Addressing Challenges in Family Planning and Reproductive Health during COVID-19
Insights from the 2021 Learning Circles sub-Saharan Africa Cohort
ROSES, BUDS, AND THORNS
Participants split into five sub-topic groups (self-care, access and quality, gender-based violence, policy and advocacy, and supply chain) to discuss roses (positives), buds (opportunities), and thorns (challenges) around working in FP/RH during COVID-19.
access & quality
policy & advocacy
Effective advocacy can push for the scale up of technological innovations.
A major barrier is ensuring quality services (eg, adherence to safety protocols) given that self-care is new to clients, there is limited infrastructure to support remote mentorship for clients, and there are low literacy levels among certain populations. Another barrier during COVID-19 is inadequate commodities and stocks-outs of self-administered methods due to increased demand for them.
Click on the sub-topics and hover over the icons to see the roses, buds, and thorns
Get the Resource
ACCESS & QUALITY
POLICY & ADVOCACY
Integrate with existing structures (eg, Ministry of Health, Ministry of Education) that can support technology access.
Mobilize community volunteers to share information on self-care and distribute self-care commodities.
Train health workers to minimize stigma and discrimination when youth seek family planning services.
The series introduced participants to the 15% Solutions approach to reflect on manageable actions they could achieve with the resources at hand. Participants then had rapid consultations with one another on their solutions and shared feedback, advice, and lessons learned. More time would have allowed for further refinement of the proposed solutions.
In May–July 2021, family planning and reproductive health (FP/RH) professionals based in sub-Saharan Africa convened virtually for the first Knowledge SUCCESS Learning Circles cohort. Through monthly Zoom sessions, interim activities, and WhatsApp chats, participants shared personal experiences around what’s working and what isn’t working in their countries. The topic focus was implementing FP/RH programs within the context of COVID-19. Scroll down for an overview of key insights from the series.
policy & advocacy
The COVID-19 pandemic highlighted the need to find innovative strategies to providing family planning services, including the promotion of self-administered contraceptives to prevent pregnancy, such as self-injectables, oral contraceptives, and condoms.
Countries are seeing an increase in access, uptake, and continuation of self-care methods, especially for youth and other marginalized populations during the pandemic, thanks to technology advancements, such as innovations in telemedicine and use of electronic platforms.
access & quality
People’s family planning needs don't stop in emergencies. To meet people’s family planning needs during the COVID-19 pandemic, access to high-quality family planning information, counseling, and services must be ensured.
Persistent barriers to family planning access include certain cultural and social norms, poor integration of CHWs in the health system, and skills gaps among health workers. New barriers posed by COVID-19 include limits imposed on household visits and frequent client interactions.
Support task sharing by training others to provide family planning services and ensure continuity of services during the pandemic, including deeper engagement of CHWs (maximize their role). In addition, take advantage of self-administered contraceptive methods and leverage technology.
Governments are committing to create an enabling environment for family planning through supportive policies. Strategies to increase access to family planning include integrating family planning with other health services and promotion of self-care methods. In addition, more reporting from stakeholders has been useful for decision making.
Restricted movement and economic and social stress resulting from the pandemic increase the risk of gender-based violence (GBV) and make it harder for those in need to access GBV response services.
Overall, there has been a rise in GBV during COVID-19 with restricted movement and fewer community meetings. Challenges include patriarchal culture, values, and beliefs, increased family socioeconomic stress from the pandemic, along with stigma, and unsupportive policy environments and decision-makers. Survivors do not receive justice through the “kangaroo court” system that favors subjective justice involving families and bribes rather than objective, structural justice in the courts.
Opportunities exist to promote comprehensive sexuality education for youth, garner youth champions at the grassroots level, enlist men and boys as social allies, promote self-care, strengthen online reporting, form civil society coalitions, and connect with religious leaders.
Virtual community sensitization and capacity building of decision-makers, availability of hotlines, peer-to-peer services, a one-stop-shop GBV center, quick win advocacy training, and gender action plans have helped improve access to GBV response services.
FP/RH advocates have been working diligently to inform local and national governments of policy changes needed to ensure continuity of family planning services during the pandemic.
Ministries of Health haven't
created enough awareness on the revised policies in the COVID-19 era and implementation at sub-national levels was slow because attention was diverted to Covid-19 response and prevention measures like lockdowns, restriction of movements, and curfews. In addition, there have been limited advocacy interventions, very little engagement online, and difficulties in fast-tracking progress online.
Stakeholders have an opportunity to learn from each other, and we can take advantage of low-cost advocacy initiatives that don't involve physical meetings.
Countries developed guidelines to sustain continuity of FP/RH care during COVID, and many supportive FP/RH policies are currently in place including briefs on COVID-19. In addition, partnerships have been cultivated among a range of stakeholders in different countries.
