Mobile Family Planning Job Aid for Community Health Workers in Tanzania

A mobile job aid for community health workers in Tanzania to support family planning programs

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Contact

Erica Layer
CEO
D-tree International
Email

Implementation Partners

Tanzania Ministry of Health and Social Welfare
D-tree International
Dimagi
FHI 360
Pathfinder International

Funder

USAID

Implementation Dates

January to July 2013

Geographic Scope

Tanzania

Target Users

Health Care Provider, Data Services Provider

Enabling Environment Building Blocks

Services and Applications, Workforce

Family Planning Program Classification

Service Delivery

Introduction

Family planning use protects the health of women and their children by spacing births, preventing unwanted or high-risk pregnancies, reducing the need for abortions, and preventing mother-to-child transmission of HIV/AIDS, ultimately leading to a reduction in maternal and child deaths. One critical determinant of adoption and continuation of contraceptives is overall client satisfaction with family planning programs. Therefore, provision of good-quality contraceptive services is vital to reducing unmet need for family planning.

In Tanzania, current contraceptive use is low; 34.4 percent of women of reproductive age use any form of contraception, and only 27.4 percent use modern contraceptive methods. Further, over a quarter of women report unmet need for family planning.

To address these low levels of contraceptive use, a pilot intervention using a mobile job aid was developed to guide community health workers (CHWs) to deliver integrated counseling on family planning, HIV, and other sexually transmitted infections (STIs).

Project/Digital Health Solution Overview

Beginning in June 2011, FHI 360, Pathfinder International, and D-tree International developed the family planning algorithm in partnership with the Tanzania Ministry of Health and Social Welfare based on a combination of evidence-based tools, such as the Balanced Counseling Strategy Plus Toolkit. The job aid was developed to help CHWs counsel, screen, provide and refer clients for family planning, HIV, and other STIs. The pilot intervention and study were implemented with 25 CHWs in three wards in Ilala district in Dar es Salaam between January and July 2013, registering a total of 710 family planning users (455 continuing users and 255 new users) and counseling them on how to use the mobile job aid over the six-month intervention period.

All users were screened for current pregnancy, questioned on partner support for contraceptive use, counseled on a range of contraceptives, and screened for HIV/STI risk. Most new and continuing family planning users chose pills and male condoms (59 percent and 73 percent, respectively). Pills and condoms were provided by the CHWs at the community level. Referrals were made to the health facility for pregnancy confirmation, injectable contraceptives, long-acting reversible contraceptives, and HIV/STI testing. Follow-up visits with clients were planned to confirm completion of the health facility referral.

Since the initial pilot project was implemented, the system was rebuilt using the Logiak software platform and enhanced to include a more comprehensive workflow, supervisory system, citizen feedback reporting, and a pay-for-performance system. This updated system has been used by more than 400 CHWs in Tanzania with technical support from D-tree International, implemented by Pathfinder International and Shirati KMT Hospital.

Evaluation and Results Data

Routine data collection and analysis was performed throughout the intervention, evaluating the performance of the program using the data collected to execute it. The key findings were:

Scale of Initiative

Over the six-month implementation period, 710 clients were registered and received family planning counseling using the mobile job aid: 455 clients (64 percent) who were already using some form of contraception (continuing users) and 255 (36 percent) who were not using any contraceptives (new users).

Contraceptive Use

Some 455 clients who were already using contraception received a total of 1,044 follow-up visits from the CHWs over a period of six months. At the time of the first visit by the CHW, nearly 35 percent of the continuing users were using condoms and 38 percent were using oral contraceptive pills. Some 255 new clients received a total of 269 follow-up visits from the CHWs. The majority (n = 232) of clients stated they were planning to have a baby in the near future and were educated on short-acting contraceptive methods. The remaining clients were educated on long-acting contraceptives and permanent methods.

HIV Counseling and Services

All 710 clients received education, risk assessment, and pretest counseling for HIV and other STIs. The majority of both the continuing users (73 percent) and the new users (58 percent) said they had been recently tested for HIV. Among those who were willing to share their test results, 57 percent of the 276 continuing users and 54 percent of the 138 new users tested HIV-positive. The high percentage of individuals with HIV in the study is due to the fact that the mobile job aid intervention was piloted as part of Pathfinder’s community home-based care for people living with HIV/AIDS program.

Referral Services

Clients were referred to the health facility for services that could not be directly provided by the CHW at the community level. For example, 21 percent of new family planning users and 28 percent of continuing family planning users were referred for HIV testing/STI services. Of the clients who received referrals and follow-up by the CHWs, nearly 50 percent completed their referrals.

Lessons Learned

  • While the counseling algorithm can support the systematic delivery of information about a wide range of contraceptives, actual client use of contraceptives is still influenced by the contraceptive knowledge of the CHWs, the client’s readiness to start using contraception, and the availability of contraceptive methods.
  • The data emphasize the need to continue training CHWs on balanced and comprehensive counseling techniques. The mobile job aid should serve as an adjunct—not a substitute—for continued investments in human resources and health systems.
  • Systems to encourage CHWs to follow up on clients more systematically are critical. The study suggested that less than 50 percent of the clients who were referred to the health facility were followed up by the CHWs to confirm referral completion.

Conclusion

The use of mobile job aids for delivery of integrated family planning programs holds great promise. However, in order to scale effective programs, a critical appraisal and open discussion of the challenges and solutions is necessary. Implementing organizations must understand that mobile tools support the work of CHWs who still need proper and consistent training to be able to do their jobs well. These applications can serve as guides, encouragement, and reminders to follow up with their clients. In this pilot implementation, 25 CHWs were able to serve more than 700 clients with the appropriate family planning support, improving contraceptive usage and testing rates. Because of their success, these services were extended to a much wider population by upwards of 250 CHWs. The services available through the job aid were expanded to include free direct communication between clients and CHWs, as well as SMS reminders and a supervisory application and dashboard.

References

Family Planning Counseling in Your Pocket: A Mobile Job Aid for Community Health Workers in Tanzania (www.ghspjournal.org/content/4/2/300)