Family planning

Improving women’s access to mobile family planning services

Cash-strapped NGOs could reach more clients in rural areas – at no extra cost – by basing their visit frequency on data rather than habits.

Put yourself in the shoes of Maïly, a fictional community leader working for an NGO. In charge of managing mobile family planning clinics in Kenya, it can deploy 12 medical teams. Each of them can only set up about one mobile clinic per (working) day, as the villages are often remote and difficult to reach. In some places, all it takes is a driver with a megaphone announcing that the team is there to attract a crowd. In others, filling the clinic requires more advance marketing through radio spots or posters.

Maïly’s problem is: which villages should her teams visit and how often, given their diverse needs? With limited resources, it might be tempting to stick to high-traffic places. But over time, frequent visits to the same sites might become less fruitful, as family planning needs might be met. Also, for the sake of fairness, it cannot neglect the other villages. If clinic visits become too far apart and few in number, patients will stop trusting the NGO – or simply turn to other options. Moreover, it would be unethical to deprive patients of the possibility of regular follow-up after certain medical procedures, such as the implantation of an intrauterine device.

To study this problem of optimal allocation of resources, Harwin de Vries, Lisa Swinkels and I* partnered with Marie Stopes International (MSI, renamed MSI Reproductive Choices in 2020), an NGO that gave us access to a large dataset of mobile family planning visits in Madagascar, Uganda, and Zimbabwe . This allowed us to model the relationship between the number of patients seen during a team visit and the time elapsed since the last visit. We were able to develop simple frequency policies that showed a potential increase in patient numbers of between 7 and 10%. In the context of MSI’s work, an increase of just 7% would mean more than 175,000 additional families to whom family planning services could be provided worldwide, per year.

This is important because access to family planning plays a crucial role in achieving many United Nations Sustainable Development Goals (SDGs). In addition to reducing unwanted pregnancies, universal access to contraception is estimated to reduce maternal deaths by 25% and infant mortality by 10%. By allowing women to postpone the birth of their first child, it also helps them to advance their studies. In all, family planning supports four UN SDGs: good health and well-being (3), no poverty (1), quality education (4) and gender equality (5). Unfortunately, in many rural areas of the world, access to these services is limited or non-existent. In a context of declining funding, it is essential to maximize the reach of NGOs providing these services.

Simple policies can go a long way

Often, NGOs grow organically. They start with a few outposts, perhaps based on the founders’ networks. As they grow, their leaders are reluctant to impose policies due to a culture that favors decentralized decisions. There are indeed several factors that favor this decentralization. Who better than those on the ground to know weather and road conditions, market days and other local variables? But over time, this can lead to spaghetti-like growth. Decisions can become based on sheer force of habit, more than logic.

The good news is that, according to our research, simple rules are enough. We found that simply dividing visit sites into two different categories (based on historical visit data) and assigning a specific visit frequency to each category would increase the number of patients served by up to 10%. . In most cases, moving from two to three categories – and thus making the frequency rules more complex – would improve reach by a mere 1% more. Simple rules fit with the organizational culture of NGOs, which values ​​flexibility and empowerment of local staff.

While our study focused on a family planning NGO operating in Africa, our findings apply to mHealth access initiatives in general. Whether the health needs are related to Covid, tuberculosis or dengue for example, and whether the mobile health teams operate in Africa, Asia or South America, devising simple rules to streamline outreach efforts could yield tremendous results.

Impact is often difficult to measure. It’s far from a numbers game. Reaching fewer people can be meaningful if those people could not otherwise dream of accessing health services. But whatever the objectives of an NGO, it is important to start with some data, such as the number of clients or patients served and the number of visits.

Outreach team leaders like Maïly should receive basic training in analytics. The frequency of sensitization is important and should be reviewed periodically, with a critical eye. However, just as important, leaders need to know how to motivate their teams to adhere to simple policies. There may be valid reasons for them to deviate from the recommended frequency of visit – such as weather, accessibility or safety – but overall simple rules, when followed, can help to expand access without additional investment.

*Our paper, Site Visit Frequency Policies for Mobile Family Planning Serviceswas published in Production and operations management.

Luk Van Wassenhove is Emeritus Professor of Technology and Operations Management and Henry Ford Professor Emeritus of Manufacturing at INSEAD. He is co-author of Humanitarian logistics and the director of INSEAD Humanitarian Research Groupsupported by the Hoffmann Global Institute for Business and Society.

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