Challenges

A needs assessment (2020) in Nepal revealed that the modern contraceptive prevalence rate (mCPR) has stagnated at 43 percent among all married women. 57 per cent of women delivered in a facility, while 31.5 percent of women have an unmet need for family planning during the postpartum period. Nepal’s Ministry of Health was facing the challenge of how to ensure that women who wish to delay or avoid future pregnancies have the ability to do so by using safe and effective contraceptive measures.

In Sri Lanka, the mCPR is 54 percent. A review of the National Family Planning programme in 2016 showed that stock-outs for contraceptives was common, resulting in women and couples not having access to contraceptives of their choice. The need was identified to improve the Logistics Management Information System (LMIS) to prevent stock-outs of reproductive health commodities.

Toward a Solution

This initiative is part of the Family Planning Accelerator project of the World Health Organization (WHO), implemented by the WHO Department of Sexual and Reproductive Health and Research, with the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction. The initiative supports partners and Ministries of Health to improve access to quality and rights-based family planning services in countries.

Through the initiative, Nepal was assisted to integrate family planning services in a decentralized environment using a life cycle approach to improve postpartum family planning (PPFP) uptake. Sri Lanka was assisted to convert its paper-based Logistics Management Information System (LMIS) to a web-based logistics management of family planning commodities for better reporting of stock-outs. Improvements in the quality of family planning services through this project contributes to attainment of SDG goals 3 (good health and wellbeing) and 5 (gender equality).

A reciprocal South-South learning exchange took place between Nepal and Sri Lanka using a five-step methodology: preparation, planning, exchange, implementation of lessons learned and dissemination of results. The exchange was facilitated by WHO and Knowledge Success. Due to the COVID-19 pandemic, the learning exchanges were conducted virtually.

Both countries identified their learning needs, in accordance with their national family planning policies and plans. Nepal’s learning need was to improve the organization of clinical services to strengthen the integration of PPFP with a focus on provincial level ownership and the practical ‘how-to’ provide reproductive health services throughout the lifecycle. Sri Lanka’s learning need was to transform a paper-based logistic management system to an electronic-LMIS (e-LMIS) for contraceptives to enable district and central levels commodity security.

A series of meetings were organized between the two country teams to share their best practices and learning needs. These were followed by in-country meetings to absorb the information gained and implement the lessons learned. The discussions during the meetings were led by the Ministries of Health in both countries. The partners in Nepal were the Ministry of Health and Population, including provincial health officials, academia, professional societies, WHO, UNFPA, USAID, DFID, Ipas and Marie Stopes. In Sri Lanka, the partners were the Family Health Bureau of the Ministry of Health, UNFPA, the Family Planning Association of Sri Lanka, Sri Lanka College of Obstetricians and Gynaecologists and WHO. Both countries crafted their objectives and developed a monitoring system to track progress. By December 2021, both countries began implementing the learnings.

An advocacy tool for PPFP was designed in Nepal. This was used to conduct policy dialogue with policymakers and programme managers in two provinces. The Ministry of Health and Population allocated 2.1 million rupees for all seven provinces to initiate and strengthen PPFP in 20 referral hospitals. Three indicators to monitor PPFP uptake are proposed for inclusion in the Demographic Health Survey (DHS) and the National Health Facility Survey (NHFS). This will help improve the availability of family planning counselling and contraceptive services during the antenatal and postpartum period, which in turn will help women secure their rights to decide freely and for themselves whether when and how many children they want to have.

In Sri Lanka, a dedicated page on the reporting system of contraceptive commodities at different levels was included in the District Health Information Software 2. It was piloted in nine districts of the Northern and Eastern Provinces and scaled up to all 28 health districts. The Officers in Charge of Regional Medical Supplies Divisions were trained on the new formats and the web-based platform. This will ensure availability of contraceptives in health facilities, thus reducing unmet family planning needs in the country.

The lessons learned from the project are listed below and should be considered by other countries wanting to replicate this initiative.

• The learning objective of the South-South Learning Exchange must be clear, specific and in accordance with the country plans and needs.
• The Ministry of Health and stakeholders should lead the process of the South-South Learning Exchange. This is beneficial not only for obtaining their guidance but to ensure their support to implement the lessons learned.
• The use of an in-built monitoring system is critical from the start to track progress. This can be done by using tools like monthly reports, meetings, post-meeting participant questionnaires and after-action reviews.
• Countries facing common challenges and seeking to achieve common goals can make faster progress through shared learning and experiences.