the future] who is a specialist.”

“I had opportunities to network, to learn, and also [to] reflect on how to work and innovate in the FP sector.”

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Explore the participants’ challenges and suggested solutions below

Training

Community volunteers

Media mix

community-driven approaches

field workers’ houses were used as alternative repositories of contraceptives

FP/RH services continued during the pandemic through innovative community-based and community-driven approaches. For example:

community-driven approaches

MEDIA MIX

Community volunteers

TRAINING

house-to-house delivery of contraceptives

inclusion of the concept of self-care in trainings given to public and private healthcare providers

creating special SRH satellite clinics in refugee camps

local NGOs providing consultation and basic FP/RH services

Community volunteers (female volunteers, community health promoters, youth) were mobilized to provide FP/RH services, disseminate FP/RH information, or collect essential FP/RH data (e.g., engaging young people using digital apps to provide comprehensive FP/RH information).

Health service providers benefited from training on government’s emergency protocols, such as the MISP for COVID.

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Download our practical how-to guide on applying the knowledge management tools and techniques used in the series.

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Explore the FP insight cohort collection to discover resources related to the theme of Essential FP/RH Services During Emergencies

This interactive synthesis report is made possible by the support of the American people through the United States Agency for International Development (USAID) under the Knowledge SUCCESS (Strengthening Utilization, Capacity, Collaboration, Exchange, Synthesis, and Sharing) project. Knowledge SUCCESS is supported by USAID's Bureau for Global Health, Office of Population and Reproductive Health and led by the Johns Hopkins Center for Communication Programs (CCP) in partnership with Amref Health Africa, The Busara Center for Behavioral Economics (Busara) and FHI 360. The content of this webpage is the sole responsibility of CCP. The information provided on this webpage does not necessarily reflect the views of USAID, the U.S. Government, or Johns Hopkins University.

Dr. Farhana Huq Bangladesh Regional program manager, Pathfinder International

Khandoker Abu Jafor Md. Saleh Bangladesh Senior Communication Specialist, Bangladesh Center for Communication Programs

Syed Abul Farah Bangladesh Project Coordinator, ActionAid Bangladesh

Sam Ol Channa Cambodia Technical Advisor for QI/Health System Strengthening, Enhancing Quality of Healthcare Activity (EQHA) project/FHI360

Abhinav Pandey India Coordinator, Policy Working Group, The YP Foundation

Dr. Aakash Shinde India Senior Program Officer, Jhpiego

Priti Chaudhary India National Program Officer, Jhpiego

Sarah Tanishka Nethan India Lead, Family Planning & Reproductive Health, Vihara Innovation Network

Sheetal Kandola India Project Manager, GIWA

Dewa ayu putu Mariana Kencanawati Indonesia Lecturer, Kupang Health Polytechnic

Jum’atil Fajar Indonesia Medical Care Manager, RSUD dr. H. Soemarno Sosroatmodjo Kuala Kapuas

Thiri Kyaw Myanmar Program Officer, Clinton Health Access Initiative

Jessica Thapa Nepal Senior Project Officer, Family Planning Association of Nepal

Kewal Shrestha Nepal Program Manager, Association of Youth Organisations Nepal

Narayani Tripathi Nepal Program Officer (Youth and CSE), Family Planning Association of Nepal

Pankaj Bhattarai Nepal Family Planning Program Officer, United Nations Population Fund (UNFPA) Nepal

Sujit Kumar Sah Nepal M&E Manager, ADRA Nepal

Dr. Suman Rawal Nepal Technical Advisor-Health, ADRA Nepal

Afshan Ameen Pakistan Technical Lead, Operational Research Project on DMPA SC (SI), Jhpiego

Dr. Aisha Fatima Pakistan Senior Program Manager SRH/FP Programming, Jhpiego

Ehtesham Abbas Pakistan Director Programs and Operations, Center for Communications Programs Pakistan

Madiha Latif Pakistan Senior Program Managers, Pathfinder International

Bernardo Cielo II Philippines Policy & Health Systems Advisor, RTI International (ReachHealth Project)

Caridad Pineda Philippines Project Coordinator, Likhaan Center for Women’s Health

Emilyne De Vera Philippines Project Officer, The Forum for Family Planning

Myra G. Julia Philippines Knowledge Management Specialist, USAID BARMMHealth Project

Common issues

Countries in Asia shared similar issues, such as challenges with prioritizing other health issues alongside COVID-19 and recognizing the benefits of using digital technology during emergencies.

Key themes that emerged included:

Focus on local

The local is the solution (e.g., strengthening local capacity, ensuring local coordination). Focusing on the “local” can help to quickly turn around a problem into a solution during an emergency.

Self-care

The concept of self-care (e.g., for injectables) became important during emergencies.

Human-centered design

Using human-centered design with audience participation and grounding solutions on audience needs are effective ways to develop new solutions.

Low-technology solutions

There is still a need to use low-technology solutions to reach people who have limited or no internet connection.

