TCI’s Universal Referral Approach Institutionalized Across Benin in Five-Year Strategy
Contributors: Hugues Gnahoui and Sarah Brittingham
When The Challenge Initiative (TCI) started working in Benin in 2018, the universal referral approach – TCI’s signature high-impact best practice in Francophone West Africa that ensures no missed opportunities for family planning counseling and service uptake – was not part of the Ministry of Health’s five-year strategic plan for family planning (2014-2018). Universal referral is unique in its ability to reach a broad population of women of reproductive age with contraceptive counseling and services by building the capacity of providers to counsel, then refer or offer a method to every woman of reproductive age who enters a facility – regardless of the services that they seek.
TCI offered support to Benin to help reach its goal of increasing the modern contraceptive prevalence rate from 12.4% in 2018 to 21.8% in 2023 by ensuring access to a complete range of quality, affordable family planning services. Through advocacy, TCI engaged key government stakeholders wherever they convened – at strategy meetings, quarterly data review meetings, or regional and international conferences – and urged them to include the universal referral approach in the new national five-year strategy for family planning (2019-2023). During the country’s five-year strategic planning workshop, Hugues Gnahoui, TCI’s Country Program Manager, presented the universal referral approach and its evidence base as a high-impact best practice.
According to TCI’s project management information system data from April 2019 to February 2020 from TCI-supported facilities in Abomey Calavi and UCOZ, 69% of new family planning clients were recruited via universal referral, 20% from another TCI high-impact approach called Special Family Planning Days, and 11% from other sources. Thanks to the universal referral approach, almost 300,000 women were counseled on family planning during that period.
Dr. Gaston Ahounou, Head of Family Planning and Adolescent and Youth Health Services of the Maternal and Child Health Department and national trainer for reproductive health within the Beninese Ministry of Health, has become a tireless champion for universal referral. After TCI coached him on the approach, he facilitated a training of trainers and a training of providers in Abomey-Calavi in April 2019. Dr. Ahounou also eagerly worked with TCI to get the approach included in the national 2019-2023 family planning strategic plan.
“Universal referral is a truly holistic approach that systematically identifies the client’s needs in terms of family planning, thereby reducing unmet needs,” said Dr. Ahounou.
Because of Dr. Ahounou’s support and TCI’s persistent advocacy efforts, the Ministry of Health ultimately institutionalized universal referral in its five-year strategy (2019-2023) as a high-impact approach to be scaled up across Benin. All annual health workplans across the 12 departments that make up Benin’s health system are now expected to include universal referral, which means it is being deployed in at least 50 additional health facilities every year from 2019 to 2023. In 2019 alone, 349 providers were trained on universal referral. The systematic inclusion of the universal referral represents important progress for the scale up and sustainability of the approach, and ultimately for the women of Benin.