Health Services Research Commons^™

Paidar: Private Sector Allied For Inclusive Delivery Of Accessible Reproductive Health, Population Council Pakistan

Sexual and Reproductive Health, Rights, and Choices

Pakistan continues to face critical challenges in increasing contraceptive use and reducing the unmet need for family planning (FP). While public-sector facilities remain key providers, a substantial proportion of healthcare seekers rely on private family physicians as their initial point of contact.

Recognizing this strategic opportunity, the PAIDAR study was designed to strengthen the role of private- sector male family physicians in FP service delivery. Implemented across six diverse districts of Punjab, supported by Health Care Commission Punjab and Department of Health and Population Punjab, the intervention enhanced providers' capacity to deliver quality FP counselling, contraceptive services, structured referrals, and …

Making Better Use Of Data For Improved Health Service Delivery In Punjab: Transforming Data Into Action Evidence, Population Council Pakistan

Sexual and Reproductive Health, Rights, and Choices

Strong health systems depend not only on collecting data, but on using it effectively for planning, monitoring, and decision-making. To strengthen evidence-based management across Punjab's health sector, the Population Council partnered with the Health and Population Department, Punjab, particularly the Health Information and Service Delivery Unit (HISDU), to improve the utilization of routine health information. This brief summarizes the collaboration's focus on three complementary areas: (1) Development of the ASET (Analytics for Service Efficiency and Tracking) platform to transform routine data into actionable information; (2) Strengthening the Capacity of Data Users through specialized training in data analytics, visualization, and use …

Voucher Model For Family Planning: Empowering Poor Women And Expanding Access To Family Planning Services In Punjab, Population Council Pakistan

Sexual and Reproductive Health, Rights, and Choices

Pakistan continues to face significant inequalities in access to family planning (FP) services, with the poorest women bearing a disproportionate burden of unmet need. Financial constraints, transportation costs, limited mobility, restricted decision-making power, and inadequate access to quality services often prevent women from obtaining the family planning services they need.

To address these barriers, the Population Council, in partnership with the Benazir Income Support Programme (BISP) and the Punjab Population Innovation Fund (PPIF), designed and rigorously evaluated an innovative Family Planning Voucher Scheme.

The model linked social protection with reproductive health services, enabling poor women from Rahim Yar Khan (RYK) …

From Evidence To Action: Case For Further Investment In Family Planning For Faster Fertility Decline, Population Council Pakistan

Sexual and Reproductive Health, Rights, and Choices

For over three decades, the Population Council Pakistan has generated evidence and supported governments in designing innovative approaches to address population and reproductive health challenges. Building on evidence around fertility transition, reproductive health, and the nationally endorsed Tawazun (balance) narrative, the Population Council supported the Government of Punjab through the FCDO-funded Delivering Accelerated Family Planning in Pakistan (DAFPAK) initiative and other strategic partnerships to implement scalable solutions for strengthening family planning services. This brief outlines five high-impact, proven interventions ready for institutional scale-up and provides an actionable path forward to transform routine health encounters into sustainable health system reforms.

Trends In Family Planning Uptake In Tanzania: An Analysis Of National Survey Data 2021-2022, Harun Yussuf Ayoub, Sabarinah Prasetyo

Jurnal Biostatistik, Kependudukan, dan Informatika Kesehatan

The purpose of this study is to uncover the socioeconomic and demographic factors that influence the usage of contraceptives by analysing trends and patterns in Tanzania's family planning uptake using data from national surveys. The results show that while Tanzania has made progress in increasing contraceptive prevalence from 27% in 2010 to 39% in 2021-22, disparities persist across socioeconomic and demographic lines. Women in urban areas, from higher wealth quintiles, and with higher educational attainment have significantly higher contraceptive prevalence rates compared to their counterparts. The study also reveals that the majority of women are aware of family planning methods, …

Understanding Community Health Volunteer Incentive Preferences In Kenya, Frontline Health Project, Johns Hopkins Bloomberg School Of Public Health

Reproductive Health

In Kenya, community health services are implemented through community health units. Community health volunteers (CHVs) who serve these units are chosen by the community and trained by community health extension workers. This brief summarizes qualitative and quantitative findings from the Frontline Health project’s discrete choice experiment study in Kenya, which aimed to understand incentive preferences of CHVs with the aim of improving motivation, performance, and retention of CHVs.

