East Africa Toolkit: Services & Supply
An integrated family planning outreach is a health service delivery activity done in the community away from the facility with the aim of bringing contraceptive services closer to the community. The services are provided at the community level within locally available venues, such as schools, social halls, workplaces, community grounds, markets and religious facilities, etc. targeting both the men and women of reproductive age.
This animated video describes the steps for conducting an integrated outreach.
The TCI Tutorial below features a webinar held in October 2019 to explain what an integrated outreach is, as well as considerations for holding a successful one.
Why Is Integrated Family Planning Outreach Important?
- Increase access to contraceptive services among the under-served urban population.
- Reduce barriers and associated indirect costs of accessing services at the health facilities by bringing them closer to the community, in areas where facilities are far away or where there are negative attitudes towards the health facilities.
- Serve as opportunities for closer interaction between heath facility staff and the community. Such interactions foster community dialogue and assist to initiate community action.
- Provides an opportunity for provider-initiated counselling for contraceptive services including for couples.
- Reduces the missed opportunities for other reproductive health services due to integration.
According to the program data, between July 2018 to December 2022, 534,007 family planning users have been reached with contraceptives from an integrated outreach. Of these, 57% (305,856) represent adolescents and youth (15- to 24-years-old) and 47% (253,633) obtained a long-acting and reversible contraceptive (LARC).
The breakdown of family planning users reached by integrated outreaches by country for the same time period is:
- In Kenya, 81,503 family planning users were reached via integrated outreaches. Fifty percent (41,097) were adolescents and youth and 37% (30,970) took up a LARC method.
- In Uganda, 200,658 family planning users were reached through 1,464 integrated outreaches. Fifty-four percent (108,824) were adolescents and youth and 46% (92,539) of the total reached took up a LARC method.
- In Tanzania, 251,846 family planning users were reached through 2,254 integrated outreaches. Sixty-one percent (155,935) were adolescents and youth and 51% (130,124) took up a LARC method.
Integrated outreaches ensure that potential family planning users are counseling and have access to the full basket of method choices as illustrated in the bar chart below.
Guidance: How to Conduct Integrated Family Planning Outreach
- Review the data to identify gaps in the catchment area to determine:
- Need for family planning and other MNCH services in areas with low coverage
- Types of services to be offered during the outreaches
- Involve the local government health managers, implementers and teams involved in mobilization activities while scheduling dates for the outreach. Seek all necessary statutory approvals and permits that are required from relevant government agencies before conducting mobilization activities.
- Conduct pre-outreach meetings with key stakeholders to effectively plan for the outreach. Ideally, all integrated outreaches should be planned and managed strategically to avoid interfering with facility and other routine operations.
- Prepare and avail adequate supplies, commodities and equipment for the outreach based on services to be provided. FP commodities and expendable supplies for outreach services need to be projected, quantified and procured in advance and should be part of the routine supplies for health facilities. Resource planning for outreaches need to be done at least three months prior to the activity.
- Plan to conduct the outreach for 2 days depending on the FP demand in the area.
- Mobilize communities for 2 to 4 days, including the outreach days, to be ready for the services. Use community health workers, the door-to-door approach, posters and flyers and announcements during community gatherings for community mobilization. Where budgets allow, announce on radio or TV to expand reach. This will ensure that the targeted communities are aware of the services to be offered. Mobilize the special groups including the youths, and people living with disabilities to be ready for services through the use of established groups, like the male champions, religious/key opinion leaders and youth community health assistants etc.TIP: During mobilization consider using what is locally available and acceptable, i.e., community radio, mega phones, etc.
- Identify and prepare the community venue that will host the outreach in collaboration with all stakeholders, ensuring cleanliness and safety. The venue should ideally be centrally located and easily accessible to community members. Use health wagons, where available, to enhance privacy and enable provision of services that require a high degree of infection prevention. Remember to adhere to COVID-19 protocols at all service delivery points in the facility.
