RFI New Family Planning Design with attachements.pdf

U.S. AGENCY FOR INTERNATIONAL DEVELOPMENT

1A Nady El Etisalat Street (off Laselki) New Maadi, Cairo, Egypt Postal Code11435

(2-02) 2522-7000 cairomedia@usaid.gov usaid.gov/Egypt | #usaidegypt | @usaidegypt

Request for Information (RFI) #72026325RFI00004

Activity: New Family Planning Activity Design

Issuance Date: November 04, 2024

Response Date: December 12, 2024, at 15:00 Cairo Local Time

Response emails: nafify@usaid.gov and avonbriesen@usaid.gov

USAID/Egypt’s new family planning (FP) activity design will support and contribute to the Government of Egypt’s (GOE) National Population Strategy (NPS) 2023-2030 and the national human development project "Bedaya" launched in August 2024, and will align with "Egypt Vision 2030" and the framework of the National Dialogue.

This new activity will incorporate high impact practices in FP and innovative, promising approaches to improve family health outcomes. The Mission will work with the Ministry of Health and Population (MOHP), the National Population Council (NPC), and potentially other Ministries to support the achievement of NPS milestones.

This Request for Information (RFI) aims to provide public information to parties interested in USAID’s support to family planning in Egypt as well as to collect realistic, evidence-based solutions, recommendations, and concrete examples to advance the Mission’s efforts in the FP sector.

This RFI is issued solely for informational and planning purposes; it does not constitute a request for proposals or applications, nor promise to issue a future solicitation. The RFI does not commit the U.S. Government to procure any supply or service. Further, USAID/Egypt is not seeking proposals or applications at this time.

Interested parties are advised that the U.S. Government will not pay for any costs associated with responding to this RFI. Responding to this RFI will not give any advantage to any organization in any subsequent procurement (if any).

If a future solicitation is issued, it will be announced on one of two U.S. government sites (www.grants.gov or sam.gov) depending on the type of instrument selected. All interested parties must respond to that solicitation announcement separately, if applicable, from any response to this announcement.

In an effort to provide information as widely and transparently as possible, attached to this RFI are four documents containing the transcripts/notes of four group discussions which constitute all the qualitative data that the Strengthening Egypt’s Family Planning Program (SEFPP)/JSI and OSRA/Pathfinder projects participated in during data collection in the governorates of Fayoum and Sohag, and which were part of an ongoing USAID Family Planning data collection activity. (Note: SEFPP and OSRA are current USAID/Egypt funded activities in the FP space.)

We appreciate any perspectives or insights on some or all of the following questions. Please note that you do not have to answer all questions.

1. Provide examples of innovative approaches that you have successfully used to decrease discontinuation of family planning methods.

2. How would your organization change FP counseling to better meet the needs of women who may encounter side effects?

mailto:nafify@usaid.gov mailto:avonbriesen@usaid.gov

Documentation of Group Discussion with Service Providers

1- Fayoum -1

Discussion session to guide and advise upcoming activities related to family planning projects

1st of July 2024 Date

Fayoum Location

MoHP

SEFPP

Moderators

9:50 – 10:55 am Duration

2 doctors

3 RR

3 Nurses

1. Nurse task share

2. Doctor

3. Doctor

4. Nurse task share

5. Nurse task share

6. RR

7. RR

8. RR

Participants

SEFPP Note taker

Questions

What are the main reasons behind women not using family planning methods? What makes a woman not use family planning methods even though she wants to stop having children or maintain a distance?

1- Working women (working hours are overlapping with PHC time, so women don’t have time to go to the HCU.

2- HCUs are far away

3- Rumors about the methods side effects (RRs offer those counseling on side effects) – rumors affect the community and family members (decision makers) influence on women.

4- Family rejects in general and wants more kids.

5- Husbands are travelling (in frequent sex).

Inquiry area 1:

Perceptions, motivations and beliefs of people who are not users of family planning services

What are the main reasons why women who used contraception stop using it? What makes a woman stop using the method during the first year?