Adaptations

Critical adaptations to ensuring continuity of services during COVID-19 included engaging community volunteers within the health system, providing them with needed support (e.g., skills, tools, and techniques), and recognizing their contributions to instill a sense of pride for being part of this cohesive group of healthcare workers.

Scroll down for more key insights that emerged from the series.

Objective 5 - Prevent unintended pregnancies

Objective 6 - Plan for comprehensive SRH services, integrated into primary health care as soon as possible. Work with the health sector/cluster partners to address the six health system blocks: service delivery, health workforce, health information system, medical commodities, financing, and governance and leadership.

A type of event or imminent threat that produces or has the potential to produce a range of consequences, and which requires coordinated action, usually urgent and often non-routine. Note: ‘emergency’, is sometimes used interchangeably with the term ‘disaster’ as, for example, in the context of biological and technological hazards or health emergencies…

Coordination/ Collaboration

Knowledge Sharing

use of New Technology

Coordination/ Collaboration

I commit to coordinate with the Family Planning Field Extension Officer to discuss what can be done if a pandemic condition occurs again where the hospital must close the obstetrics and gynecology polyclinic that provides family planning services.

I commit to identifying 5 organizations and/or connecting and collaborating with 2 participants from Learning Circles on exploring how self-care around SRH can be implemented in the Indian context.

I commit to coordinate with 3 different FP leaders from 3 different organizations in my province and discuss the possibility to collaborate.

I commit to identify 5 key organizations that work on youth in my region.

Knowledge Sharing

use of New Technology

I commit to convey messages on gender integrity in FP and youth-led FP services in my territory

I commit to reach out to two leading producers in Pakistan to fund an entertainment education program targeting married couples and youth in Pakistan on FP/RH

I commit to contacting 3 youth leaders/community population volunteers in 2 provinces

I commit to identify and initially engage with 10 volunteer organizations in 2 provinces and 1 city

I commit to share resources within my team and other FP circles

I commit to advocate for inclusion of FP in emergencies in our strategy and to government officials in different forums (as an on-going process).

I commit to use digital solutions to follow up and track FP clients and to minimize drop out and ensure continuity from 1st quarter of 2022 onwards.

Strategy Development

I commit to plan 2 different urban strategies for my region, ensure quality FP services with gender integration in 20 ready-made garments (RMG) factories, and ensure FP awareness messages in 4 urban slum areas including adolescents.

Strategy Development

Situational Analysis

I commit to identify key adolescent health issues by facilitating a one-to-one meeting of STEPS youth advocates with state-level health officials in at least 5 states of India

Situational Analysis

I commit to identify mother and adolescent reproductive health problems by coordinating with the relevant health office in my district

I commit to engage and partner with the Philippine Health Insurance Corporation for data sharing and collaboration in analyzing FP and MNCHN benefits utilization in the Philippines

Adaptations

Participatory approaches

Digital technology

To promote FP/RH services during the pandemic, programs used a mix of modern and traditional media (e.g., through radio, digital technologies, and digital applications such as WhatsApp).

digital technology

Use of digital technology (either developing or using mobile apps; use of tele-health or tele-consulting) ensured adherence to COVID-19 safety protocols between service providers and clients while continuously providing FP/RH services.

Participatory approaches were especially crucial in the fast-changing pandemic environment to ensure programs and services met the needs of community members. Examples included engaging youth in advocacy and policy and strategy reviews in Nepal, engaging young people using digital apps to provide comprehensive FP/RH information in Pakistan, and bringing in the right stakeholders such as youth and other marginalized groups to provide their input.

Participatory approaches

Overall, being open to adapting approaches and ensuring immediate responses were key factors in ensuring continuity of services (e.g., having alternative distribution access points, converting FP trainings into virtual format, creating virtual classrooms for pregnant mothers, having standard practices like MISP in place to facilitate immediate response).

Adaptations

When asked how the FP/RH context in the Asia region might have to change if these exceptional experiences were to become the norm, the participants shared the following insights:

Respect

Providers should always strive to respect the patient’s/ client’s choices. Both providers and clients should be aware of human rights when it comes to FP/RH services.

Confidentiality

FP/RH providers and programs should also improve confidentiality and safety of information being shared by clients, especially by youth and adolescents.

Strategy

Programs should be more strategic rather than reactive to ensure sustainability of successful initiatives (e.g., integrating activities within the social health insurance scheme to ensure that operations will continue even if the emergency ends).

Local planning

Civil society organizations (CSOs) and FP/RH organizations need to be more active and proactive in being involved at the local level planning for FP/RH programs (especially for countries with devolved health systems).

