East Africa: Services and Supply
Increasing Access to Family Planning through In-Reaches
An in-reach is a high-impact intervention used to increase access to family planning services in health facilities that have inadequate capacity for the provision of services.
In-reaches utilize skilled service providers from within and outside the facility to provide family planning services to clients with a focus on Long-Acting Reversible Contraceptives (LARCs). It also provides an avenue for staff undergoing mentorship to build their capacity on LARCs. The in-reach is a single-day event (conducted for one day) with prior mobilization.
Why In-Reaches Are Important in Provision of Family Planning Services
Benefits for family planning clients:
- Enables clients to access Long-Acting Reversible Contraceptives (LARCs) and permanent methods in a facility that routinely does not provide these services, removing the need for referral on the same.
- Increase method mix for clients seeking services within the health facility.
Benefits of Conducting an In-reach
- Opportunity for on-site mentorship of staff with inadequate LARC skills
- Increased access to free/affordable quality FP services among the underserved opportunities to integrate FP and other RH-related services
Evidence
- The number of clients served per day during family planning in reaches was 5.5 higher than on the routine fee-for-service basis, with 6 new clients and 21 existing clients
Familiale, A. P. L. P. Innovative Strategy to Increase Adherence to Family Planning (FP) in Mauritania. Project Summary, (10).
Guidance on Organizing In-Reaches
At Facility Level
- Select health facilities where the in-reaches will be conducted based on demand for FP and skills gap amongst service providers
- Ensure the availability of commodities at the facility
- Sites within a certain geographical area are mapped and linked to an appropriate referral center (usually a higher-level health facility) where major and minor complications can be handled on and as-needed.
- Facility to place a poster /notice in places where clients frequently see, such as the maternal child health department, outpatient, the gate, and public areas including market places. Indicating the services which will be offered, the date and time.
- Select the team(s), ideally comprised of healthcare providers with at least
- Competent and trained in the provision of LARC
- Mentees who are already undergoing on-site mentorship
- Service providers to offer other services including counseling
At Community Level
Use CHWs/CHPs/VHTs to:
- Mobilize clients at least at least 2 days before and on the day of the in-reach as CHWs/CHPs/VHTs can integrate the mobilization with other household visits.
- Publicize the events through the use of posters at the community and facility level, door-door, word of mouth, community announcements using megaphones, announcing on radio shows, community dialogues, community action days and gatherings, and consider the use of drama
- Give referral notes to clients who are sent from the community to help account for the effective referrals.
During the In-Reach
- The facility team sets up and offers services. Register clients and get informed consent.
- When the clients arrive, conduct group health education followed by individual counseling before a client uses a method. Use the MEC wheel when the client is choosing a preferred method.
- Ensure adequate commodities and supplies are in place to cater for the demand and increase method mix.
- The team lead assigns roles to healthcare providers based on the number of service delivery points and services being offered.
- Subsequently offer the method of choice to clients while adhering to the quality standards.
- Monitor the client post-procedure and provide a return date.
- After each event, fill in the relevant MoH daily activity register and summarize the information in an appropriate summary tool at the end of each day.
- Conduct the family planning in reach quality assessment checklist where applicable.
- Ensure all checklists/tools/forms for assessment and mentorship are in place.
- Conduct a post-in-reach review meeting to inform future planning.
Onsite Mentorship
- During the in-reach, the team mentors service providers at the facility who first observe the LARC skills, and then perform the services under supervision
- Each service provider being mentored has a Mentee Log Book where the mentee records each skill observed and performed
- The facility team keeps a log of each mentee’s progress and quarterly gives the MOH a list of mentees ready for assessment and certification
- Supportive supervision is provided to the mentees an ongoing basis
Tips
- Conduct a dialogue before the in-reach
- During team selection priority should be given to nurses/midwives
Key Outcomes for In-Reaches
- Increased access to family planning
- Improved family planning method mix especially LARCs
- Increased number of health care providers with the capacity to offer LARCs
Monitoring Processes
- Uptake of FP services at in-reaches
- Method mix during in-reaches
- Number of providers mentored during the on-site mentorship during the in-reach
- Quality of FP services
Success Indicators
- Improved method mix
- Improved access for FP services
Costs
- Transport refund and lunch for the CHVs/VHTs/CHWs lunch for mobilization
- Lunch/transport for health providers
- Allowances and transport for mentors
- Mentee refreshment
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