1- Husband travelled

2- Women change their mind and want to get pregnant

3- Women started getting Side effects – went back to the HCU and get medicine and if the medicine did not work women get scared and stop the method. RRs follow-up on discontinued users to know the reasons

4- Women get normal side effects, but the private doctor tell the women that the HCU methods are bad and of poor quality. HCU shows the expiry to patients.

5- Above 45 years they stop the method and poor understanding of women on how FP methods work.

6- Women Working hours

7- Women get sick and private doctors ask women to stop all used methods.

8- Husband refuse

9- Women got separated (fights with husbands)

10- Methods failure (she got pregnant) so women lose trust in the methods.

What factors do women take into consideration when making decisions related to family planning? What does a woman think about when making a family planning decision? Or her decision not to use a method?

1- women health condition

2- Just delivered a baby so need to take a break

3- Mother-in-law influence and husband’s influence

4- Better education for her kids

5- HCU is good and offers good quality health.

6- Offer better socio-economic standards for her kids

7- Willing to have kids with small age gaps

8- Economic status (poor women would go more the HCUs)

“The good service delivery venue attracts women to get FP method” – Task share Nurse - Fayoum

Who participates in women's discussions and decisions about family planning?

Mother-in-law plays an important role. Husband as well makes a decision.

Women mother as well.

Women discuss with RR as well and share with the RR the rumours she hears from her community. And same for nurses.

who makes the decision? Husbands and mother-in-law (even more than the husband) – Urban and rural

RR try to raise the mother-in-law awareness and HCU offer awareness campaigns for mothers in law.

What sources of information do women use when seeking advice about family planning methods?

Neighbours offer info (incorrect on methods and their side effects)

HCU / hospital

RR is the main source.

Mass media

If applicable, what digital information sources do women use when seeking advice on family planning methods?

Google search -

Small percentage of women, it is easier to go to the HCU or ask the RR.

MoHP program (not sure it is there in place) – Nurses get training on this online platform. Not sure if this is available for beneficiaries.

Women won’t be able to tell the difference between the wrong and correct info available online.

Online channels for doctors on FB.

(infrastructure)RRs had different idea (leave more room) not all women have access to the internet.

Rural areas have poor infrastructure/ urban areas are better and women are using smart phones.

What barriers or challenges do women face in accessing family planning services or information?

1- HCU is far away, and they spend a lot of money to commute to the HCU. Methods are free. We offer mobile clinics. Nurse offers

2 months method stock to save woman one trip to the HCU. And

RR Inform women about mobile clinic dates

2- Unavailability of methods in the HCU (others say all methods are available). Nurse convinces women with alternative available in the

HCU.

What role do health care providers play in women’s journey with family

RR: awareness of women on need for methods, suitable methods for the women case. And offer information about the place to get the method

(mobile clinic/HCU)

Nurse: get woman information, offer counselling, promote LARC methods. Follow-up on women and update them on mobile clinic dates.

Doctor: decide which method to use and provide the method and offer counselling if needed.

MoHP need to focus on the task-share nurse and offer financial and mental recognition for them. Task share nurse – Fayoum.

How can providers better support contraceptive users?

RR: nothing requested

Nurse: equipment and tools need to be available (sterilizing equipments).

Need more FP nurses in the HCU. Currently one FP nurse in the HCU.

Other nurses refuse to cover for the FP nurses in case of absence. We don’t have any incentives to cover for the high load of work. Incentives are needed to compensate for the load of work. Nurses need more recognition. (Job description) more awareness materials in the HCU.

FP unit is the dynamic place at any HCU- Task share nurse – Fayoum.

Doctor: need more training and practice on FP methods. More doctors are needed and focused on the FP responsibilities.

AC in the mobile clinic.

Looking to the future, what changes or improvements would you like to see in family planning services or policies to better meet the needs of individuals and communities?

System to offer correct trusted information for women on methods and side effects. (publicly accessible)

Technology: (1) awareness using the existing PC in the HCU. Trusted links of data sources and (2) track women and follow-up on women and update their status on a system.

Mass media is very important (TV/social media/ communities) everywhere.

Have you ever used any technology to provide information about family planning? Examples cover a wide range of channels, most often including instant messaging apps (such as WhatsApp), social media platforms (such as Facebook and Instagram), We know there are wrong info on social media, but we don’t interfere with that info.

