Strengthening family planning with community-based nutrition interventions in Ethiopia : a qualitative study / Daniel Sellen [u.a.]. Washington DC : World Bank, 2013
Content
STRENGTHENING FAMILY PLANNING WITH COMMUNITY-BASED NUTRITION INTERVENTIONS IN ETHIOPIA:
A Qualitative Study
Daniel Sellen, Sharmin Sharif, Bethlehem Tefera, and Ziauddin Hyder
List of ABBREVIATIONS AND Acronyms
Acknowledgments
PREFACE
Executive Summary
part 1. Linking family planning and nutrition programs
1.1. Study rationale, aims, and objectives
1.2. Integrated approaches: a global perspective
1.2.1. Integrating FP with other services
1.2.2. Integrating FP with community-based nutrition (CBN) support services
1.2.3. Operational research needs
1.3. Operational context in Ethiopia
PART 2. Study design
2.1. Data collection methods
2.2. Sampling
2.2.1. In-depth interviews with individual representatives
2.2.2. Site selection for community-based observation and discussion
2.2.3. Observations
2.2.4. Focus group discussions
2.3. Analysis and reporting
2.4. Study limitations
PART 3. Results AND DISCUSSION
3.1. Characteristics of selected study sites
3.2. Qualitative indicators of service delivery (supply side)
3.2.1. Activities and messages delivered
3.2.1.1. FP services delivered at monthly growth monitoring and promotion sessions
3.2.1.2. FP services delivered at quarterly community health days
3.2.1.3. FP services delivered at monthly community conversations and home visits
3.2.2. Record keeping
3.2.3. Supervision
3.2.4. Motivation of health extension and volunteer community health workers
3.2.4.1. Job satisfaction
3.2.4.2. On-the-job challenges
3.2.4.3. Work time, workload, and incentives for staff retention
3.2.5. Supplies
3.2.6. Multisectoral coordination
3.3. Qualitative indicators of service delivery (demand side)
3.3.1. Community-level support
3.3.2. Mobilization of beneficiaries
3.3.2.1. The health extension program platform
3.3.2.2. Observations on gender
3.3.2.3. Regularity and quality of CBN activities
3.3.3. Acceptance of messages
3.3.3.1. Cultural acceptability of links between FP and nutrition needs
3.3.3.2. FP method mix
3.3.3.3. Quality of training
3.3.4. Motivation
3.4. How is CBN perceived to improve FP service and uptake?
PART 4. Lessons learned for scale-up
4.1. Potential limiting factors and obstacles
4.2. Gaps noted
4.3. Other challenges identified
4.3.1. Capacity to support implant removal
4.3.2. Maintaining human resources for health
4.3.3. Addressing FP needs of youth
4.4. Ongoing Changes within CBN, FP, and HEP in Ethiopia
PART 5. CONCLUSIONS AND Practical recommendations
ANNEXES
Annex 1. Study time frame, 2011
Annex 2. themes used to organize discussion with service providers and users
Annex 3. Themes used to organize content analysis of data collected
Annex 4. Example of an interview guide used
Annex 5. Examples of Focus Group Discussion Guides used
Annex 6. Observed activities integrating FP within CBN
Annex 7. FP Messages Health Extension Worker report giving during CBN activities
Annex 8. Examples of stakeholder statements on service delivery, organized by selected themes
Supervision
They (HEWs), after a few months, come crying to us for a transfer. No one wants to work on those (hard to reach) kebeles, and supervision is also very difficult.
Job satisfaction
Incentives
Coordination
Support in the community
Mobilization
How CBN works
Why CBN works
Weak targeting of youth
Resource and funding gaps
Annex 9. Summary of stakeholder workshop