Family Planning Integration

• Family planning could prevent up to one-third of maternal deaths by allowing women to delay motherhood, space births, avoid unwanted pregnancies and unsafe abortions, and stop having children when they have reached their desired family size.
  Carr, B., Gates, M. F., Mitchell, A., & Shah, R. (2012). Giving women the power to plan their families. The Lancet, 380(9837), 80-82.
• Interventions to integrate FP and HIV services have reported positive outcomes, including increases in voluntary contraceptive use or increases in completed referrals from HIV services to family planning clinics 
  Wilcher, R., Hoke, T., Adamchak, S. E., & Cates Jr, W. (2013). Integration of family planning into HIV services: a synthesis of recent evidence. Aids, 27, S65-S75.
• Results from a five-year research initiative that evaluated four different models of integrated sexual and reproductive health (SRH) and HIV services in “real-world” settings in Kenya, Malawi, and Swaziland confirmed an existing unmet need for SRH services among women living with HIV (including family planning), and found that integrated services can help women realize their fertility intentions and meet their contraceptive needs
  Integra. (2013). Making sense of complexity: key findings from the Integra Initiative. Integra Newsletter, 1-4

Important steps to follow during facility integration for family planning:

• Carry out initial assessment and identification of areas of integration using agreed-upon criteria. The criteria for selecting facilities should focus on institutions that have shown some level of preparedness and readiness in terms of space availability, equipment, and staffing in delivering services, information, and counseling. Identify Important areas to offer family planning services like; Antenatal, Child Welfare (immunization, sick/well baby clinic), Postnatal, Outpatient clinic, HIV/ART clinic In-patient clinical services, Labor ward, Postnatal ward, Obstetrics and Gynecological ward and Mothers in the Children’s ward.
• Build the capacity of service providers on FP. Technical service providers are expected to carry out family planning integration as per the national guidelines. Consider offering regular training and skills updates or mentorships to help increase competence and confidence of the providers in delivering quality services. See Whole Site Orientation and Onsite Mentorship.
• Determine levels of integration based on the graph above considering the infrastructure, equipment, supplies, and staffing to determine the optimal level of integration.
• Introduce Provider Initiated Family Planning (PIFP) to both clinical and non-clinical staff. This process is recommended to assist both the health provider and clients identify unmet needs for family planning.
• Use information, Education & Communication (IEC) materials to provide family planning information, counseling, and FP method provision.
• Ensure necessary arrangements are in place for referral and linkage where services cannot provided within the same setting
• Equip the integration service areas with relevant equipment, stationery, IEC/job aids, FP commodities/supplies, referral tools, and documentation tools. Needs will vary by integration level. (Note: Refer to country-specific MoH tools)
• Brand/Name the service delivery areas to inform clients on the availability of family planning services.
• Ensure documentation of all services provided (e.g., information, counseling, referral, and FP method) at the integration service area. Use existing tools such as FP registers, referral, and integration summary tools. Consolidate and report the data from the integration area using existing reporting channels.

Useful Tips

• Facilities that are at a higher level and high volume will have more potential integration areas.
• Out-of-facility services should also be integrated with FP.

 
• Increased number of facilities offering integrated family planning services per service delivery point
• Increase number of service delivery points (SDPs) offering FP in a facility
• Increased proportion of family planning acceptors from integration points

• Number of HFs with functional FP integration areas
• Number of clients served at various SDPs with FP
• Number of HCP trained and offering FP at various SDPs

• Cost of conducting whole site-orientation on family planning.
• Cost of conducting mentorship
• Cost of materials for integration (IEC materials, job aids, data collection tools, referral booklets, summary books)
• Cost of family planning equipment, and commodities e.g., IUCD and implant with their sets

• Continued capacity building within the facility for integration of FP services
• Scale up FP integration policies and guidelines in facilities