COVID-19 has created significant disruptions to public health supply chains, but available data indicate that many countries have adapted to the crisis and have been able to resume operations through mitigation strategies.
Restrictive laws/policies still exist (eg, youth access to family planning) and change takes time. Financial, human, and programmatic resources have been strained, diverted, or eliminated due to COVID interventions. Supply chain issues are very specialized and complex, with fewer experts. In general, there has been information overload related to COVID-19, and finally patients’ fear of infection can limit access to family planning services even if movement restrictions are not in place.
Identify actors pushing out supply chain lessons from COVID adaptations, leverage private clinics, and partner with FBOs and CSOs. Rural areas still have limited access to FP. Finally, this Learning Circles group may lead to connections between FP/RH professionals and solutions.
Family planning is increasingly understood to be a “best buy” in development and evidence exists for integration of family planning into other sectors and systems. Governments ramped up efforts to secure contraceptive supplies and delivery and to pay attention to the full supply chain during COVID-19, prompted in part from advocacy by CSOs. In addition, awareness of digital tools is growing.
Participants grouped their Roses, Buds, and Thorns into Affinity Clusters to explore key themes.
As a sub-group, participants developed a problem statement for the group to address based on themes that emerged around the positives, opportunities, and challenges.
ACCESS & QUALITY
POLICY & ADVOCACY
Hover over the boxes below to view the problem statements
How might we support women and girls with limited access to technology to benefit from self-care?
How might we reimagine responsive spaces for adolescents and young women to access FP during and after COVID-19?
How might we strengthen policies to avoid systems and services failure in GBV to provide equitable services?
How might we strengthen the advocacy capacity of health advocates and organizations to assess policy options, set goals and activities, and develop SRH/FP strategies for advocacy impact?
How can we create stronger (effective and efficient) FP supply systems that can still function during emergencies (e.g., pandemics)?
Hover over the pins to learn more about each participant
38 FP/RH professionals from 11 countries in sub-Saharan Africa
MEET THE PARTICIPANTS
Grace Wairimu Gichuna
Technical Advisor, Palladium-Health Policy Plus
To find out more about Learning Circles
Reproductive Health Advisor,
Uganda Protestant Medical Bureau
Coordinator Woman's Health Program,
Cameroon Baptist Convention Health Services
Emmanuel Odeke Okallany
Senior Family Health Advisor,
FP Program Manager,
Study Manager, Centre of Infectious Diseases and Research in Zambia
Ethiopia/Kenya Country Manager, International Youth Alliance for Family Planning
Dr. Isaac Theuri
Senior Program Manager, RMNACH,
Advocacy Technical Manager, Johns Hopkins Centre for Communication Programs
Ngong Justin Chee
Co-Founder and Program Lead,
Youth 2 Youth
Assistant Programs Officer,
The Centre for the Study of Adolescence
Technical Advocacy Advisor, Jhpiego Kenya
Senior Program Manager SRHR,
Save the Children International, East and Southern Africa
Community Engagement Manager, Options Consultancy Ltd
Aisha Sani Faruk
State RH/FP Coordinator,
Kano State Ministry of Health
Health Division Lead,
Corona Management Systems
Medical Officer, Technical Support to Primary Care Health Facilities, Western Cape Department of Health, South Africa
Advocacy and Partnerships Officer,
Foundation for Male Engagement Uganda
Provincial FP Coordinator, USAID SAFE
Sakina Amin Bello
Ephraim Kumi Senkyire
Ga West Municipal Hospital-Ghana Health Service
Case Management Officer, Public Health specialist, UCAHAEC
FP/RH Specialist, USAID
Clinton Health Access Initiative
Jean Yves NTIMUGURA
Gender and SRH Advisor, EngenderHealth
Action 4 Health Uganda
Program Manager, HealthRight International- Kenya
Jane Amanda Mweziwina
Plan International Malawi
Youth Focal Point,
Family Planning Advisor, GIZ/Healthfocus
Dr. Moses Macheka
Director Technical Services/Medical Officer,
Zimbabwe National Family Planning Council
Youth Coordinator, HealthRight Family Health Options Kenya
Think about budget for technology access and consider girls in rural areas who don’t have access to technology.
Think about how to find and select community volunteers and how to ensure the training is efficient
Implement peer-to-peer support.
Think about how to deal with different age groups to ensure age-appropriate information and services are provided; Think about how to ensure reporting within the government structures is being captured.
ACCESS & QUALITY
Take services to adolescents’ safe spaces where they meet for social activities or where they can easily access.
Engage youth constantly to get their advice on how best to provide services based on changes in events/environment/humanitarian event.
Training should include "values classification" and needs to be experiential. For example, incorporate an icebreaker that asks the participants to remember what they felt like when they were 14 years old. Changing health workers’ attitudes and behaviors will require more than "training," e.g. managers need to model acceptable behavior, rewards should be given for those who are "youth-friendly."