Identifying Factors That Support Community Health Worker Motivation, Job Satisfaction, And Retention In Haiti, Frontline Health Project, Johns Hopkins Bloomberg School Of Public Health

Reproductive Health

Community health workers (CHWs) play a critical role in Haiti’s health system, by connecting communities—particularly rural and hard-to-reach populations—to healthcare services. The Frontline Health project conducted a study to better understand the types of incentive structures that can best support the CHWs in Haiti and this brief summarizes those findings.

Women's Perceptions On The Effects Of Covid-19 On Access And Use Of Private Sector Family Planning Services In Nigeria: The Integrate Project, The Integrate Project

Reproductive Health

In Nigeria, Community Pharmacists (CPs) and Patent and Proprietary Medicine Vendors (PPMVs) are the first point of care for many common illnesses. Although CPs and PPMVs are not formally recognized as family planning (FP) service providers, 22% of modern contraceptive users report receiving their last method from a PPMV and 12% from a private pharmacy. PPMVs are popular for FP because of their widespread availability, consistent drug stocks, extended hours, personable interactions, and lack of separate fees for consultations. As in many places, the COVID-19 pandemic poses unprecedented challenges to health services in Nigeria. By limiting person-to-person contact, especially during …

Integrate Project Results: Family Planning Knowledge And Quality Of Care Received From Community Pharmacists And Patent And Proprietary Medicine Vendors, The Integrate Project

Reproductive Health

In Nigeria, Community Pharmacists (CPs) and Patent and Proprietary Medicine Vendors (PPMVs) are the first point of care for many common illnesses. Although CPs and PPMVs are not formally recognized as family planning (FP) service providers, 22% of modern contraceptive users report receiving their last method from a PPMV and 12% from a private pharmacy. PPMVs are popular for FP because of their widespread availability, consistent drug stocks, extended hours, personable interactions, and lack of separate fees for consultations. As the Federal Ministry of Health explores expanding its task sharing policy to include CPs and PPMVs, evidence is needed on …

Preferred Incentives For Improving Community Health Worker Satisfaction And Retention In Bangladesh, Frontline Health Project, Johns Hopkins Bloomberg School Of Public Health

Reproductive Health

Community health workers (CHWs) are critical actors within community health systems, providing a range of reproductive, maternal, child, and primary health information, counseling, and services. To better understand factors that influence CHWs’ work motivation and satisfaction in Bangladesh, the Frontline Health project, implemented with collaborators from Johns Hopkins Bloomberg School of Public Health, and supported by the government of Bangladesh’s Directorate General of Health Services and the Directorate General of Family Planning, conducted a discrete choice experiment (DCE) study. This brief presents key qualitative findings from the DCE study in Bangladesh and implications for program and policy stakeholders.

Issues For Consideration In The Scale-Up Of The Inclusion Of Family Planning In The National Health Insurance Benefits Package In Ghana, Kamil Fuseini, Augustine Ankomah

Reproductive Health

Ghana is working toward achieving universal health coverage (UHC). This is driven, in part, by the Sustainable Development Goals (SDGs), specifically SDG 3—Good Health and Well-Being, which seeks to ensure healthy lives and promote well-being for all at all ages. Achieving this feat will improve equity of access as people, especially the poor can access quality health services without financial hardships. Ensuring equitable access to family planning (FP) is essential to securing the well-being of women and supporting the health and development of communities. One pathway to ensuring equity is the inclusion of FP in affordable insurance. While the inclusion …

Evaluating The Inclusion Of Family Planning Within The National Health Insurance Benefits Package In Ghana, Kamil Fuseini, Augustine Ankomah

Reproductive Health

Contraceptive use in Ghana has remained low despite annual increases since 2012. Having a high unmet need for family planning (FP) suggests that there may be barriers to access and uptake. Over time, several policies, including Ghana’s Costed Implementation Plan from 2015–20, have suggested FP initiatives to improve contraceptive use yet they have not been entirely implemented. Further, although FP was included in the health insurance act passed in 2003, amended in 2008, and revised in 2012, which indicated that health-care benefits include FP, people continue to pay out of pocket for services at National Health Insurance Authority facilities because …

