Implementing Best Practices at the International Conference on Family Planning

The fourth International Conference on Family Planning (ICFP) on January 25-28, 2016, in Nusa Dua, Indonesia calls for “Global Commitments, Local Actions.” The conference is co-hosted by the Bill and Melinda Gates Institute for Population and Reproductive Health at Johns Hopkins Bloomberg School of Public Health and the National Population and Family Planning Board of Indonesia (BKKBN).

I was eager to participate in an entire Implementing Best Practices (IBP) track at the International Conference on Family Planning (ICFP) in Nusa Dua, Indonesia, last week. In July of 2015, in partnership with the IBP Initiative, the Leadership, Management, and Governance (LMG) Project ran a one-day workshop at the West African Health Organization Forum on Good Practices in Health in Ougadougou, Burkina Faso. The subject of the workshop was systematic scale up approaches and how they have been used to bring some successful family planning activities to scale in the field. We gave participants hands-on practice applying tools to actual case studies and analyzing how to prepare for scale up. At ICFP, we led a similar workshop to give participants a chance to see how systematic approaches to scale up have been used in the field.

The IBP Initiative is a partnership of 46 member organizations that aims to identify, implement, and scale up effective practices and facilitate knowledge-sharing to increase access to information and resources and foster collaboration among partners and the broader family planning/reproductive health (FP/RH) community. The IBP track at ICFP included a range of sessions and interactive workshops where experts shared their thoughts and experiences from the field on scaling up effective health practices, using strategic planning tools, assuring human rights, integrating FP services into existing programs, and adopting high impact practices, among other topics. There were lively discussions and debates at many of these events, and participants raised some important questions. Some overarching themes emerged from the many panels and workshops over the four day conference.

Here are my six key takeaways about scaling up from ICFP:

1. I heard again and again over the course of many sessions and workshops that government ownership is key for scale up to be successful. Institutionalization of successful programs and effective practices into the health system (vertical scale up) is absolutely essential for sustainability. To make this happen, government needs to be involved, because often a change in policy (e.g. to allow task shifting) or training curriculum (e.g. to train providers on youth-friendly FP services) is required. Beyond that, sustainability often requires a budget line item to be able to implement the scaled-up program (e.g. with materials, equipment, vehicles, and capacity building).” If you don’t get it into national and district level budgets, it remains words on paper,” said one participant. And this can take time! For instance, Dr. V Chandra-Mouli of the World Health Organization spoke about scaling up a sexuality education program in Nigeria. The NGOs and local partners involved in the pilot refused to scale it up until the inter-sectoral government signed off on it – a process that took 6 years.

2. Engage all your stakeholders, including potential opponents. Reach out to community actors and faith leaders to bring them into the conversation. This is especially true of programs that seek to overcome social stigma or long-held misconceptions about sensitive subjects such as family planning. If the faith leaders in a community are onboard with messaging about birth spacing, a program is more likely to succeed.

3. In addition to the results and outcome data we are already collecting, we need more and better documentation of scale up processes, so we can learn from one another about what works and what does not work. For example, how have others ensured that quality remained high as they scaled up programs or integrated family planning services into other health services? Who did they engage? How did they tailor the program from the “Cadillac model” we often see in donor-funded pilots to something more sustainable in the long term? The more we know about the implementation of scale up, the better we can plan for it in the future.

4. Following a systematic approach to scaling up helps you avoid missing important steps. Looking at the Guide to Fostering Change, the ExpandNet Nine steps for developing a scaling up strategy, and Beginning with the end in mind can help you plan carefully for scale up, even before you start a pilot. These tools help you to consider both horizontal and vertical scale up, and how you can plan to monitor and evaluate the program throughout the scale up process.

5. It is important to look at a few critical high impact practices and adopt them to a certain extent – but not to take them all on at once. If at the national level the leadership does not know where to start on reform, a prioritization process can help identify which activities would be most feasible and have the most impact.

6. Good planning and strategy are important (see point 4), but also critical is good management of the implementation itself.  Scale up does not happen in a day, it takes time. Even with a strong strategy, the change team must be able to adapt to new circumstances, continue to engage stakeholders throughout the process, and document the scale up.