About the Compendium

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.

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MyChoice

Transdigital—using the same “Family Planning story (content)” across different platforms

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Contact

Robert Ainslie
Senior Technical Advisor
Johns Hopkins Center for Communication Programs
Email

Implementation Partners

BKKNB, national counterpart
Jhpiego PPFP BCS counseling
Muslimat and Aisyiyah, outreach organizations

Funder

Bill and Melinda Gates Foundation

Implementation Dates

2015 - Present

Geographic Scope

Indonesia

Target Users

Client, Health Care Provider

Enabling Environment Building Blocks

Services and Applications, Infrastructure, Workforce

Family Planning Program Classification

Service Delivery

Introduction

The MyChoice—Pilihanku in Indonesian—initiative is designed to create a consumer-focused, consumer-driven approach to assist Indonesia in addressing its stagnating contraceptive prevalence rate, unmet need, and skewed method mix where long-acting reversible contraceptives (LARCs) have fallen out of use. In partnership with Indonesia’s National Population and Family Planning (FP) Board, BKKBN, the MyChoice consortium, including Johns Hopkins Center for Communication Programs, JSI Research & Training Institute, and Jhpiego, developed an integrated demand-supply model to reach a new generation of FP adopters, focused on both demand and supply side factors, including consumer life stage, postpartum FP (PPFP), supply chain management, FP leadership, and advocacy. A number of digital solutions were developed to take advantage of the high penetration of smartphone use as well as internet use.

On the demand side, the digital solutions for this project included an integrated information and communications technology platform called Skata using a mobile website, smartphone app, and social media. With this content, MyChoice also developed two community outreach apps for field workers and volunteers to work with tablets and phones. For counseling, the Balanced Counseling Strategy (BCS) was digitized with an app. The counseling app was first used for PPFP, and then expanded for interval counseling for FP. 

Project/Digital Health Solution Overview

The Skata Digital platform was used to reach consumers directly with FP information and resources. Research showed that while FP was well-known, the knowledge was only superficial, and there was a heavy reliance on short-term methods. Women were able to name one or two methods, but didn’t have much information about the method. Skata, which means “to decide as one,” was designed to reach women and their partners with correct information provided in a user-friendly way. Skata provides an app and mobile website with articles, videos, graphics, infographics, and simulations to help women to plan their pregnancies.

The Field Worker Outreach (Aplikasi KKBPK and Aplikasi Kader) apps were first developed to be a job aid for 600 FP “motivators” from two of the largest Muslim women’s organizations. These apps were then adapted for the national FP program field workers. The apps included comprehensive information on FP methods, using videos, text, and infographics. To build field worker capacity, the apps include a counseling component and self-learning. With the tablet, the workers were better prepared to discuss FP with clients and groups as well as share resources from the national FP program.

The BCS app was developed to improve counseling skills for PPFP. As there was a lack of structured counseling for PPFP, the app helped to ensure better counseling with correct and comprehensive information and also ensure that more women were counseled. It also serves as a way for the counselors to do self-assessments of their skills. Due to the success of the PPFP counseling tablet, it was adapted to counseling for family planning at the primary health center (Puskesmas) for people coming into the health facilities for FP counseling. 

Evaluation and Results Data

Since launching in 2016, the Skata platform has generated the following:

  • 5.35 million page views.
  • 96,500 downloads of the app.
  • More than 15.5 million social media impressions.
  • 2,579 field workers taking e-learning supporting over 80,000 health volunteers.
  • 300,000 to 400,000 visitors per month to the Skata site.

