Postpartum family planning integration with maternal, newborn and child health services: a cross-sectional analysis of client flow patterns in India and Kenya

Abstract

ObjectivesMaternal, newborn and child health (MNCH) services represent opportunities to integrate postpartum family planning (PPFP). Objectives were to determine levels of MNCH–family planning (FP) integration and associations between integration, client characteristics and service delivery factors in facilities that received programmatic PPFP support.Design and settingCross-sectional client flow assessment conducted during May–July 2014, over 5 days at 10 purposively selected public sector facilities in India (4 hospitals) and Kenya (2 hospitals and 4 health centres).Participants2158 client visits tracked (1294 India; 864 Kenya). Women aged 18 or older accessing services while pregnant and/or with a child under 2 years.InterventionsPPFP/postpartum intrauterine device—Bihar, India (2012–2013); Jharkhand, India (2009–2014); Embu, Kenya (2006–2010). Maternal, infant and young child nutrition/FP integration—Bondo, Kenya (2011–2014).Primary outcome measuresProportion of visits where clients received integrated MNCH–FP services, client characteristics as predictors of MNCH–FP integration and MNCH–FP integration as predictor of length of time spent at facility.ResultsLevels of MNCH–FP integration varied widely across facilities (5.3% to 63.0%), as did proportion of clients receiving MNCH–FP integrated services by service area. Clients travelling 30–59 min were half as likely to receive integrated services versus those travelling under 30 min (OR 0.5, 95% CI 0.4 to 0.7, P<0.001). Clients receiving MNCH–FP services (vs MNCH services only) spent an average of 10.5 min longer at the facility (95% CI −0.1 to 21.9, not statistically significant).ConclusionsFindings suggest importance of focused programmatic support for integration by MNCH service area. FP integration was highest in areas receiving specific support. Integration does not seem to impose an undue burden on clients in terms of time spent at the facility. Clients living furthest from facilities are least likely to receive integrated services.

Integration of HIV and reproductive health services in public sector facilities: analysis of client flow data over time in Kenya

“…This predated the Integra Initiative (often through widespread PMTCT initiatives funded by the US Government) and remained evident in most facilities—both intervention and comparison—by the final round. These findings are consistent with the patterns of integration documented via CFAs in Swaziland, 22 Kenya and India, 27 in which child health, ANC and FP offered the best opportunities for integration with HIV, and HIV-PNC integration was observed least often. The collection of data at six time points in this analysis, versus only three time points in Swaziland (and one time point in the cross-sectional study conducted in India and Kenya in 2014 27 ) allowed for more detailed observations over time, including the initial, short-term boost that would have been missed in Swaziland.…”

“…Considerable variation across facilities was also observed in CFAs in India and Kenya. 27 The Integra case study analyses 12 draw on multiple methods, including qualitative and context data to explore the interactions of structural factors and ‘people’ factors (also called ‘health systems software’) that influence integrated service delivery. Findings from the case studies suggest that although structural factors like stock-outs, distribution of staffing and workload, and rotation of staff can affect how integrated care is provided, all these factors can be influenced by staff themselves: both front line and management.…”

What mechanisms drive uptake of family planning when integrated with childhood immunisation in Ethiopia? A realist evaluation

“…This realist evaluation sought to identify key mechanisms driving the implementation of an intervention of integrated childhood immunisation and FP services in BGRS, Ethiopia. It contributes to a growing body of literature that seeks to understand uptake of MCMs when FP services are integrated with other health services (7)(8)(9)(23)(24)(25)(26). Recent studies from Rwanda, Zambia, and Ghana have looked speci cally at the integration of FP with immunisations services and have found varying levels of success (7)(8)(9).…”

What mechanisms drive uptake of family planning when integrated with childhood immunisation in Ethiopia? A realist evaluation

“…In this realist evaluation, we sought to identify key mechanisms driving the implementation of an intervention of integrated FP services and child immunisations in BGRS, Ethiopia. This evaluation contributes to a growing body of literature that seeks to understand uptake of FP when FP services are integrated with other health services (7)(8)(9)(26)(27)(28)(29). Recent studies from Rwanda, Zambia, and Ghana have looked speci cally at the integration of FP with immunisations services and have found varying levels of success (7)(8)(9).…”