Audio Job Aids for Family Planning Providers

Introduction

There are approximately 35 million women of reproductive age (15 to 49 years) in Nigeria; however, only 12 percent of married women within this age group are using modern family planning (FP) methods (Nigeria Demographic Health Survey 2018). Increased use of modern FP methods could help reduce the high maternal mortality rate in Nigeria. To increase the modern contraceptive prevalence rate (mCPR), the Nigerian government developed a task-shifting, task-sharing policy that allows community extension health workers (CHEWs) to include long-acting and reversible contraceptives in their FP service provision. The U.S. Agency for International Development (USAID) funded Sustaining Health Outcomes through the Private Sector (SHOPS) Plus project supported task-shifting to a lower cadre of clinical providers by offering updated training tailored to CHEWs. SHOPS Plus also offered in-person follow-up to all of its newly trained providers across four supported states in Nigeria (Federal Capital Territory, Oyo, Akwa Ibom, Plateau). However, FP providers requested additional resources that were more accessible than a highly technical, paper-based FP manual.

To complement and extend the existing training and follow-up with newly trained providers, SHOPS Plus developed audio job aids for FP providers that could be accessed through interactive voice response (IVR) messages on-demand and through regularly scheduled biweekly calls.

Project/Digital Health Solution Overview

Through user-centered problem-specification and solution design workshops with FP providers in Nigeria, SHOPS Plus identified two additional channels of training reinforcement: 1) on-demand audio job aids that FP providers could call at any time to select and listen to key technical messages on FP topics of interest, and 2) a schedule of voice-recorded content that SHOPS Plus could routinely push to FP providers to maintain engagement, remind providers about best practices, and monitor knowledge, attitudes, and self-reported practices. These two approaches were selected because they met the needs of CHEWs who could access this information using basic phones— since many did not have smartphones or wifi (rendering mobile apps and websites inaccessible). Further, the on-demand approach was selected because it was sustainable beyond the duration of the SHOPS Plus project.

To implement this intervention, SHOPS Plus partnered with Viamo to leverage the existing 3-2-1 platform with the Airtel network operator. Viamo is a social enterprise that specializes in using IVR, short message service (SMS), Random Digit Dialing, and unstructured supplementary services data (USSD) to support partners with behavior change communications and evidence-gathering via simple mobile phones. The 3-2-1 platform is accessible for free to anyone in Nigeria with an Airtel SIM card and it already offered on-demand voice recordings on health topics, including general FP, for beneficiaries. All informational content on the platform is developed in partnership with local experts, developent organizations and apporopriate government agencies. In Nigeria, on average, the health messages are accessed 35,000 times each month. SHOPS Plus developed and validated FP curriculum-based content with FP providers and posted 38 key messages, which providers can listen to for free by navigating through an interactive menu. The menu topics for FP providers include: counseling, general FP information, safety and documentation, short-acting methods, long-acting methods, and pelvic exam.

In addition to the on-demand component, SHOPS Plus pushed key messages and quizzes to all clinical providers on a weekly basis (one key message and one corresponding quiz per week). Messages were pushed to providers’ primary phone numbers on any network. This gave SHOPS Plus the opportunity to continuously engage with providers and to monior whether clinical providers were retaining the technical knowledge and applying it in practice.

Lessons Learned

• On-demand message popularity was correlated with its order in the menu, indicating that providers were browsing for general information rather than seeking specific content. This correlation made it difficult to determine which topics were particularly useful to providers.
• FP providers gave feedback that SHOPS Plus should not schedule push messages during the hours of service provision in the facilities because FP providers were often too busy to pick up.
• Not all trained providers had an Airtel SIM, which SHOPS Plus remedied by purchasing and giving to providers. However, while SIM cards were inexpensive and easy to purchase, the manual registration process required by law in Nigeria proved time-consuming and difficult since providers had to register and activate their SIMs within a specified time period or the cards would expire.
• FP providers were concerned that people who had not received the in-person training would listen to the technical content and consider themselves trained. Because the audio job aids were meant to be complementary to—and not in place of—in-person training, they requested that the technical content be accessible only to individuals who had participated in the SHOPS Plus training. Therefore, providers who completed the FP training were given a special access code that was required to access that specific content on 3-2-1.

References

• National Population Commission—NPC/Nigeria and ICF. 2019.
• Nigeria Demographic and Health Survey 2018. Abuja, Nigeria and Rockville, Maryland, USA: NPC and ICF.