Elements of Successful Family Planning Programs: Online Survey and Global Forum Discussion

From the introduction to the survey:

"The INFO Project, in collaboration with the World Health Organization and partners of the Implementing Best Practices (IBP) Initiative, sponsored an online global discussion forum on the IBP Knowledge Gateway (www.ibpinitiative.org). The objective of the forum was to share program experiences, review research findings, highlight resources, and reach consensus on the core elements of successful family planning programs....Before launching the forum, the INFO Project at the Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs conducted an online survey on the elements of successful family planning programs. The survey and forum kick off a larger INFO Project activity to create a community and supporting resources focused on defining the elements of successful family planning programs."


445 health care professionals from 98 countries responded by ranking the importance of a variety of factors involved in running family planning programmes. Results showed that "staffing tops all other factors necessary to the success of family planning programs. Effective communication strategies and outreach ranked second after staffing as one of the most important factors for success. Logistics and client-centred care followed closely, and then supportive government policies." The survey also asked respondents to rank these factors in ease or difficulty of achievability. Adequate budget topped the list in difficulty. The others generally followed the rank of importance - the most important being the most difficult.


"The survey paved the way for the online discussion forum focused on elements of family planning program success. Some 280 health care professionals in 63 countries joined the forum." Each factor from the ranking survey was posed as a discussion topic for the follow-up online discussion. Survey and discussion results were used as the basis for an interactive website on family planning, which was available from February of 2008 (but as of the end of 2009 is no longer archived).


Topics include:

1. "Well-Trained, Supervised, and Motivated Staff
2. Client-Centred Care
3. Logistics and Contraceptive Method Mix
4. Integration With Related Health Services
5. Mix of Service Delivery Points
6. Communication and Outreach
7. Research, Monitoring and Evaluation, and Management Information Systems
8. Good management, Strong Leadership, and Up-to-date Service Delivery Guidelines
9. Financial Resources and Services for the Poor"

Communication approaches shared by online discussion participants include interpersonal communication, mass media channels, and community channels. Several contributors noted that their areas have technological and financial constraints to effective use of cell phones or internet. The following, listed here by the respondent's country, are some of the discussion contributions:

• Bangladesh's approaches - educational materials for clients, folk songs, cinema slides, TV serial spots, mobile phone messaging, and advertisements on rickshaws. Family planning staff also developed a resource package for religious leaders with key messages to read following the prayer service. Another approach is to enlist famous television actors, sports players, and satisfied clients to promote messages.
• India's communication activities - grassroots-level health care workers visit households to distribute posters, handbills, and pamphlets. A special family planning activity or camp in the community will be promoted via loudspeaker or announcement system.
• Pakistan's approaches - interpersonal and community communication channels to address the numerous myths and misconceptions about family planning through sending outreach workers and providers to the community. The programme also uses telephone hotlines to address client concerns.
• Senegal's combination of three communication approaches - send health professionals into the community to discuss family planning, display health communication messages on billboards where literacy rates are sufficient, and air radio spots with family planning messages.
• Iran's most common channel of communication - face-to-face counseling in a clinic setting. In addition, there are pre-marriage classes to communicate about family planning, as well as pamphlets, brochures, and advertisements in newspapers and journals, with experimental use of the internet.
• Canada's several communication approaches - word-of-mouth and posters that are placed in schools, community recreation centres, and clinics, a web site under development, and e-mail and cell phone text messaging to follow up on clinic visits or test results.

Communication challenges and solutions are summarised as:

1. "Challenge: Lack of community interest in family planning messages due to socio-cultural factors, such as religious beliefs.
   Solution: Convince local leaders before disseminating messages to the community and convince local leaders to help spread the messages.
2. Challenge: Radio spots have limited reach.
   Solution: Repeat radio programs and spots at different times throughout the day to reach a wider audience.
3. Challenge: Lack of qualified and committed health care providers and outreach staff.
   Solution: Capacity-building activities for health care providers and outreach staff.
4. Challenge: Time-consuming for providers to counsel clients.
   Solution: Decrease provider workload.
5. Challenge: Expensive to air mass media messages.
   Solution: Negotiate with production studios to air mass media messages at a discounted rate.
6. Challenge: Messages reach only female clients.
   Solution: Develop messages to address men by organizing a community meeting."

Reasons to undertake communication activities, according to respondents, include:

• Bangladesh - using communication to reach specific groups, such as adolescents and people not currently using contraception.
• India - addressing myths and misconceptions is a top priority. “For example, male vasectomy has almost vanished from the Indian family planning program since most of the people think that it causes weakness among the men."
• Senegal - updating the community on new methods and services, such as a new HIV voluntary counseling and testing centres; addressing clients’ myths and misperceptions; letting new clients know where they can find services, as well as helping continuing clients know where they can find information; and helping to influence the attitude of community leaders towards the programme.
• Iran - educating the community about family planning choices is among the most important reasons to undertake communication activities. Programmes can also address myths and misperceptions by using mass media channels to disseminate accurate information about contraception.
• Canada - decreasing unplanned pregnancy among youth. Communication messages can also address parents to dispel the common misconception that, if you teach young people sex education, they are more likely to engage in sexual activity.

In response to a question about whether a portion of funding goes to behaviour change communication (BCC), replies included percentages of 20 - 30% in some programmes and none in others, particularly where the entire budget goes to staffing needs. This question references earlier discussion in which a respondent identified behaviour change as a tool appropriate for adding value through integration of interventions. "...[T]he article ...describe[s] three principles of integration: First, interventions being integrated should be effective. Second, interventions need a common field of operation (e.g. within clinical services, mass media behavior change activities, or high-level policy making) as well as common audiences. Third, there should be synergies between the two interventions that enhance the impact of both."

Respondents remarked on participation in creating family planning programmes. They stated that they use community members, including support and auxiliary groups, for planning and evaluating communication programmes. The Canadian programme that focused on family planning for teenagers cited the importance of parent inclusion in message design.