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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.
A university without walls that offers a comprehensive model for continuous, dynamic learning.
Lisa Mwaikambo
Senior Program Officer/KM Lead
Johns Hopkins Center for Communication Programs
Email
Bill & Melinda Gates Institute for Population and Reproductive Health
Johns Hopkins Center for Communication Programs
Jhpiego
IntraHealth International
PSI
Bill & Melinda Gates Foundation
September 1, 2016 – June 30, 2021
Nigeria, Kenya, Tanzania, Uganda, Benin, Burkina Faso, Cote d’Ivoire, Niger, Senegal, India (Uttar Pradesh, Madhya Pradesh, Odisha)
Health Care Provider
Workforce
Service Delivery
The ChalIenge Initiative University (TCI-U) serves as the foundation for rapidly scaling up evidence-based family planning and adolescent and youth sexual and reproductive health (AYSRH) interventions that have been proven to work in urban poor settings in East Africa (Kenya, Tanzania, and Uganda), Francophone West Africa (Benin, Burkina Faso, Côte d’Ivoire, Niger, Nigeria and Senegal), and India—what TCI refers to as Accelerator Hubs.
Recognizing that adults learn in different ways, TCI-U offers opportunities for blended learning, providing in-person as well as virtual coaching, access to curated, practical information and tools, and engagement with fellow coaches and implementers of the proven interventions. TCI-U’s primary audiences are TCI coaches and local government counterparts—decisionmakers and health system staff—who are interested in adapting and implementing the evidence-based family planning and AYSRH interventions.
TCI-U is an online platform as well as an app and includes three main components: Toolkits, Coaching, and Community of Practice.
The Global Family Planning Toolkit, AYSRH Toolkit, and Hub-specific Toolkits are collections of highly synthesized how-to guidance and tools to help cities design and implement the proven interventions. Evaluations of four urban reproductive health initiatives found that programming that deliberately targeted Services and Supply, Demand Generation, and Advocacy—and ensured that they were interconnected—led to significant increases in contraceptive prevalence. As a result, the toolkits are organized around these three program areas, as well as Essentials (such as effective leadership and data for decisionmaking), which are core competencies that every family planning programmer should master.
TCI’s coaching centers on helping local government counterparts to expand their perspectives: to shift from seeing only problems that need to be “solved” to recognizing that opportunities are often disguised as obstacles. Planned and on-demand support is provided by TCI Accelerator Hubs and those trained as master coaches who have expertise in designing, adapting, and implementing the proven interventions. As coaches, the Accelerator Hubs act as knowledge brokers—connecting city and health system decisionmakers and implementers to the critical tools, information, and expertise they need to design and carry out a successful program. Coaching typically starts out at high intensity, but city implementers expect this to gradually taper off as implementation progresses and city teams gain confidence.
The Community of Practice is a shared space for seeking advice and sharing knowledge with fellow coaches and implementers of the evidence-based interventions. Users can also earn badges for engagement with TCI-U by posting a question, replying to a post, taking an assessment, passing an assessment, and scoring 100 percent. This adds a level of “gamification”—and incentivizes the use of TCI and provides recognition of users.
The demand for, engagement with, and use of TCI-U is high. As of December 2019, TCI-U had 4,413 registered users, and more than 690 family planning and AYSRH tools available to adapt for the local context. A total of 661 registered users completed 6,662 assessments to examine the approach adopted in the TCI-U. TCI trained 1,154 coaches, held 2,199 coaching sessions, responded to 210 online coaching requests, and witnessed 1,744 posts made to the Community of Practice by 178 unique users. Given the significant mobile use of TCI-U, a mobile app was launched in November 2018 and now has more than 2,000 users.
Findings from annual TCI-U user surveys and in-depth interviews with coaches and coaches reveal that TCI’s coaching approach is effective in transferring capacity to local counterparts.
TCI-U uses an open-access approach to learning, where participants are inspired and driven by their desire for results. Learning from each other is the only way for us to ensure impact. As a result, TCI-U is constantly being updated with the latest adaptations of tools and evidence as to what works as we expand into new cities.
As TCI expands into new cities, it will simultaneously graduate existing cities. This will require the triangulation of its various data sources—HMIS, survey data, Quality and Sustainability Assessment tool and qualitative data collection approaches—to assess a city’s progress and readiness for graduation. As cities graduate, they will still have access to TCI-U and become part of an alumni network. Their content and training needs can be accessed so that TCI-U can continue to provide them with on-demand support—but no coaching support.