Integrated Family Planning Outreaches
What Is an Integrated Outreach?
Integrated outreach provides health services outside of health facilities, especially in hard-to-reach areas or where static centers are unavailable. By taking the services outside the health facilities, service providers can cater to those with unmet needs for family planning, particularly those hindered by accessibility constraints.
The chosen location for integrated outreaches aims to enhance a women's accessibility. Areas with limited coverage and population of marginalized segments are given priority.
In Pakistan, there are two approaches for reaching inaccessible areas:
- Integrated Outreach: also known as 'Satellite camps'; these are conducted in the residences of community health workers (CHWs) or influential figures, such as the head of the village, and integrated with other MNCH services, including nutrition, vaccinations, antenatal and postnatal care and management of other minor ailments such as cough, fever, scabies, etc.
- Integrated Outreach on Wheels: also known as ‘Mobile Outreach Services'; these are executed on vehicles near schools, mosques or surrounding areas where communities can conveniently reach and provide integrated health services. The services include family planning, vaccinations, MNCH services, counseling, child health services, general disease management treatments, etc.
What are the benefits?
- Family planning and other related health services are provided as a package.
- Extends services to hard-to-reach areas and communities, especially for people who face accessibility constraints, such as long distances from facilities, unreliable transportation, etc.
- It also may reduce stigma related to culturally sensitive health services, such as family planning, by offering the services alongside other MNCH services, vaccinations, etc.
How to implement
Step 1: Assess Community Needs, Issues and Resources
This step is critical in planning and identifying which areas have low access to services and what types of services are lacking that can be provided through the two different types of integrated outreach services. One-on-one interviews or focused group discussions with the communities can help identify the facilitators or barriers that should be addressed prior to implementation and what resources are available within the community to support outreach services – whether that is ‘satellite camps’ or mobile outreach services.
In satellite camps, some communities may seek other services beyond family planning and reproductive health (FP/RH), As a result, the Departments of Health and Population Welfare need to review community data and indicators, like the unmet need for FP/RH, MNCH and other health needs, to identify a package of integrated outreach services according to sites that are apropos to people's needs. Proper sites/areas should be prioritized because there are few service delivery centers or facilities. So, the site should:
- Be accessible to the community that it seeks to serve,
- Relatively high population density and
- Have available amenities, such as toilets and clean water.
TCI suggests conducting a mapping exercise to identify women of reproductive age in the community, which may also help determine an ideal location.
Does this happen often? Is this appropriate? Are we saying that FP/RH services can be integrated with emergency services?
Step 2: Identify and Prepare Outreach Site
Selection of the right site for providing outreach services via a satellite camp is essential. It should:
- Be centrally located,
- Provide privacy for clients and
- Meet the storage, hygiene/infection prevention and safety needs for the services being provided and the population being targeted.
Step 3: Maximize Outreach through Service Integration
Integrating and packaging FP/RH services with other related health services, can help generate demand for family planning. However, TCI advises that the number and types of services should be limited and provided based on the availability of trained staff, commodities and supplies at appropriate facilities to conduct outreach activities – whether via satellite camps or mobile outreach services.
During the planning process, consider how to sustain integrated outreach services. For example:
- Conduct advocacy with national, provincial, district, and community stakeholders to ensure resources are allocated and available and that satellite camps or mobile outreach services activities are included in the appropriate budget and plans.
- Allow provincial/district health teams to plan, coordinate and manage integrated outreach activities, using and adapting this tool.
- Use cost sharing to limit the expense of activities for each stakeholder. For example, leverage community and district resources, such as influential figures or CHWs opening their homes and facilities to the community via satellite camps.
Step 4: Collaborate with Provincial, District and Community Health Management Teams
Collaboration with local stakeholders ensures that integrated outreach services – whether via satellite camps or mobile outreach services – are incorporated into annual plans and budgets. If necessary, work with local health officials to gain approval for scheduling outreach activities and permissions for the outreach site. There could be times when an integrated outreach activity needs to be conducted in a military-protected area. Seek approvals from government agencies that manage the environment or local government, depending on the scope of the integrated outreach activities. Planning must consider the operations of existing facilities and community events to avoid clashing purposes and low turnout.
Planning should also include reviewing existing data to inform planning and follow-up to manage integrated outreach activities. In addition, data should be collected as part of integrated outreach services so stakeholders can study and learn from it to improve future integrated outreach services. If the integrated outreach services are a part of regular services, then maintain a separate register to isolate integrated outreach data from standard service data.
Step 5: Collect and Prepare Materials for Outreach Activities
Collect and prepare supplies, commodities, equipment and promotional materials based on what services will be provided and what venue will be used.
Step 6: Ensure Quality Service by Trained Staff
The provincial and district management teams should appropriately train the integrated outreach services staff and provide supportive supervision during the service offerings.
Step 7: Mobilize Communities
Engage CHWs to mobilize communities to participate in integrated outreach through various social mobilization efforts. CHWs may conduct door-to-door mobilization activities, distribute and post flyers and posters and provide information at community meetings about upcoming outreach services. They can also bring clients to integrated outreach/integrated outreach on wheels for effective services.
Step 8: Monitor and Evaluate Activities
Monitoring activities should measure the extent of the provision of services, quality controls and venue standards. Post-outreach meetings provide an opportunity to review any operational or logistical issues that arose and discuss the quality of services provided to inform future integrated outreach activities. TCI proposes the use of the following two indicators to measure success:
- The number of conducted within the catchment area.
- The proportion of clients reached through satellite camps/mobile outreach services.
Note what exactly should we call these? Camps? Mobile service units?
Indicators for success
- Number of clients counseled on FP/RH during the satellite camp/mobile outreach services
- Number of services provided at the satellite camp/mobile outreach services site
- Number of FP/RH commodities distributed (Condoms, IUCDs, Pills, Injectables, implants etc) at the satellite camp/mobile outreach services site
- Number of FP/RH clients served at the satellite camp/mobile outreach services
Resources needed
- Venue
- Transportation
- IEC materials
- Commodities
- Refreshment if necessary (for staff only)
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Tips
- Implementation of integrated outreach services may be limited by financial constraints, inadequate commodities and supplies, low demand from the community for services and/or no follow-up care and support provided.
- Integrating too many services can overwhelm and overextend staff. When planning integrated outreach, limit the number of services to be integrated to two or three related health areas.
- Due to cultural and religious constraints, receiving community support for integrated outreach services can be challenging if the mobilization activities focus only on promoting the FP/RH services instead of all health services being offered.
