Abstract
Postpartum family planning (PPFP) refers to the initiation of family planning services during the 12-month period following delivery. It has the potential to reach large numbers of women with life-saving information and services, thus preventing unintended pregnancies, and, in turn, avoiding potentially adverse health outcomes. The integration of family planning (FP) service delivery across the continuum of care could help to mitigate this unmet need by providing postpartum women with multiple opportunities for family planning counseling and services (Gaf eld & Egan, 2014). For service- delivery integration to be successful, solid leadership, management, and governance (L+M+G) is required.
This report summarizes the endline findings from a quasi-experimental research study that aimed to evaluate the added value of a leadership, management, and governance capacity-building intervention (Leadership Development Program Plus [LDP+])
on a PPFP service-delivery improvement project within maternal, neonatal, and child health (MNCH) departments of tertiary-care hospitals. The LDP+, implemented by Management Sciences for Health (MSH) through the USAID-funded Leadership, Management, and Governance project (LMG), complements an existing PPFP service-delivery intervention implemented by the USAID-funded Evidence to Action project (E2A), which aimed to improve clinical and counseling skills of MNCH staff in tertiary hospitals in Yaoundé, Cameroon.
The study involved purposively sampled non- equivalent intervention and comparison site hospitals. The study had three arms with two hospitals in each:
- Arm #1: Leadership Development Program plus (LDP+), FP clinical- capacity building, and FP commodities
- Arm #2: FP clinical training and FP commodities
- Arm #3: FP commodities
Data were collected at baseline and endline. Quantitative data included PPFP service-delivery outcomes and LDP+ participants’ L+M behavioral self- assessments. Focus group discussions and interviews provided data about the barriers to and facilitators of PPFP provision in MNCH departments, as well as the effect of L+M capacity building on health providers’ ability to improve PPFP services.
Results show that the LDP+ intervention led to a statistically significant increase in the number of women who received counseling during antenatal care (0% to 57%) and postnatal care (17% to 80%) compared to the clinical training intervention alone. Our results suggest that when the LDP+ combined with clinical training is implemented in a hospital, the percentage of expectant and new mothers who receive FP/SRH counseling increases; on average, the LDP+ intervention increased antenatal care (ANC) rates by 49% and postnatal care (PNC) rates by 59%. LDP+ facilities had statistically significant increases in couple years of protection with an average increase of 10 couple years per facility. Additionally, when comparing the change in PPFP counseling across the study arms, there was a significant difference in the number of ANC and PP women who received counseling between Arm #1 versus Arm #2 and also Arm #1 versus Arm #3, indicating that the LDP+ in combination with the clinical training intervention contributed to a greater increase in the number of postpartum women and women attending ANC who received FP/SRH as compared to the clinical training alone. However, there was no statistically significant effect of Arm #1 on the range of contraceptive methods made available by the hospital (study arms were not equivalent at baseline) nor on the number of service-delivery points with FP/PPFP Information, education, and communication materials (IEC) materials for clients or job aids for staff.