DISRUPTION OF FP/RH SERVICES

SUPPLY CHAIN DISRUPTION

LACK OF HEALTH WORKERS

MALE ENGAGEMENT

LOW PRIVATE SECTOR ENGAGEMENT

TOPICS

(Click to explore challenges and feedback)

LOW COMMUNITY ENGAGEMENT

DATA COLLECTION BURDENS

CHALLENGE

ADVICE

DISRUPTION OF FP/RH SERVICES

SUPPLY CHAIN DISRUPTION

LACK OF HEALTH WORKERS

MALE ENGAGEMENT

LOW PRIVATE SECTOR ENGAGEMENT

LOW COMMUNITY ENGAGEMENT

The closure of the health facilities across countries limited women’s access to contraceptives.

Participants referred back to discussions on exceptional experiences that worked well, for example, leveraging health workers’ houses and other community-level facilities to facilitate service delivery, providing house-to-house FP/RH services, and engaging community-based workers as healthcare assistants (trained non-medical personnel).

Intensify advocacy work, including requesting letters of support from the highest authority for continuity of FP/RH services.

Introduce the concept of self-care (self-injectables) to clients.

Although there is budget to buy FP/RH commodities, stock-outs still happen either due to lockdown/border restrictions or political issues such as the ban from purchasing FP/RH stocks between some countries. Also, stocks were often not distributed to the lowest facility level.

Collaborate between NGOs and development agencies to provide contraceptives and FP/RH supplies to users.

Start a global advocacy that focuses on FP/RH response mechanisms during emergencies (like creation of a facility similar to COVAX Facility but focused on FP/RH supplies and contraceptives)

Promote local manufacturers of contraceptives and FP/RH supplies.

Health workers were diverted to COVID-19 vaccination drives, creating a health worker shortage gap for FP/RH project implementation. Many health workers, including community health workers, became infected with COVID-19 themselves, which also contributed to health worker shortages.

Mobilize community champions to assist with FP/RH project implementation.

Introduce the concept of self-care (e.g., self-injectables) to clients

Use Facebook chat groups to provide health workers updates on FP/RH implementation.

Advocate to the local government units to provide budget and to spearhead the implementation of FP activities, and to recognize health workers and facilities to boost their motivation to work.

Because the government's priority was COVID management and not necessarily SRH there was difficulty in engaging and mobilizing the village councils, mostly composed of men, on SRH.

Invest in Social and Behavior Change Communication (SBCC) in engaging males.

The private sector does not prioritize FP/RH and is also not committed to providing quality FP/RH services.

Advocate to strengthen regulation of the private sector to hold them accountable

Consider creating Public-Private Partnership Guidelines in providing quality FP/RH services such as in India

Due to disruptions in community gatherings, clients often did not know when and where FP/RH services had restarted. Radio was used to reach out to the community but the audience was very small. Using TV is a challenge given the numerous existing channels such as in Bangladesh. Taboos against COVID further affected FP/RH service access. Because schools were closed, reaching youth and newlywed couples on issues of FP/RH and child marriages was difficult.

Use digital applications (e.g., AskNivi ) to engage with the community

Explore who can serve as FP champions in the community to advocate for FP and provide counseling and services. For example, in the Bangsamoro Autonomous Region in Muslim Mindanao (BARMM) in the Philippines, health service providers use their motorcycles to do house-to-house visits to women of reproductive age and give them counseling.

Engage telecommunication companies to send FP messages to people.

Engage Muslim Religious Leaders as an additional arm to disseminate FP messages in the communities.

Use a mix of virtual and face-to-face interactions with the community.

Coordinate with the Head of Education Department and let him/her know the issues at hand (e.g., GBV, increase in pregnancies) and recommend activities to address them despite the pandemic (e.g., formation of Technical Working Group to conduct adolescent camps, out-of-school seminars on FP) so that FP provision will not be hampered among adolescents.

Create social media awareness campaigns

FP/RH services for married adolescents were introduced for the first time in one of the emergency projects addressing floods. However, there are no recording tools available to document age-segregated data and health service providers do not have the skills in monitoring such data. The project provided new recording tools but it was considered an additional burden.

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Integrate new data requirements into existing recording tools to save time.

Explore using Kobo ToolBox, a free open source tool for mobile data collection.

Improve user-interface or user-experience design of the data collection tools

Continue sensitization of service providers and do regular follow-ups with them.

Have regular data audits for proper monitoring and validation.

SENSITIVITIES IN GATHERING FP/RH DATA

DATA COLLECTION BURDENS

SENSITIVITIES IN GATHERING FP/RH DATA

Within a refugee camp context, it was a challenge to find the balance between collecting standard FP/RH data within the host country (such as the couple registration system) and respecting the beliefs and culture of the refugees who find this information taboo and sensitive.

Explore a holistic health approach by linking FP with other health services provided to refugees.

Create a digital database on FP/RH information about the refugees that is coordinated and available for use to all sectors working in refugee camps. This will avoid duplication of data collection and information gathering from the refugees.

Emphasize assurance of privacy and data protection.

Provide refugees with small incentives for participation.

Rogelio C. Diaz, Jr Philippines Managing Director, Advocates for Social Protection, Innovation and Resilient Ecology