We use WhatsApp to inform certain women on the mobile clinic dates/and offer counselling as well for women upon request of women.

Nurses ask the doctor to offer advice and they share it with the beneficiaries.

WhatsApp groups invade the privacy of women. all communication is one-on-one with the beneficiaries. The WhatsApp group may create rumours among the beneficiaries. Nurses don’t have time to follow-up all the time.

Area of Inquiry 2:

Digital

Communications and Behavior

Change

Digital communication tools are increasingly important and play an important role in family planning services. Based on your experiences...:

Have you ever used any technology to provide family planning services?

Examples include online forums and communities, virtual meeting platforms and events

We use WhatsApp to inform certain women on the mobile clinic dates/and offer counselling as well for women upon request of women.

Nurses ask the doctor to offer advice, and they share it with the

One side communication with beneficiary or interactive tailored one-on-one channel with beneficiaries for beneficiary privacy and avoiding negative rumours.

MoHP Hotline is a good example. Women are using the hotline. Nurses write down the number for beneficiaries. When the nurses are on vacation (FP room is closed) women call the hotline.

hotline can alleviate the burden from nurses and cover for their absence.

If so, have you faced any challenges or obstacles when using this technology? And what has been the community’s reaction to this technology?

Respond to WhatsApp takes a lot of time from the nurse’s time.

In your opinion, how accurate and reliable is technology-based information or services compared to traditional methods of providing family planning information or services?

Currently available info online is not trusted (informal pages).

In your opinion, in what ways can technology be improved to better support family planning needs? Is there an opportunity to use technology to better support family planning needs?

MoHP need to have stronger presence online with accurate information.

Doctors are very calm (almost silent) – young

Urban nurse is advocating for technology / rural areas RR are advocating against

There is a FP page (حقك تعرفى – it is your right to know( but the nurses are not aware of it. It offers online counseling and awareness material.

Notes:

4- Suhag - 2

Discussion session to guide and advise upcoming activities related to family planning projects

06.08.2024 Date

Suhag Location

MoHP

OSRA

Moderators

1 hour (9:54 am – 11:00 AM) Duration

(Total 8)

- One Women club rep

- Two RRs

- Two Doctors

- One Media rep

- Two Nurses

OSRA Note taker

What are the main reasons behind women not using family planning

1- Women are busy and want to get the service at home

2- Husband and mother-in-law refuse

3- HCU is far away but we provide mobile clinics

4- The new HCUs are far away from villages so this issue of accessibility will increase in the coming years

5- High cost to commute to the HCU

6- The long procedures in the HCU and must visit the national campaigns which take a lot of time from the woman.

7- The high cost of ticket in the HCU and must pay for the other checkups before it gets to the FP doctor to get counseling and method. It is cheaper to get the method from the pharmacy

Women awareness increase over time especially with the current economic situation – doctor – Suhag

Inquiry area 1:

Perceptions, motivations and beliefs of people who are not users of

1- 2 What are the main reasons why women who used contraception stop using it? What makes a woman stop using the method during the first year?

2-

3- Side effects

4- Husband travel

5- Private sector doctors’ negative rumors about the HCU FP methods

6- Absence of doctors to offer counseling to the women in case of side effects. Nurses are afraid to give counseling related to side effects and the women prefer the doctor over nurses advise.

7- Women change their mind and decide to have more kids.

8- Women decide to get the method from private sector due to the long wait time/distance of HCU and high cost to commute to the

HCU and high-ticket cost.

3 What factors do women take into consideration when making decisions

1- Influence of their small circles

2- Number of kids, the less kids the more intention women to use FP method

3- Education level of women, the higher education the more aware women are and willing to use FP methods.

4- The welcoming environment in the HCU and good service and easy language of the service providers in the HCU.

5- Doctor availability in the HCU

6- Financial status (higher economic situation is the more kids)

7- The availability of the method. Implants as a trend in Suhag / then they want to remove it due to side effects. They get another method temp till they get the implants.

8- Religious input as well.

4 Who participates in women's discussions and decisions about family

Husband is the main decision maker

RRs contribute to the decision of the women but not the decision maker.

