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.
Community-based family planning system, with multiple implementations, which supports community health workers and supervisors who provide family planning services in the community. This system follows the Balanced Counseling Strategy Plus and Tanzania guidelines.
Shirati KMT Hospital
Bruyere Research Institute
Rorya District CHMT
International Development Research Center Canada
January 1, 2014 - November 30, 2020
Tanzania: Shinyanga, Mara, Arusha, Manyara, Kigoma, Katavi
Client, Health Care Provider, Health System Manager, Data Services Provider
Services and Applications, Workforce
Although family planning services in Tanzania are offered free of charge and citizens have a high awareness of contraceptive methods, uptake of family planning in Tanzania remains low. As of 2010, 24 percent of married women of reproductive age (MWRA) were using a contraceptive method with a total fertility rate (TFR) of 5.4. The situation is more pronounced in the rural Shinyanga region, where only 12.5 percent of MWRA are using a modern contraceptive method, total fertility rate is 7.1 and 22 percent of women have an unmet need for family planning, as well as in the Lake Zone region, where use of a modern contraceptive is 15 percent and the unmet need is 33 percent. The Lake Zone region also experienced more frequent stockouts of family planning commodities than elsewhere in Tanzania.
One factor affecting initiation of contraception and continued use is satisfaction with family planning services, and studies have shown that the most common reason for discontinuation is dissatisfaction with the quality of family planning services.
Through eight years of developing and implementing family planning systems, D-tree International has worked to address this gap with a solution, Family Planning Plus (FP Plus), a comprehensive digital system supporting community-based family planning service provision, based on the Balanced Counselling Strategy Plus (BCS+). This solution has proved to be flexible and impactful, as it has been modified for different settings and has seen sustained positive program outcomes. We will reference three different implementations in this case study to show the evolution and impact of the solution.
The digital solution, FP Plus, comprises two mobile applications (one for Community Health Workers or CHWs and one for supervisors), on-device reports for users to track their individual and program performance, and comprehensive program dashboards. The system applies to the continuum of family planning services, from CHW counselling with the client, to facility referrals and follow-up between the CHW and supervisor. The solution supports:
At the core of this digital system is the CHW, guided by a mobile application with the Balanced Counseling Strategy + to help the CHWs organize and schedule the appropriate series of client interactions needed to ensure their needs are satisfied. The solution is flexible, as it can be configured for the program context and customized based on program needs and focus area. For instance, the system included enhanced reporting for the Shirati Hospital program and a unique first-time mother component for the Population Health and Environment program
The original program in Shinyanga was implemented with 224 CHWs and 16 supervisors, and has served nearly 40,000 clients. This intervention resulted in a 70 percent increase in the use of family planning methods in the intervention location, and a five-fold increase in follow-up visits.
As a result of the original program success, the solution was implemented and adapted in other programs. Overall, more than 900 CHWs and 100 supervisors have been trained on this system. The implementations have supported more than 110,000 clients and more than 400,000 home-based visits. We have seen the following improvements across programs:
Multiple implementations are still active with the FP Plus system in Tanzania, and the programs are continuously monitored for improved family planning counseling and access to family planning and sexual and reproductive health services. Looking toward the future, program teams continue to learn from these implementations and the success of the systems approach, where the program focuses beyond technology to motivation, follow-up, and supervisory structures. Program teams are looking to continue to expand on the Family Planning Plus system and leverage the lessons learned from previous implementations, with the ability to implement in other contexts and with other technology platforms.