- Identify competent staff with support from the local Health Management Teams (HMTs) to conduct integrated family planning outreach services.
- Ensure quality service provision during the integrated family planning outreaches. This can be supported by the available outreach quality checklist.
- On the day of the integrated outreach, ensure that all the relevant staff are aware of their roles and duty stations, easy registration and retrieval of records and short waits (and swift referral when necessary). Maximize the day through integrating other related health services, such as child health, cervical cancer screening, prostate cancer screening, HIV testing and counseling, immunization and de-worming, without losing focus on family planning. The extent of integration is dependent on available resources (staff, supplies and commodities). It is advised to include at least 3 to 4 integrated services in one outreach.
- Where several stakeholders are involved, it is advisable that providers from local government carry out the actual implementation and service delivery while stakeholders provide technical assistance and resources.
- Ensure emergency Outreaches offer multiple health services and as such outreach teams need to be prepared to manage basic medical emergencies.
- Documentation of the service statistic data is done in the relevant primary MOH data collection tools (e.g. family planning registers) for reporting and review of outreach outcome.
- Conduct post-outreach meeting to evaluate the outreach and use the outcome for future planning.Where several stakeholders are involved, it is advisable that providers from local government carry out the actual implementation and service delivery while stakeholders provide technical assistance and resources.
- Use of the Provider Initiated Family Planning (PIFP) job aid to ensure that clients coming for integrated services do not miss an opportunity for family planning. The number of clinical and community staff participating in integrated outreaches needs to be rationalized based on the scale of the integrated outreach.
- All integrated outreaches should be planned and managed strategically to avoid interfering with facility and other routine operations.
- Mobilize youth to be ready for services through the use of established youth groups and youth community health assistants.
- Improved FP method mix
- Increased uptake of FP/contraceptive services (i.e., client volumes)
- Reduced sexual and gender-based violence (SGBV) in that community after understanding importance FP
- Reduced number of myths and misconception around FP services at community level
- Better client engagement with enhanced provider-initiated FP
- Improved male engagement in provision of FP services
- Increased number of referrals for long-acting permanent methods (LAPM)
- Monitor the level of integration to assess the extent of integration of services during outreaches.
- Monitor the quality of integrated services through laid-down structures. (Use outreach quality list, ensure privacy, confidentiality and infection prevention procedures are followed.)
- Conduct post-outreach meetings to review quality and operational issues that may have arisen.
- Monitor the level of family planning commodities and expendable supplies expended and remaining from the integrated outreach.
- Ensure data from the outreach has been captured in the in the right tool (Kenya – MOH 512, Uganda – FP integrated 074, Tanzania – MTUHA No 8).
- Percentage of new FP/contraceptive acceptors from integrated outreaches
- Proportion of clients reached through outreaches with other integrated services
- Proportion of health facilities conducting outreach
- Percentage of new users receiving LARCs
- Proportion of Adolescents and Youth reached in the outreaches
- Number of LAPM clients referred
- Transport allowance to the outreach venue for the health workers and mobilizers (CHV/CHW/VHT)
- Lunch allowance for the community mobilizer (CHVs, CHWs, VHTs), health care providers, activity supervisor, driver
- Coordination airtime
- Fuels costs
Resources needed to conduct an integrated outreach are listed in the outreach guidelines.
- Consistent advocacy with city stakeholders to provide resources for outreach services.
- Inclusion of integrated outreach activities in geography work plans, strategic policies and guidelines and allocating budget for these activities.
- Ensure planning, management, coordination and implementation of outreach activities are led by the geography health staff.
- Cost reduction can be achieved through cost-sharing among stakeholders and leveraging of community resources such as venues, community staff and local leaders and structures for mobilization assists to minimize costs.
- Work with community gatekeepers to strengthen the community referral and linkages for outreach processes.
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Outreaches in Action
Other East Africa Program Areas