Best Bets: Vouchers For Rights-Based, Voluntary Family Planning—International Evidence On Financing Of Family Planning, Benjamin Bellows, Moazzam Ali, Ali M. Mir

Reproductive Health

To meet the FP2020 and Sustainable Development Goals (SDGs), significant investments are required by countries and donors in priority areas, including sustainable financing, reaching all adolescents, expanding availability of services to the poorest and hard-to-reach populations, and improving the quality and increasing the range of methods available. Studies show that vouchers can substantially contribute to SDG goals by expanding contraceptive access and choice among underserved populations. Vouchers can be an effective financing tool to enhance equity, increase access, and improve the quality of FP services available to underserved populations within Pakistan.

Modeling The Impact Of Inclusion Of Family Planning Services In Ghana's National Health Insurance Scheme, Justin Archer, Gillian Eva, Augustine Ankomah, Saumya Ramarao, Kamil Fuseini, Anne Coolen, Stephen Duku, Benjamin Bellows

Reproductive Health

While access to and uptake of modern family planning (FP) in Ghana has steadily risen over the last decade, the modern Contraceptive Prevalence Rate (mCPR) among all women reached only 22% in 2019 with 30% of women still reporting unmet need. To increase FP uptake via mitigation of cost barriers among women with unmet need, the Government of Ghana is seeking to integrate claims-based FP services into the National Health Insurance Scheme benefits package. The impact of these activities has the potential to be significant with the proportion of women accessing modern FP shifting dramatically to public facilities over the …

Best Bets For Accelerating Family Planning In Pakistan: The Case For Engaging Family Physicians And The For-Profit Private Sector, Ashfaq Rehman, Anam Malkani

Reproductive Health

Many women in the developing world already rely on private sector providers for various types of treatment, as well as for family planning (FP) services, due to ease of access, shorter waiting times, and a perception of better service. Drug shops and pharmacies are also important for improving access and basic information about contraceptive products. Private pharmacies and shops are key when public sector facilities face frequent shortages and stock outs.

Best Bets For Accelerating Family Planning In Pakistan: Inducting Men, Sharing Responsibility, Kiren Khan, Zeba Sathar

Reproductive Health

Pakistan's family planning (FP) program remains more or less exclusively aimed at women, yet evidence from both international as well as programming from within Pakistan suggests that including men in FP could improve results. Given the large youth cohort entering reproductive life in Pakistan, there are compelling grounds for also including younger men and adolescent boys, especially those about to wed, within the country's reproductive health (RH) and FP strategies.

Best Bets: Additional Funding For Family Planning—International Evidence On Financing Of Family Planning, Zeba Sathar

Reproductive Health

Additional financing for family planning (FP) in Pakistan is strongly justified, not only to increase contraceptive prevalence, reduce unmet FP need, and avert millions of unwanted pregnancies, but also to reduce maternal mortality and effect improvements in other spheres of development. As a safeguard against unintended fertility, FP contributes to national savings in multiple ways, and additional annual funding of $93 million—or 40 cents per capita—is a relatively minor investment that promises huge dividends.

Best Bets For Accelerating Family Planning In Pakistan: Invest In Community Health Workers, Ali M. Mir, Kiren Khan

Reproductive Health

Integration of trained, equipped, and supported community health workers (CHWs) within a health system is recognized as a proven high impact practice for family planning (FP) services, with evidence from around the world confirming the need to complement facility-based FP services with CHW programs, particularly in areas where people’s access to health care is limited. There is also substantial evidence that delivering essential health services through CHWs can be cost-effective in a diversity of contexts, with a review of FP programs in 10 developing countries revealing that the average cost per couple-year of protection (CYP) was considerably lower among programs …

Improving Data Reporting To Nhmis From The Private Sector In Nigeria: Lessons From A Dhis2 Pilot With Community Pharmacists And Patent And Proprietary Medicine Vendors, Population Council

