How strong are Malawi’s family planning programs for adolescent and adult women? Results of a national assessment of implementation strength conducted by Malawi’s National Evaluation Platform

Chipokosa, Samuel; Pattnaik, Anooj; Misomali, Amos; Mohan, Diwakar; Peters, Michael A.; Kachale, Fannie; Ndawala, Jameson; Marx, Melissa A.

doi:10.7189/jogh.09.020901

Cited by 7 publications

(12 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Two recent reports further highlight this problem. A study from Malawi found that only 29% of health surveillance assistants had the family planning methods they were supposed to have in order meet their clients’ needs [ 59 ]. In Kenya, only 6% of CHWs had all of the job aids and tools specified in the national guidelines for their maternal health activities [ 60 ].…”

Section: Resultsmentioning

confidence: 99%

Community health workers at the dawn of a new era: 9. CHWs’ relationships with the health system and communities

LeBan

Kok

Perry

2021

Health Res Policy Sys

View full text Add to dashboard Cite

Background This is the ninth paper in our series, “Community Health Workers at the Dawn of a New Era”. Community health workers (CHWs) are in an intermediary position between the health system and the community. While this position provides CHWs with a good platform to improve community health, a major challenge in large-scale CHW programmes is the need for CHWs to establish and maintain beneficial relationships with both sets of actors, who may have different expectations and needs. This paper focuses on the quality of CHW relationships with actors at the local level of the national health system and with communities. Methods The authors conducted a selective review of journal articles and the grey literature, including case study findings in the 2020 book Health for the People: National CHW Programs from Afghanistan to Zimbabwe. They also drew upon their experience working with CHW programmes. Results The space where CHWs form relationships with the health system and the community has various inherent strengths and tensions that can enable or constrain the quality of these relationships. Important elements are role clarity for all actors, working referral systems, and functioning supply chains. CHWs need good interpersonal communication skills, good community engagement skills, and the opportunity to participate in community-based organizations. Communities need to have a realistic understanding of the CHW programme, to be involved in a transparent process for selecting CHWs, and to have the opportunity to participate in the CHW programme. Support and interaction between CHWs and other health workers are essential, as is positive engagement with community members, groups, and leaders. Conclusion To be successful, large-scale CHW programmes need well-designed, effective support from the health system, productive interactions between CHWs and health system staff, and support and engagement of the community. This requires health sector leadership from national to local levels, support from local government, and partnerships with community organizations. Large-scale CHW programmes should be designed to enable local flexibility in adjusting to the local community context.

show abstract

Section: Resultsmentioning

confidence: 99%

Community health workers at the dawn of a new era: 9. CHWs’ relationships with the health system and communities

LeBan

Kok

Perry

2021

Health Res Policy Sys

View full text Add to dashboard Cite

show abstract

“…The ISA does not capture quality of care received; for instance, even if a health facility has a high IS score, its health workers could be providing poor quality care in person to the client. Still, capturing structural quality is important and the indicators are often more easily measurable [1,2,7,10]. There could also be more ways to combine information across content and health system levels that were not explored in this study.…”

Section: Discussionmentioning

confidence: 99%

“…In 2017, as part of the National Evaluation Program (NEP), the National Statistics Office (NSO) of Malawi conducted an ISA to understand the intensity of implementation of their national family planning program [10]. Studies similar to this type of evaluation, where the output of multiple programs rather than a single one is evaluated were reviewed to inform the design of this evaluation [5,6,11,12].…”

Section: Introductionmentioning

confidence: 99%

From raw data to a score: Comparing quantitative methods that construct multi-level composite implementation strength scores of family planning programs in Malawi

