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Integrating family planning with other health services: the NURHI Approach

During health facility assessments, NURHI realized that many potential family planning clients visited High Volume Sites (HVS) for antenatal care, childhood immunization services, labor and delivery, post abortion care or HIV services.  Yet, these clients were rarely counseled about family planning, nor were they provided family planning services.  To address these missed opportunities, NURHI embarked on a program of “Active Referrals” for family planning services from points where women of reproductive age group access care in a health care facility and these became points of integration.  According to the MLE Midterm Survey, these integration efforts have resulted in substantial increases in the proportion of women and HIV clients receiving family planning information.

Planning for Integration. NURHI drafted a strategy for integrating family planning counseling, services and referrals with MNCH and HIV services, which it shared with heads of HVS, State Ministry of Health, and Federal Ministry of Health for inputs. It was agreed that to promote family planning information, counseling and services, clients attending antenatal care (ANC), delivery, post-natal care (PNC), immunization clinics, post abortion care (PAC), HIV counseling and testing (HCT), and Antiretroviral Therapy services would be referred to the FP clinic. The Integration Strategy was revised accordingly.

Training FP Providers at Integration Sites. NURHI conducted a 10-day training in family planning counseling for service providers working in ANC, PNC, labour and delivery, immunization, ART, and HCT wards at HVS, and provided IEC materials.  Service providers working in labour wards were trained to counsel clients in the immediate post-delivery period while those providing PAC services were trained to provide family planning methods.

Establishing Post-Partum IUD Services. NURHI selected one HVS per city with the highest volume of labor and delivery clients to provide post-partum IUDs insertions.  From these, midwives and doctors were trained on post-partum IUD insertion. Providers working in ANC counseled in post partum IUD and registered those interested with the labour and delivery ward.  A system for ensuring adequate supplies of IUDs and the necessary equipment were also provided.

Monitoring and Tracking Integration. Monitoring of family planning services referrals provided through integration sites is an important aspect of referrals. NURHI established a referral system with color-coded referral cards to track sources of referrals within health facilities, from social mobilization, community health workers, or from other facilities. Through this system, NURHI is able to monitor the number of referrals for family planning services, as well as the numbers of clients at each integration sites who were counseled for family planning. Using this information, supervisors can provide targeted interventions to address performance gaps as they arise.