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. 2020 Jun 24;17(12):4530.
doi: 10.3390/ijerph17124530.

Integrated Family Planning and Immunization Service Delivery at Health Facility and Community Sites in Dowa and Ntchisi Districts of Malawi: A Mixed Methods Process Evaluation

Chelsea M Cooper  1 , Jacqueline Wille  1 , Steven Shire  2 , Sheila Makoko  2 , Asnakew Tsega  3 , Anne Schuster  1 , Hannah Hausi  4 , Hannah Gibson  2 , Hannah Tappis  1
Affiliations

Integrated Family Planning and Immunization Service Delivery at Health Facility and Community Sites in Dowa and Ntchisi Districts of Malawi: A Mixed Methods Process Evaluation

Chelsea M Cooper et al. Int J Environ Res Public Health. .

Abstract

The Government of Malawi's Health Sector Strategic Plan II highlights the importance of service integration; however, in practice, this has not been fully realized. We conducted a mixed methods evaluation of efforts to systematically implement integrated family planning and immunization services in all health facilities and associated community sites in Ntchisi and Dowa districts during June 2016-September 2017. Methods included secondary analysis of service statistics (pre- and postintervention), focus group discussions with mothers and fathers of children under age one, and in-depth interviews with service providers, supervisors, and managers. Results indicate statistically significant increases in family planning users and shifts in use of family planning services from health facilities to community sites. The intervention had no effect on immunization doses administered or dropout rates. According to mothers and fathers, benefits of service integration included time savings, convenience, and improved understanding of services. Provision and use of integrated services were affected by availability of human resources and commodities, community linkages, data collection procedures and availability, sociocultural barriers, organization of services, and supervision and commitment of health surveillance assistants. The integration approach was perceived to be feasible and beneficial by clients and providers.

Keywords: Malawi; child health; contraception; evaluation; family planning; immunization; integrated service delivery; reproductive health.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
The family planning–immunization integration implementation approach.
Figure 2
Figure 2
Total family planning users at implementation sites in Dowa, pre- and postimplementation.
Figure 3
Figure 3
Facility- and community-based depot medroxyprogesterone acetate (DMPA) provision, pre- and postimplementation in Dowa.
Figure 4
Figure 4
Method mix for total family planning users, pre- and postimplementation in Dowa.
Figure 5
Figure 5
Percentage contraceptive methods and immunization doses administered at the community level in Dowa.
See this image and copyright information in PMC

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