Contributors: Josephine Achulet and Nancy Aloo

In the realm of public health, continuous learning is crucial to develop and implement sustainable interventions that address the health needs of communities. One such approach is the use of learning visits to high-performing locations to observe the implementation of various health interventions in facilities.

The Challenge Initiative (TCI) first engaged Mukono District, Uganda, in February 2018, and Mukono graduated from TCI’s direct support in June 2021. The district has continued to implement high-impact family planning practices and other interventions (HIPs & HIIs) to reach more women, men and young persons with quality services and information. Following an online learning webinar, the Mukono District health management team asked to visit Kenya to learn from their counterparts about their approach to sustaining the implementation of HIPs & HIIs. A visit was subsequently organized to Bungoma County, Kenya, which began implementing TCI in February 2022.

Dr. Anthony Khonde, Senior Medical Officer of Mukono District, shared:

 The implementation of quality health interventions requires ongoing efforts to sustain and build on progress made. Sustaining implementation is necessary to ensure that the positive impact of these interventions is felt in the long term. The context of our work can be really different between countries but there are also similarities.”

Through open and constructive discussions during the visit, health care providers explored ways to align their health goals with the broader health agenda. One participant said:

 By involving us in this visit, we have been able to learn how to work with the private sector, coaching, postpartum family planning and financing strategies so that we can ensure that the implementation of our activities is well-coordinated and in line with the needs and priorities of the community.”

Insights from Coaches on Sustainability

A meeting with TCI-trained coaches can provide valuable insights into the challenges and successes experienced during the implementation of HIPs & HIIs. By sharing their experiences, coaches can provide lessons on sustaining the implementation of these interventions. Dr. Andrew Wamalwa, Bungoma County Executive Chief of Health, shared:

 Coaches play a significant role in supporting the implementation of HIIs & HIPs. They provide guidance, mentorship, and training to health workers and other stakeholders involved in the delivery of health services.”

Field Visit with Community Health Promoters on Sustaining Demand for Family Planning

One critical aspect of sustaining quality family planning programs is ensuring continuous demand. A field visit with community health workers also provided a firsthand experience of efforts made to sustain the demand for family planning within the community. Another participant noted:

 I found that community health workers are critical in demand generation activities especially before in reaches and outreaches and the County had been able to allocate funds to pay them for their efforts.”

Community health promoters in Bungoma County were able to share their experiences of what really works and take the Mukono team through the activities they support within the facilities they are attached to.

Mukono serves as an excellent example of how local governments seek to sustain successful implementation of family planning interventions. Learning from other TCI-supported locations provides an opportunity for stakeholders to witness firsthand the strategies and practices that have contributed to growth and impact.

Dr. Khonde witnessed how Bungoma could strengthen the capacity of private sector service providers by integrating mentorship into the government’s existing service delivery supervision system.

 In Uganda, we don’t (directly) support private pharmacies work. But a key learning for me is that we can contribute a lot to building strong partnerships even if it isn’t your direct agenda. Pharmacies are reporting, building awareness on services offered. So even if this work isn’t in a project’s core work, it’s time we start integrating this piece into all of our projects.”

While sustaining the implementation of family planning interventions is essential, it is not without its challenges. Some common challenges include limited funding, lack of political commitment, and inadequate human resources. However, these challenges can be overcome through innovative solutions such as resource mobilization, advocacy, and strengthening partnerships.

For Dr. Khonde, this increasing funding for family planning programs is a key area of potential advocacy.

 We can use Kenya as a great case study, when we advocate for resources at facility level for family planning services provision.”

Nakuru County health management teams also participated and shared their efforts regarding resource mobilization“>. These include continuous monitoring and evaluation, capacity building of stakeholders, community engagement, and strengthening health systems.
Through learning visits, engaging geography leadership, insights from coaches, field visits, and learning from successful implementations, stakeholders can identify strategies and best practices for sustaining family planning interventions. Despite challenges, innovative solutions and a commitment to ongoing knowledge sharing can pave the way for improved health outcomes and strengthened community well-being.