Integrated Family Planning and Immunization Service Delivery at Health Facility and Community Sites in Dowa and Ntchisi Districts of Malawi: A Mixed Methods Process Evaluation

Chelsea M. Cooper, Jacqueline Wille, Steven Shire, Sheila Makoko, Asnakew Tsega, Anne Schuster, Hannah Hausi, Hannah Gibson and Hannah Tappis
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Chelsea M. Cooper: Maternal and Child Survival Program, Jhpiego, Washington, DC 20036, USA
Jacqueline Wille: Maternal and Child Survival Program, Jhpiego, Washington, DC 20036, USA
Steven Shire: Maternal and Child Survival Program, Jhpiego, Lilongwe, Malawi
Sheila Makoko: Maternal and Child Survival Program, Jhpiego, Lilongwe, Malawi
Asnakew Tsega: Maternal and Child Survival Program, John Snow, Inc., Arlington, VA 22202, USA
Anne Schuster: Maternal and Child Survival Program, Jhpiego, Washington, DC 20036, USA
Hannah Hausi: Maternal and Child Survival Program, John Snow, Inc., Lilongwe, Malawi
Hannah Gibson: Maternal and Child Survival Program, Jhpiego, Lilongwe, Malawi
Hannah Tappis: Maternal and Child Survival Program, Jhpiego, Washington, DC 20036, USA

IJERPH, 2020, vol. 17, issue 12, 1-14

Abstract: The Government of Malawi’s Health Sector Strategic Plan II highlights the importance of service integration; however, in practice, this has not been fully realized. We conducted a mixed methods evaluation of efforts to systematically implement integrated family planning and immunization services in all health facilities and associated community sites in Ntchisi and Dowa districts during June 2016–September 2017. Methods included secondary analysis of service statistics (pre- and postintervention), focus group discussions with mothers and fathers of children under age one, and in-depth interviews with service providers, supervisors, and managers. Results indicate statistically significant increases in family planning users and shifts in use of family planning services from health facilities to community sites. The intervention had no effect on immunization doses administered or dropout rates. According to mothers and fathers, benefits of service integration included time savings, convenience, and improved understanding of services. Provision and use of integrated services were affected by availability of human resources and commodities, community linkages, data collection procedures and availability, sociocultural barriers, organization of services, and supervision and commitment of health surveillance assistants. The integration approach was perceived to be feasible and beneficial by clients and providers.

Keywords: Malawi; family planning; contraception; immunization; reproductive health; child health; integrated service delivery; evaluation (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
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