Pattnaik

Mohan

Zeger

et al. 2021

Preprint

Self Cite

View full text Add to dashboard Cite

Background: Data that capture implementation strength can be combined in multiple ways across content and health system levels to create a summary measure that can help us to explore and compare program implementation across facility catchment areas. Summary indices can make it easier for national policymakers to understand and address variation in strength of program implementation across jurisdictions. In this paper we describe development of an index that we used to describe the district level strength of implementation of the Malawi national family planning program. Methods: To develop the index, we used data collected during a 2017 national, health facility and community health worker Implementation Strength Assessment survey in Malawi to test different methods to combine indicators within and then across domains (4 methods: simple additive, weighted additive, principal components analysis, exploratory factor analysis) and combine scores across health facility and community health worker levels (2 methods: simple average and mixed effects model) to create a catchment area-level summary score for each health facility in Malawi. We explored how well each model captures variation and predicts couple years protection and how feasible it is to conduct each type of analysis and the resulting interpretability. Results: We found little difference in how the four methods combined indicator data at the individual and combined levels of the health system. However, there were major differences when combining scores across health system levels to obtain a score at the health facility catchment area level. The scores resulting from the mixed effects model were able to better discriminate differences between catchment area scores compared to the simple average method. The scores using the mixed effects combination method also demonstrated more of a dose and response relationship with couple years protection. Conclusions: The summary measure that was calculated from the mixed effects combination method captured the variation of strength of implementation of the Malawi national family planning program at the health facility catchment area level. However, the best method for creating an index should be based on pros and cons listed, not least, analyst capacity and ease of interpretability of findings. Ultimately, the resulting summary measure can aid decisionmakers in understanding the combined effect of multiple aspects of programs being implemented in their health system and comparing strengths of programs across geographies.

show abstract

“…Additionally, the tool was adapted to the Malawi context. A more indepth description of the study and tool can be found in Chipokosa et al [27].…”

Section: Tool Developmentmentioning

confidence: 99%

Testing the validity and feasibility of using a mobile phone-based method to assess the strength of implementation of family planning programs in Malawi

Pattnaik

Mohan

Chipokosa³

et al. 2020

BMC Health Serv Res

Self Cite

View full text Add to dashboard Cite

Background: To effectively deliver on proposed objectives, it is vital that practitioners, policymakers, and other stakeholders are able to clearly understand how strongly their large-scale program is being implemented. This study sought to test the feasibility, cost-effectiveness, and validity of a phone-based method as an innovative and cost-efficient approach to assessing program implementation strength (through an Implementation Strength Assessment-ISA), alternative to the traditional in-person field methods. Methods: We conducted 701 mobile phone and 356 in-person interviews with facility in-Charges and two types of community health workers who provide family planning services in the Dowa and Ntcheu districts in Malawi. Responses received via the phone interview were validated through in-person review of records and inspections. Sensitivity and specificity were calculated to determine validity. Results: Most indicators at the health facility and community health worker levels were above a 70% threshold for sensitivity. However, there were fewer indicators that met this threshold for specificity. The primary reason for lower specificity was due to poor recordkeeping. Collecting data via mobile phone was found to be feasible and twice as cost-efficient as collecting the same data via in-person inspections. Conclusions: The rapid increase in mobile phone ownership and network availability in lower income countries could offer an alternative, cost-effective avenue to collect data for a better understanding of program implementation. Through rigorous assessment, this study found that using mobile phones could be a low-cost alternative to collect data on health system delivery of services, especially in places where routine data quality is poor and traditional, in-person methods are costly.

show abstract

How strong are Malawi’s family planning programs for adolescent and adult women? Results of a national assessment of implementation strength conducted by Malawi’s National Evaluation Platform

Cited by 7 publications

References 19 publications

Community health workers at the dawn of a new era: 9. CHWs’ relationships with the health system and communities

Community health workers at the dawn of a new era: 9. CHWs’ relationships with the health system and communities

From raw data to a score: Comparing quantitative methods that construct multi-level composite implementation strength scores of family planning programs in Malawi

Testing the validity and feasibility of using a mobile phone-based method to assess the strength of implementation of family planning programs in Malawi

Contact Info

Product

Resources

About