Health Facility Strengthening

This tool provides guidance on how to strengthen facilities to be ready to offer quality family planning services by focusing on capacity building through:

  • Contraceptive technology updates (CTU)
  • Mentorship
  • Whole-site orientation
  • Commodity management
  • Data management
  • Provision of essential equipment
  • Formation and operationalization of quality improvement teams
  • Integration of family planning (FP) to other service areas

 

Why Facility Strengthening Is Important

Quality family planning services are offered within an enabling environment where equipment is available and service providers are knowledgeable and skilled to offer these services. This reduces missed opportunities for offering family planning and increases the number of women who can access quality services. (Commodity Security) The following aspects are important in provision of quality family planning services:

  • Capacity building for service providers to equip them with interpersonal communication, counseling, clinical and commodity management skills and support supervision to competently offer quality family planning services
  • Infection prevention and training on appropriate practices are required to ensure client and provider safety
  • Quality improvement systems
  • Renovations and repairs of health facilities are required where necessary to increase client satisfaction with services
  • Provision of a conducive working environment and basic cleanliness
  • Clients have access to information material relating to all family planning methods
  • Service providers have relevant material (job aids, checklists, guides)
Evidence

There is sufficient evidence from Tupange program monitoring data, reports and baseline and midline surveys from Monitoring Learning and Evaluation (MLE) that facility strengthening contributes to the increase in family planning uptake and improves method mix, especially Long-Acting and Permanent Methods (LAPM). Strengthening of facilities in Tupange program contributed to the following:

  • An increased uptake of services in all supported facilities as evidenced in the daily activity register (MoH 512) and District Health Information System (DHIS 2)
  • An increased client satisfaction with services offered by the health facilities as evidenced in the Client Exit Report (CER)
  • An improved method mix of family planning services provided with (LAPM) on the increase
  • Quality improvement teams actively involved in monitoring quality of services in the facilities
Guidance: How to strengthen facilities to improve family planning services
  • Conduct facility needs assessment
  • Training
    • Conduct a Contraceptive Technology Update (CTU) targeting eligible service providers. A CTU is classroom-based training that focuses on family planning knowledge transfer as well as practice on humanistic models. The CTU is followed by on-site mentorship to ensure skills acquisition by service providers
    • Conduct coaching and mentorship on a regular basis to increase the number of competent skilled service providers within the facility able to offer services. This ensures all new staff transferred to the facility are competent in provision of family planning services. In the absence of skilled mentors, there is a need to conduct a 3-day mentorship training for eligible facility staff
    • Carry out whole-site orientation, which entails a facility-based orientation targeting both clinical and non-clinical staff with focus on family planning, data and commodity management to ensure all staff have the necessary knowledge to enable them promote family planning services
    • Quality improvement training that focuses on formation and operationalization of work improvement teams that address the quality improvement gaps in all service areas. A work improvement team has representatives from all service areas and meets on monthly basis. Quarterly support supervision by the local government health management team is essential in assessing and maintaining quality standards
    • Training for managers on data management, analysis and reporting for decision-making including the indicators
    • Infection prevention training
  • Carry out the necessary renovations
  • Procure in line with the procurement policy, brand/label the equipment (such as Intrauterine Contraceptive Device (IUCD)/Implant insertion/removal sets, client examination couches, blood pressure machines, ward screens, weighing scales, trolleys, infection prevention buckets)
  • Maintaining an inventory at facility, county, district and municipality levels
  • Reproductive Health (RH) commodity management training and ensure commodity security is maintained
  • Develop and distribute family planning-related job aids and Monitoring and Evaluation (M&E) tools
  • Ensure availability of information, education and communication materials in the family planning health facilities. This can be in form of posters, leaflets or audio materials. (Demand Creation resources)
  • Strengthen the community facility linkage through CHW/VHT facility meetings, action/dialogue days
  • Integration of family planning into other services
  • Conduct whole-site orientation to update all service providers on family planning. This will enable all service providers to initiate family planning in all service areas through provider initiated family planning (PIFP)
Monitoring Processes
  • Monitor, on a quarterly basis, the quality of service provision through supportive supervision reports by the local government health management team
  • Monitor data recorded and reported on a monthly basis
  • Review quality of data reported through routine data quality assessment done by facility data quality focal person
  • Hold monthly quality improvement meetings to report on progress and develop plans on how to address gaps by quality improvement teams
  • Conduct routine gaps assessments using any of the following approaches: client satisfaction exit interviews, facility assessment, support supervision and focused group discussions
  • Maintain and update facility equipment inventory to monitor the state of equipment at any given time in the facility
Success Indicators
  • Number of facilities providing quality family planning services
  • Proportion of gaps identified and addressed within specific time period
  • Number of facilities updating equipment inventories semi-annually
  • Number of quality improvement meetings held and agreed upon actions plans implemented
Cost
  • Cost of equipment,
  • Training costs for service providers (Stationery, training manuals, Trainers’ resource fee, printing of certificates, transport cost/accommodation for participants, conference package)
  • Social, Behavioral Change (SBC) materials, posters, flyers, sign posts
  • Job aids
  • Cost of renovations and facelifts as needed
  • Tools and guideline materials
Sustainability
  • Advocacy with the local government health officials to ensure funding for facility activity strengthening component is included in the budget
  • Incorporate facility strengthening activities in the facility and government annual work plans
  • The government support supervision team to carry out quality audit on regular basis. This should include assessment of infrastructure, service delivery and human resources
  • Quality improvement teams should hold monthly meetings where quality is discussed and steps taken to maintain high standards of service delivery
  • Continuous capacity building through mentorship, whole-site training by facility mentors to address staff turnover and maintain competency in service provision. All training should be incorporated into the ongoing Continuing Medical Education (CMEs) at the facility and in-service programs to cut training costs

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