Strengthening Family Planning with Community-based Nutrition Interventions in Ethiopia : A Qualitative Study
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World Bank, Washington, DC
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A small-scale, exploratory, and
qualitative operational research study was conducted in
early 2011 to capture and examine stakeholder perspectives
on integrated family planning (FP) programs implemented
through Ethiopia's health extension program (HEP).
Qualitative indications are that various stakeholders on
both the supply and the demand side perceive that specific
community-based nutrition (CBN) activities also delivered
within HEP serve to link nutrition, family planning, and
other health issues in socially acceptable and qualitatively
effective ways. Remarkable concordance of qualitative
indicators of service delivery, uptake, and satisfaction was
noted on both the supply and demand side of service delivery
at the sites studied. Respondent reports suggested the
following: (i) active and successful delivery of both CBN
and FP activities; (ii) some challenges with record keeping,
supervision, and supplies; (iii) strong uptake of services
and messages; (iv) a highly positive community-level
perception of service quality, even in a partially
capacitated kebele (neighborhood); and (v) an engaged
response by participants. Qualitative indicators of
community-level HEP staff, volunteer performance, and
community satisfaction were generally positive. However,
gaps and challenges to improving integration and delivery of
FP and CBN within HEPs and in achieving sustainability in
scale-up of integrated programs include (i) increasing
capacity to support implant removal, (ii) maintaining human
resources for health within the health extension program,
and (iii) addressing the needs of youth in general and
out-of-school youth in particular. Recommendations for
improved delivery of integrated FP and CBN programs are to
explore ways to (i) step up planning and resourcing for
contraceptive implant removal, (ii) reduce staff turnover at
the health posts and health centers, (iii) strengthen
integrative supportive supervision and management of CBN,
(iv) enhance recruitment and training of youth as health
workers, (v) target adolescents and out-of-school youth for
FP and CBN, (vi) harmonize integrated FP and CBN messaging,
(vii) harmonize donor support for integration, and (viii)
measure the effectiveness of integration.
Palabras clave
ACCESS TO FAMILY PLANNING, ADOLESCENTS, AGED, AGRICULTURE, ANTENATAL CARE, BREAST FEEDING, BREASTFEEDING, CHILD HEALTH, CHILD MORTALITY, CHILD NUTRITION, CHILD SURVIVAL, CHILDBEARING, CIVIL SOCIETY ORGANIZATIONS, COMMUNITY HEALTH, COMPLEMENTARY FOOD, CONTRACEPTIVE PREVALENCE, CONTRACEPTIVE USERS, COUNSELING, DECENTRALIZATION, DEMAND FOR FAMILY PLANNING, DEVELOPMENT EFFORTS, DEVELOPMENT GOALS, DEVELOPMENT PLANS, DEWORMING, DIET, DISSEMINATION, EARLY DETECTION, EARLY MARRIAGE, EARLY MOTHERHOOD, ECONOMIC GROWTH, EQUIPMENT, FAMILIES, FAMILY HEALTH, FAMILY HEALTH INTERNATIONAL, FAMILY PLANNING, FAMILY PLANNING SERVICE, FERTILITY, FERTILITY RATE, FOCUS GROUP DISCUSSIONS, FOOD SECURITY, GENDER, GENDER ISSUES, GOVERNMENT SUPPORT, HARMFUL TRADITIONAL PRACTICES, HEALTH CARE DELIVERY, HEALTH CARE SERVICE DELIVERY, HEALTH CARE SERVICES, HEALTH CENTERS, HEALTH EDUCATION, HEALTH EXTENSION, HEALTH FOR ALL, HEALTH MESSAGES, HEALTH OFFICIALS, HEALTH OUTCOMES, HEALTH POSTS, HEALTH PROBLEMS, HEALTH PROGRAMS, HEALTH SECTOR, HEALTH SERVICE, HEALTH SERVICE PROVIDERS, HEALTH SERVICES, HEALTH STRATEGY, HEALTH WORKERS, HIV, HIV/AIDS, HOME VISITS, HOUSEHOLD LEVEL, HUMAN CAPACITY, HUMAN DEVELOPMENT, HUMAN HEALTH, HUMAN RESOURCES, HUSBANDS, HYGIENE, ILL HEALTH, ILLNESS, ILLNESSES, IMMUNIZATION, INCOME, INFANT, INFANTS, INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES, INTEGRATING FAMILY PLANNING, INTEGRATION, INTERNATIONAL COOPERATION, IODINE DEFICIENCY, IRON, KNOWLEDGE OF FAMILY PLANNING, LESS EDUCATED MOTHERS, LIMITED RESOURCES, LIMITING FAMILY SIZE, LOW BIRTH WEIGHT, LOW-INCOME COUNTRIES, MALARIA, MALNOURISHED CHILDREN, MALNUTRITION AMONG CHILDREN, MARRIED WOMEN, MATERNAL DEATHS, MATERNAL HEALTH, MATERNAL MORTALITY, MATERNAL MORTALITY RATIO, MILLENNIUM DEVELOPMENT GOAL, MINISTRY OF HEALTH, MODERN METHODS OF CONTRACEPTION, MORTALITY, MOSQUITO NETS, MOTHER, NATIONAL DEVELOPMENT, NATIONAL HEALTH SYSTEM, NATIONAL LEVEL, NATIONAL PLANS, NATIONAL POPULATION, NATIONAL POPULATION POLICY, NGOS, NUMBER OF CHILDREN, NUMBER OF HOUSEHOLDS, NUMBER OF WOMEN, NURSES, NUTRITION, NUTRITION PROGRAMS, OBESITY, ORAL CONTRACEPTIVES, PLAN OF ACTION, POLITICAL SUPPORT, POPULATION GROWTH, POPULATION INCREASE, POSTNATAL CARE, PREGNANCY, PREGNANT WOMEN, PREVENTIVE HEALTH CARE, PRIMARY HEALTH CARE, PRIMARY HEALTH CARE SERVICES, PRIMARY HEALTH SERVICES, PROGRESS, QUALITATIVE APPROACH, QUALITATIVE INFORMATION, QUALITY ASSURANCE, QUALITY OF SERVICES, QUANTITATIVE MEASURES, RELIGIOUS BELIEFS, REPRODUCTIVE HEALTH, RESPECT, RISK OF DEATH, RURAL AREAS, RURAL WOMEN, SAFE MOTHERHOOD, SANITATION, SCHOOL YOUTH, SCREENING, SERVICE DELIVERY, SERVICE DELIVERY POINTS, SERVICE PROVIDERS, SERVICE PROVISION, SERVICE QUALITY, SEXUALLY ACTIVE, SOCIAL MOBILIZATION, SPILLOVER, SUSTAINABLE POPULATION, TEENS, TRADITIONAL PRACTICES, TREATMENT SERVICES, UNFPA, UNINTENDED PREGNANCIES, UNMARRIED WOMEN, UNMET DEMAND, UNPLANNED BIRTHS, UNPLANNED PREGNANCIES, UNSAFE ABORTIONS, URBAN AREAS, USE OF CONTRACEPTIVES, USE OF FAMILY PLANNING, VACCINATION, VULNERABLE GROUPS, WASTE, WORKERS, YOUNG CHILD, YOUNG CHILDREN