Reproductive Health

The IntegratE Project is a four-year initiative (2017–21) implemented by the Population Council and partners that seeks to increase access to contraceptive methods by involving the private sector (community pharmacists [CPs] and patent and proprietary medicine vendors [PPMVs]) in family planning (FP) service delivery in Lagos and Kaduna States, Nigeria. The project aims to establish a regulatory system with the Pharmacists Council of Nigeria to ensure that CPs and PPMVs provide quality FP services, comply with FP regulations, and report service statistics to the Health Information Management System (HMIS). To achieve this, the project is implementing: a pilot three-tiered accreditation …

The Effects Of A Family Planning Training On Community Pharmacists And Patent And Proprietary Medicine Vendors’ Knowledge In Nigeria: Preliminary Pre And Posttest Results, The Integrate Project, Population Council

Reproductive Health

The IntegratE Project is a four-year initiative (2017–21) implemented by the Population Council and partners that seeks to increase access to contraceptive methods by involving the private sector (community pharmacists [CPs] and patent and proprietary medicine vendors [PPMVs]) in family planning (FP) service delivery in Lagos and Kaduna States, Nigeria. The project aims to establish a regulatory system with the Pharmacists Council of Nigeria to ensure that CPs and PPMVs provide quality FP services, comply with regulations, and report service statistics to the Health Information Management System. To achieve this, the project is implementing: a pilot three-tiered accreditation system for …

Quality Of Care Received For Family Planning From Community Pharmacists And Patent And Proprietary Medicine Vendors In Lagos And Kaduna, Nigeria: The Integrate Project, Population Council

Reproductive Health

The IntegratE Project is a four-year initiative (2017–21) implemented by the Population Council and partners that seeks to increase access to contraceptive methods by involving the private sector (community pharmacists [CPs] and patent and proprietary medicine vendors [PPMVs] in family planning (FP) service delivery in Lagos and Kaduna States, Nigeria. The project aims to establish a regulatory system with the Pharmacists Council of Nigeria to ensure that CPs and PPMVs provide quality FP services, comply with regulations, and report service statistics to the Health Information Management System. To achieve this, the project is implementing: a pilot three-tiered accreditation system for …

Integration Of Services: Making Integrated Services A Reality, Frontiers In Reproductive Health

Reproductive Health

Programs seeking to provide a more comprehensive RH service may establish or strengthen referrals between related yet separately provided services that enable a client to receive the range of needed services. There are two main rationales for integrating services. First, many clients have needs for several services; and second, there is an expectation that providing integrated or linked services can be more efficient programmatically. Little empirical evidence exists to support these underlying rationales, or to guide policies and programs in organizing services effectively and efficiently. Lessons from FRONTIERS have demonstrated not only the demand for multiple services, but also the …

Maximizing Utilization Of Research, Frontiers In Reproductive Health

Reproductive Health

Operations research (OR) can only be judged successful if results are utilized for making decisions to strengthen RH/FP policies and service delivery. How can this best be achieved? How can both process and impact of OR be measured? Drawing from ten years of FRONTIERS in Reproductive Health OR experience, a number of key principles for promoting research utilization, illustrated with documented examples, are presented here. One important first step is clarifying terms used, almost interchangeably, in research utilization, as it incorporates a range of ways in which research can be used for making decisions to strengthen RH/FP policies and programs. …

Creating The Conditions For Scaling Up The Integration Of Reproductive Health Services For Men In Health And Family Welfare Centers In Bangladesh, M.A. Mannan, Jafar Ahmad Hakim, Syeda Tazneen Waris, Ashraf Ali, Akm Nurul Hakim, Abdul Hannan, Sameena Chowdhury, Saria Tasnim, Saiful Islam, Aqm Rezaul Karim, Sharif M.I. Hossain, Ubaidur Rob, M.E. Khan

Reproductive Health

An operations research study, supported by the Population Council’s Frontiers in Reproductive Health (FRONTIERS) program, showed that reproductive health services for men could be feasibly and acceptably integrated within the Health and Family Welfare Centres in Bangladesh, which have been primarily women-centered health facilities. Given these findings, a follow-up study was implemented to create the conditions for scaling up the model through identifying and piloting the operational details to consider when taking the intervention to scale. The findings presented in this report suggest that this model of service delivery and training can be scaled up countrywide, preferably in stages. To …