The Outreach Workers app: A qualitative study using in-depth interviews was conducted with 16 motivators (from the original 600 motivators) and 48 FP clients who had received FP information from motivators either personally or in a group outreach. A survey was conducted for the project with 11,514 women in six districts. The evaluation found a change in perceptions of LARCs among women who received FP information from motivators:

  • The women perceived that LARCs were efficient because they can be used for longer periods of time, they are effective for spacing of pregnancies, and they can be removed if the woman is planning to have children in the future; the women seemed to have better knowledge that LARCs will not move inside them or limit their work and daily activity.
  • The use of the tablet increased the credibility of motivators in delivering key messages, especially personal barriers to adoption, such as fear of LARC side effects, misconceptions, and religious beliefs.
  • The women felt they obtained new information about FP as a whole from the outreach conducted by the motivators.
  • The survey found that those who received FP information through motivator outreach compared to other outreach approaches are two times more likely to have better knowledge about LARC, and 1.5 times more likely to adopt a LARC.

BCS App: MyChoice conducted monthly monitoring on the implementation of BCS and use of the app:

  • More than 60 percent of FP clients received counseling with the BCS method.
  • 86 percent of clients receiving counseling with BCS adopted an FP method.
  • 37.2 percent of those who adopted a method adopted an implant or IUD.

In addition to analyzing uptake through monthly monitoring, a three-wave evaluation was conducted with a control and intervention, with videotaping of the sessions and telephone follow-ups at 3 months and 12 months to understand the impact of BCS on FP method discontinuation rates.

  • 8.2 percent of women in the intervention group discontinued use within one year as compared to 29.2 percent of women in the control group who did not receive BCS counseling.
  • Trained providers in Wave 1 were statistically more likely than untrained providers to:
  • Provide more structured counseling.
  • Give information about healthy timing and spacing of pregnancy.
  • Explain the benefits and disadvantages of the contraceptive methods preferred by clients.
  • Describe the side effects of methods and how to manage them.
  • Clients were also more proactive with BCS-trained providers. They were significantly more likely to:
  • Ask for the provider’s opinion or advice about FP methods.
  • Express their concerns or worries about a method.
  • Ask providers technical questions about FP methods.
  • Select an FP method.

Lessons Learned

  • Flexibility: With online platforms, it is critical to have the ability to respond to your audience’s needs, filling gaps and providing new value for them. Why do they come back and use your resources? Show them the value added.
  • Do you need an app for that? Look at app vs web/mobile site. Apps are great, but not always the answer when you can use a mobile site or other online platform.
  • Look at the digital space and understand how it is evolving and how to use that new approach. The digital world is ever-changing; it is essential to stay on top of how digital technology is being used and how it is changing so that you can take advantage of it, and not be left behind.
  • When developing digital tools, make sure they are adaptable to different devices, not just one (like a tablet). Ensure tools can be used on various devices, including a phone, tablet, laptop, and others.
  • Develop your digital tools with scale and sustainability in mind. This path will change along the way, but the goal of sustainability doesn’t change. Be adaptable.
  • Offline communities can serve as a core/base moving forward. Offline activities can complement the online activities and offline communities can serve as your champions.

Conclusion

Reaching consumers with FP information in a country as large and diverse as Indonesia can be a daunting task. The MyChoice project used digital solutions because of high Smartphone use and internet penetration in Indonesia. An app was the first consideration. While the app had all the features and information needed, the app itself wasn’t the best channel to use, and a mobile website that mirrored the app was developed. People were able to easily access the site through any device, and data shows that most are using a phone to access the site.

With this content, the apps were first developed for the motivators and then for the field workers. This “Transdigital” platform was able to tell the “FP story” in a number of different ways and through different channels. Because of the high use of phones and tablets, the motivators and field workers were easily able to use the apps on their devices. They felt more confident when using them because they could refer to articles, videos, infographics, etc. when talking to clients.

The health providers (counselors) felt the BCS app was easy to use, and also helped them conduct a structured counseling session that ensured the correct information was provided, and they didn’t leave out steps. They combined the app sessions with hard copies of some materials to ensure that the sessions were interactive and tangible.

The National Indonesia FP program is in the process of scaling these digital solutions for the field workers and the providers. The Skata platform will reside in the private sector to ensure its growth and reach. 

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