Take into consideration ethical and cultural issues in Africa setting. This would require a lot of community engagement activities. In my experience where I’m working, parents may become skeptical.
YES!!! And include them not just in advising, but also in the design and implementation of the service. Also ensure that their engagement is meaningful and that they are supported by adults to contribute in spaces that are normally dominated by adults (e.g., meetings).
Have a strategic meeting with core actors who are representative at all levels to get their buy-in and ownership.
Improve awareness of the rights and responsibilities around GBV.
Translate policy into action. Disseminate policy to grassroots. Put a policy item into a supervisory checklist.
Identify the role of leadership and managerial skills in GBV.
Identify those who work within GBV and think about what capacity building might be needed. Also, ensure that following up with leaders in GBV work does not create complications and bureaucratic bottlenecks so that the work is stalled and impacts the lives of those facing violence.
Disseminate policy in accessible ways; train community members for ownership.
Improve awareness at and through schools, community groups, religious organizations, talks, print, and digital media; ensure everyone knows their roles in GBV prevention at all levels of the work that needs to be done.
Think about how to identify core actors; need for several meetings, not just one, especially in restricted times with no movement.
POLICY & ADVOCACY
Develop a simple scorecard for measuring progress and setting next goals.
Map and strengthen the capacity of key advocacy champions to assess policy options and set goals and activities on SRH/FP strategies.
Mobilize resources to fund actionable in-country advocacy strategies.
Include the specific indicators to be measured by the scorecard.
Develop an action plan to know the amount of resources required, include the person/entity responsible for resource mobilization, and indicate whether lack of resources is the only issue.
Make clear who will do the mapping and capacity building of key advocacy champions and in which geographical locations this exercise will take place. Make the solution more “SMART” (Specific, Measurable, Achievable, Realistic, Timely) by providing specific details on the number of advocates, organizations, country, types of skills/capacities, and a proposed timeline.
Review the WHO health systems strengthening guidelines to refresh my understanding of systemic change.
Advocate for budgeting for buffer stocks to cater for periods when supply gaps are experienced.
Strengthen capacity on health care commodity security in relation to supply chain management, particularly accurate reporting and data for decision making.
Tap RHSC resources and assess learning from new digital systems (e.g. cSTOCK); strengthen capacity across the health workforce, including deeper linkages with emergency cadres; at a recent webinar, pharmacist in Uganda shared a success story with making adaptations to the Central Medical Store
Focus advocacy efforts on finance and planning departments and press for consistent FP allocations and contingency funds; use FP forecasting data to inform advocacy objectives; identify “opposition” and try to address their interests; join other global and local groups/initiatives with similar goals
Ensure the global health systems strengthening principles align with local context and learn from other sectors’ experience with this work.
(Click to explore solutions and feedback)
(Hover over the grey feedback squares)
To close out the series, each participant committed to take an initial action step within the next week to address a personal work challenge. These specific, short-term commitments focus participants to take immediate action on an urgent issue within their unique context.
Reconnect with community leaders.
Map out stakeholders that are key to policy.
Share resources to support this cohort.
Share a summary brief of the plan.
Join my organization's community of practice on crisis response.
Share learnings and experience gathered from this cohort with my colleagues.
Check out MCI.org and WHO’s implementation stories in the IBP network.
Involve community leaders.
Draft a clear work plan.
Reach out to FHI 360 for resources on adolescent and youth reproductive health and economic empowerment and develop a summary of solutions from it.
Redesign the CHW data collection and reporting tool.
Share and plan some solutions with my local team.
Involve self-injection champions.
Learn more about SRH and GBV services, especially during COVID era.
Revive the youth advocates group and promote linkages with organizations outside school.
Mobilize more local organizations to influence the Ministry of Public Health to integrate adolescent and youth reproductive health in mainstream clinical care in my country.
Mobilize adolescents in my community for positive behavior change.
Hover over the avatars to see some of the key benefits participants gained through the Learning Circles experience
"The fact that likeminded people from different parts of the continent can come together to share common knowledge and best practices in area of SRH/FP."
"Eye-opener discussion, especially around policy."
"The experience was necessary for my career growth and it made me think out of the box to improve on my services and increase access too."
"I liked the Rose-Bud-Thorn activity for a comprehensive problem analysis, 15% solutions and the networking session."
"I made the commitment to develop a policy brief highlighting gaps in supply chain management for reproductive health commodities in my country."
"Most of the discussions in the small groups came from people's experiences and were very useful to my work."
"I will be able to implement the solutions to my small group challenge in my own work."
"The sessions were very participatory and built on the knowledge that participants have."
Nearly 70% of respondents said they were “very likely” to stay in touch with or connect with a new colleague met through Learning Circles.
Nearly 80% of respondents said they were “very likely” to use one or more of the KM techniques in their own work.