Strengthening The Financial Sustainability Of Two Population Services And Training Center (Pstc) Clinics (Bangladesh), Population Services And Training Center (Pstc), Frontiers In Reproductive Health

Reproductive Health

The Population Services and Training Center of Bangladesh (PSTC) operates 15 clinics and 150 satellite posts that provide an Essential Services Package (ESP) to the poor, consisting of child health, family planning, maternal health, communicable disease treatment, and limited curative care. The objective of this study was to conduct an operations research study to determine the feasibility of improving cost recovery in two clinics by raising prices. It appears that the study design was too ambitious for PSTC, a service delivery organization with no prior research experience. Lack of experience was compounded by the resignation of all three PSTC research …

Helping Egyptian Women Achieve Optimal Birth Spacing Intervals Through Fostering Linkages Between Family Planning And Maternal/Child Health Services, Nahla G. Abdel-Tawab, Sarah Loza, Amal Zaki

Reproductive Health

The Population Council’s USAID-funded Frontiers in Reproductive Health (FRONTIERS) program, in collaboration with the Egyptian Ministry of Health and Population and the NGO Social Planning, Analysis and Administration Consultants, conducted an operations research study to measure the acceptability and effectiveness of two birth spacing message models in Upper Egypt. Overall, the study found that providing birth spacing messages to low-parity women during antenatal and postpartum care and also to husbands through community awareness activities was feasible and acceptable. As a result, birth spacing messages have been integrated into service delivery guidelines for antenatal and postpartum care, and IEC materials on …

Strengthening Health And Family Planning Services In Low Performing And Hard-To-Reach Areas Of Bangladesh: Workshop Report, Ubaidur Rob, Md. Noorunnabi Talukder

Reproductive Health

Although Bangladesh has established a comprehensive physical infrastructure to deliver health and family planning services with a network of primary health care facilities in rural areas, the impact of this health service network has been much less than expected because services do not reach all regions effectively. Two divisions, Sylhet and Chittagong, remain the most disadvantaged in terms of health and population outcomes and access to services, compounded by poor utilization of facilities in these areas. Moreover, the current health and population sector programs are beset with human resources and infrastructural problems. The Population Council organized a workshop to find …

Technical Assistance To The Institute Of Reproductive Health, Georgetown University In Researching Introduction Strategies For The Standard Days Contraceptive Method (Sdm), Saumya Ramarao, James R. Foreit

Reproductive Health

The Institute of Reproductive Health (IRH), Georgetown University tested the impact of introducing the standard days contraceptive method (SDM) with the technical assistance (TA) of Population Council staff. FRONTIERS technical assistance had the immediate effect of allowing IRH to carry out evaluations of the SDM in Asia and Latin America. The IRH studies also produced important lessons learned on strategies for the introduction of natural methods. IRH staff responsible for the India and Ecuador projects learned specific skills in cost-analysis and research instrument design.

Use Of Systematic Screening To Increase The Provision Of Reproductive Health Services In Bolivia, James R. Foreit, Ricardo Vernon, Patricia Riveros Hamel

Reproductive Health

The objective of this study was to determine if the use of a checklist to screen for unmet service needs could increase the number of services per visit provided to clients using rural Bolivian health facilities. Measurement included changes in services per visit before and after the introduction of the intervention, and a comparison of services received at screened and non-screened visits. Findings show that, to the degree that provider compliance can be secured, systematic screening of clients appears to be an effective method for reducing unmet health service needs. The findings of this study replicate those of other studies …

Introduction Of Emergency Contraception In Bangladesh: Using Operations Research For Policy Decisions, M.E. Khan, Sharif M.I. Hossain, Md. Moshiur Rahman

Reproductive Health

The Directorate of Family Planning, Bangladesh, the Population Council, Pathfinder International, and John Snow Incorporated collaborated to conduct this operations research study to assess the acceptability and feasibility of providing emergency contraception pills (ECP) as a backup support to existing family planning methods. The study demonstrated that all categories of health providers, including NGO outreach workers, could be effectively trained to provide ECP services. The study also demonstrated high acceptability of ECP and revealed that if used correctly, the success rate in avoiding unwanted pregnancy was extremely high. The positive findings of the study have helped the Ministry of Health …