As low- and middle-income countries transition from paper to digital systems, family planning programs can benefit from unprecedented opportunities to improve services. Investments in digital health tools have expanded exponentially, but information on what works—and what does not— remains limited and scattered. As investments have increased, digital applications and data fragmentation have proliferated, but stakeholders are moving towards more coordinated efforts to scale digital health solutions, support countries’ digital health infrastructure, and share evidence-based learnings.
This Digital Health Compendium enables users to explore case studies across a range of digital health technologies used to enhance family planning programs mainly in sub-Saharan Africa, but also in other regions of the world. Digital health applications in family planning programs can be broadly classified as those affecting demand generation, service delivery, supply chain management, and the policy and enabling environment. In many low- and middle-income countries, digital health innovations were adopted earlier in other health sectors, including HIV/AIDS, maternal and child health, and noncommunicable disease prevention and response. As a result, much of the impact evidence is likewise restricted to those sectors. To advance greater adoption of digital technology in family planning programs, more data and information on the challenges, opportunities, scalability, and results are needed. This compendium aims to consolidate emerging information and data on applications of digital technology in family planning programs to inform adoption and scale-up of successful approaches.
All of the case studies were submitted by the implementing organizations and include a description of the digital health intervention, program context, and, if available, important findings and lessons learned through rigorous evaluations or program data. The compendium facilitates a quick search for case studies based on the target user for digital health intervention, building block for the digital health enabling environment, family planning program classification, and country location. The case studies give policy and program decisionmakers insights on real-world applications of digital health, promising practices, challenges, and other lessons that can be applied to current and future programs.
New
Digital Health Interventions (DHIs) to ensure efficient access and referral for family planning, HIV/AIDS, Sexual and Gender-Based Violence (SGBV), and relationship support.
Alden Nouga-Ngog Chief, Strategic Partnership & Development International Planned Parenthood Federation London, UK, [email protected] +1 6174129749
International Planned Parenthood Federation
Supported by a variety of unrestricted and restricted funders
Alden Nouga-Ngog Chief, Strategic Partnership & Development International Planned Parenthood Federation London, UK, [email protected] +1 6174129749
Digital Health Interventions (DHIs) to ensure efficient access and referral for family planning, HIV/AIDS, Sexual and Gender-Based Violence (SGBV), and relationship support.
Since the outbreak of COVID-19, emerging data and reports from those on the front lines have shown that all sexual and Gender-Based Violence (SGBV), particularly domestic violence, has intensified. Lockdowns, curfews, and quarantine restrictions are increasing economic hardship and confinement is having devastating impacts on women and girls at home. As COVID-19 cases continue to strain health services, essential services such as domestic violence shelters and helplines have reached capacity.
The Legal Aid Foundation of the Indonesian Women’s Association reported that in the first three months of the pandemic alone, the number of domestic violence cases had already summated to half of those reported for the entire year before.
The initial findings of the International Planned Parenthood Federation (IPPF) COVID-19 impact survey (March 2020) for Indonesia indicated that restricted movement and limited healthcare access had escalated women and girls’ needs for specialized SGBV care. Reduced Sexual and Reproductive Health (SRH) services and women’s lack of access to contraceptives prompted IPPF’s Member Association – Indonesian Planned Parenthood Association (IPPA) – to transform services in response.
As fewer facilities and service providers were available to offer face-to-face SGBV care, IPPA shifted to Digital Health Interventions (DHIs) to ensure that the heightened need for essential and lifesaving services was met. SGBV service access routes were expanded through DHIs provided to the public; a new model for some of IPPA’s provinces (Chapters) in the country. These online referral systems for SGBV complemented face-to-face case referrals and were implemented to allow for different entry points through various SRH counseling areas such as family planning, HIV/AIDS, and relationship support.
Additionally, social media became a new vehicle for promoting SRH services, SGBV outreach, and campaigns, such as for the Ratification on the Elimination of Sexual Violence Bill, through platforms such as Instagram, Zoom, Google Meet, and WhatsApp. Both the online referral implementation and social media use coincided with a generalized scaling up of SGBV care through counseling, clinical services, and education.
A specialized pilot ran in Java and Sumatra on SGBV management and expanded partnerships with government and civil society networks. Work commenced on shelters for women seeking protection as part of the comprehensive support service, and referrals to these services were made more accessible through online channels, thereby increasing use of shelters.
Central to IPPF’s and IPPA’s work, and complimentary to their service delivery, are efforts to create an enabling environment and SRHR favorable public policy. As such, digital interventions were embraced for strengthened advocacy during the pandemic through building civil society partners’ capacity and responding to the bill on the Elimination of Sexual Violence. Increased focus on social media platforms allowed for greater community mobilization which ultimately aims to ensure long-term positive change to women’s safety.
Further, through expanded COVID-19 services and advocacy, enhanced through digital technologies, IPPA chapters are involved in various SRH Task Forces and the Ministry for the Protection of Women and Children clusters.
– IPPA has seen substantially increased service delivery from these DHIs in its service delivery statistics and health data information systems.
– Overall, in 2020, it is estimated that IPPA delivered at least 3,700 Sexual and Reproductive Health and Rights (SRHR) services through DHIs.
– In West Java, during September 2020 – March 2021, online counseling services that were initiated on WhatsApp reached 230 clients, with several more clients accessed via Instagram.
IPPA’s youth volunteers have played a vital role in disseminating SRH and SGBV information through online services and South Sumatra demonstrates the impact of this, where 200 young clients were referred by youth volunteers for SRH services.
– Additionally, in IPPA in West Java, online gender perspective training was carried out for IPPA’s peer educators who contributed to the increased referrals.
– This overall increased reach by IPPA through digital innovations will have long-term health benefits for women, girls and other marginalized populations in Indonesia, whose urgent health issues may have otherwise gone unnoticed and unaddressed in the COVID-19 crisis.
Government services are not inclusive or sufficiently integrated, focusing on domestic violence cases over other forms of SGBV and not inclusive of certain vulnerable minority groups.
To increase the sustainability of digital innovations, resources are needed to improve staff capacity in this form of service delivery and to develop applications to integrate existing clinical record systems with telemedicine.
Holding monthly SGBV working group meetings to discuss referral pathway implementation and critical areas for collaboration, capacity building and technical assistance, will assist the scaling up of services.
IPPA’s telemedicine capacity is limited to text, images and sharing data, with video calls rarely used due to high costs and internet connection. Funding is needed to allocate costs to different data and internet packages across IPPA clinics.
Temporary transit homes need supporting equipment for (accompanied) SGBV survivors to feel comfortable and safe.
More must be done to prioritize addressing violence against women and girls in the COVID-19 pandemic in both response and recovery efforts. IPPA is at the forefront of this, through recognizing the increased incidence of SGBV in crises and taking active measures to mitigate the risks and ensure continuity of urgent care. This includes expanding and strengthening their SGBV services using digital innovations, such as online consultations, support and counselling, and online referrals to streamline flow of clients to facilities.
IPPA will not only pursue currently expanded SGBV services but continue to grow their reach through improving and innovating. Through applying the learnings from COVID-19 innovations, IPPA will: develop standard operating procedures for providing SGBV services (online and offline); strengthen advocacy and support to expand online counselling; recruit more volunteers for increased human resources and referral making; and develop comprehensive SGBV services for vulnerable minority groups, such as transgender people, street children, sex workers, and people living with HIV.
Widadio NA, 2020. ‘Domestic violence on the rise during the pandemic’. Andolou Agency, viewed 7 October. https://www.aa.com.tr/id/nasional/kekerasan-dalam-rumah-tangga-meningkat-selama-pandemi/1889108