India Toolkit: AYSRH Demand Generation

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Priority Strategies for Improving Contraceptive Use Among First-Time Parents

Purpose: This tool is an approach to reach first-time parents (FTPs) through frontline health workers or Urban Accredited Social Health Activists (ASHAs) to increase correct knowledge on modern contraceptive methods and improve contraceptive use among them.

Audience:

  • Additional Director/Joint Director/Divisional Program Manager
  • Chief Medical and Health Officers (CMHO/CDMO/CMO)
  • Chief Medical Superintendents (CMS)
  • Divisional Urban Health Consultant
  • Nodal Officer-Urban Health, Family Planning, Rashtriya Kishor Swasthya Karyakram (RKSK)
  • Urban Health Coordinator/Assistant Program Manager, NUHM
  • Medical Officer In-Charge

Background: The National Family Planning Health Survey (NFHS 4, 15-16) provides a growing body of evidence that the age group with the lowest contraceptive prevalence rate are married women between 15-29 years of age, more specifically young married first-time parents. This age group of 15-29 years face a unique set of challenges different to those faced by older married women with regards to accessing and availing family planning services.

Evidence of Impact

The Challenge Initiative for Healthy Cities (TCIHC) experience from five cities (Firozabad, Varanasi, Gorakhpur, Allahabad, and Saharanpur) revealed that when ASHAs are coached and mentored to periodically update urban health index register (UHIR), segregate and list women based on age and parity, they are able to prioritize young and low parity women, specifically first time parents for family planning. This practice also aids to maintain a registry of young married first-time parents (FTPs) 15-24 years, and prioritize the category for household visits. The coaching enables them to easily identify FTPs with an unmet need for FP methods and counsel them to avail family planning services on FDS days/Antaral diwas.

The strategy is showing promise as data from a population level survey among FTPs from the five AYSRH intervention cities indicate a 17% increase in modern contraceptive prevalence rate (mCPR).

Figure 1: Findings from two-rounds of Population based survey conducted by TCIHC

[1] TCIHC conducted two rounds of population based output tracking survey between September 2018 and September 2019.

Guidance on Scaling Up This Intervention

The following steps can facilitate a successful scale up of FTP interventions in a state:

Roles and Responsibilities

Role
Responsibility
Additional Director/Joint Director/Divisional Program Manager
  • Include FTP as an agenda in the NUHM/FP review/Divisional review meeting.
  • Review the progress of work for FTP in NUHM/FP review meeting/Divisional review meeting.
  • Issue guidance to all the cities to refer this FTP tool as one of the guidance documents to increase improved contraceptive use among FTPs.

CMHO/CDMO/CMO

 

  • Participate/ensure participation in the CCW.
  • Issue a directive to UPHCs to conduct WSO.
  • Issue a directive to designate one FDS for FTPs.
  • Proactively plan and organize FDS for FTPs by taking all necessary measures into account in the district.
  • Post assessment of FTP FDS results, issue a directive to UPHCs to withdraw special FDS and entertain FTPs in routine FDS/Antral diwas.
  • Issue directive to train facility staff on service provision and counselling on all methods.
  • Proactively engage with DQAC for quality assurance of UPHCs.
  • Monitor quality and outputs of each FDS for FTPs.
CMS 
  • Establish FDS/ FPD teams.
  • Supervise facility readiness.
  • Ensure that informed choice and method-specific counseling is done as per guidelines.
  • Ensure that clients are appropriately screened. In case, they are not eligible for their preferred method, clients should be counseled about other appropriate contraceptive alternatively.

 

Nodal Officer-Urban Health and FP

 

  • Lead in planning and organizing FDS for FTPs in the district.
  • Lead in organizing WSO for all UPHCs.
  • Manage the FDS/ FPD operations including team deployment and logistics.
  • Coordinate and oversee all quality parameters and work as an interface between district leadership and facilities.
  • Ensure smooth supply of commodities and supplies.
  • Monitor quality of FDS for FTPs and ensure data validation and reliability of collected data.
Medical Officer-In-Charge 
  • Develop FDS/FPD calendar.
  • Ensure supplies and commodities for FTP-FDS day and Supervise facility readiness.
  • Provide FP job aids, IEC material, supplies to ASHA.
  • Inform ASHA on the FTP-FDS schedule.
  • Release timely payment of ASHAs.
  • Ensure that clients are appropriately screened and that staff nurse offers informed-choice-counseling as per the government norms.
  • In case the client is not eligible for their preferred method, counsel them on other appropriate contraceptive alternatives.
  • Ensure that methods are provided with appropriate quality of care including recommended infection prevention practices.
  • Monitor the quality of FDS/FPD services and ensure correct reporting in HMIS.
ASHA, Mahila Arogya Samiti (MAS), NGO, Outreach Workers
  • Generate awareness and mobilize clients for family planning through home visits and group meetings.
  • Prepare prioritized client list and reach them before each FDS/FPD.
  • Use IEC materials to provide information to young adolescents and influencers about family planning and specific contraceptive methods.
  • Support post-procedure follow-up of clients.
  • Mobilize FTPs to avail FP services on special FDS/routine FDS or Antral diwas days.

Monitoring Benchmarks

  1. Number of FTPs identified by ASHA
  2. Number of FTPs reached by ASHA
  3. Number of FDS for FTPs organized
  4. Contraceptive uptake by FTP in each of the facilities
  5. Number of WSOs organized
  6. Number of meetings organized to influence non-users by users
  7. Number of one-to-one meetings with FTPs to brief them about benefits of family planning methods
  8. Number of FTPs reached in routine FDS/Antral diwas days after withdrawal of special FTP FDS

Cost Elements

The elements required for ‘reaching FTPs and improving their contraceptive behavior’ are mentioned below along with their Program Implementation Plan (PIP) codes for easy reference. They may be covered under existing budget line items, but if not, they should be incorporated through the PIP in the next cycle. Besides, any additional support can also be sought from the flexi-pool.

Cost elements/PIP budget head FMR code
Demand generation, strengthening service delivery 1.1.3.2.1; 3.2.1
IEC, Mid Media, Mass Media 11.6.1; 11.6.3; 11.6.4; 11.6.5; 11.6.6
Inter personal communication U.11.3; 11.6.2
Necessary Kits, surgical equipment and supplies U.6.1.1 & U.6.1.2; 6.1.1.3.a till 6.1.1.3.f
Printing of FP manuals, guidelines 12.3.1 till 12.3.5
Training & capacity building, additional manpower U.8.1.8.1.2; U.9.5.1 till U.9.5.8; 3.1.2.5; 9.5.3.1; 9.5.3.1 till 9.9.3.27
POL for family planning/others (including additional mobility support to surgeon’s team if required) 2.2.1
Drop-back scheme 7.3
Quality assurance U.16.2.1; U 13.1.1 & U.13.2.1

Source: NHM PIP Guideline, 2018-19

Note – The table above is indicative and illustrates the manner in which cost elements are provided in a government PIP, thus giving guidance on where to look for elements related to a particular task.

Sustainability

Family planning demand among FTPs can be sustained by linking them regularly with routine FDS/Antral diwas after withdrawal of special FTP-FDS and ensuring all providers of the facility and community regularly provide family planning services to young FTPs. Moreover, the rising demand among FTPs for family planning services will sustain this approach.

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