Mother-in-law influence is the highest according to the gender of kids (if they did not have boys yet, the mother-in-law will make the decision to have more kids.

If the woman convinced with the FP concepts, she would convince her husband – RR in Suhag 5 What sources of information do women use when seeking advice about

Small circles of family and friends

RR

6 If applicable, what digital information sources do women use when seeking advice on family planning methods?

Internet for higher educated women but very small percentage Google

TikTok for shorts/reels of doctors

Content is not necessarily accurate

Visiting doctors cannot gain the community trust unlike the resident doctor.

What barriers or challenges do women face in accessing family planning services or information?

Far distance

High cost

Availability of doctor in the HCU

8 What role do health care providers play in women’s journey with family

Load is too heavy for service providers

9 How can providers better support contraceptive users?

RRs need a car to visit families faster.

RRs need incentives and compensations for the work we are doing.

Salaries for RRs are delayed for 3 months.

10 Looking to the future, what changes or improvements would you like to see in family planning services or policies to better meet the needs of

RRs need to have contract on the HCU. And more RRs in the HCUs.

The cars are not working and cost a lot to use it in the visits and awareness sessions

More training to the service providers especially for the new methods and train the media rep on them. Update the training material

Mass media campaign in TV can be helpful.

Husbands’ awareness needs to increase.

“Women are not the solo responsible for the FP decision so other influencers need to be targeted like husbands”- doctor – Suhag.

Mobile clinics cannot insert the implant and hormonals IUD. Nor the visiting doctors capable of doing it. Expensive methods to be in mobile clinics.

Awareness sessions for men with MoY, religious leaders, women clubs.

HCU level: more medicine// available doctor/ no certain area for women.

Long-term doctor.

Task sharing is important and benefited the HCU itself.

planning? Examples cover a wide range of channels, most often including:

Nurses send messages on WhatsApp. The community have groups on

WhatsApp, and we use those groups to announce the mobile clinics.

No one announced the MoHP FP page. Hotline: not really the service providers do not know about the hotline. The women call the service providers directly.

Area of Inquiry 2:

Digital

Communications and Behavior

Change

Digital communication tools are increasingly important and play an important role in family planning services. Based on your experiences...:

11 Have you ever used any technology to provide family planning services?

We did not think about creating groups for women. Very few women have phones or phone numbers. Or at least not smart phone. They call us over the phone.

The hotline and Facebook page might work for high educated women. The internet connection is bad. And expensive to connect to the internet.

13 If so, have you faced any challenges or obstacles when using this

Did not try it.

In your opinion, how accurate and reliable is technology-based information or services compared to traditional methods of providing family planning information or services?

N.A

15 In your opinion, in what ways can technology be improved to better

N.A

Women club audience – 18 up to 60. Awareness on FP and other messages. No training vocational in the women club. Only awareness campaigns. NGOs awareness campaigns.

Screen is there in the women clubs and HCU but not used (no content).

Media officer: need posters and charts.

Religious leaders make a difference. Women and mother-in-law mainly and in some cases youth inside the HCU and NGOs.

Notes

3- Suhag - 1

Discussion session to guide and advise upcoming activities related to family planning projects

5 / 8 / 2024 Date

Suhag Location

MoHP

OSRA

Moderators

Started 10:07 – 11:15 am Duration

(total 9)

- One RRs supervisors

- One Nurses supervisors

- One Media rep

- Three RRs

- One Nurse

- Two Doctors

OSRA Note taker

1 What are the main reasons behind women not using family planning

• The HCU is far away from women and high cost to commute to the HCU.

• Reputation of the FP methods (community rumors).

• Don’t feel comfortable using the FP methods (few cases).

• Fear of the FP method and its side effects and get affected by women experiences in their communities.

• Lack of service providers (no doctors in the HCU).

• Husband and mother-in-law refuse to let woman use FP method.

Inquiry area 1:

Perceptions, motivations and beliefs of people who are not users of

2 What are the main reasons why women who used contraception stop

• Husband travels

• Bad counseling and having side effects with minimal information about those side effects

• Bad treatment in the HCU and long wait time in the HCU

• Women not convinced with the FP method, influenced by husband’s decision yet she really want to have more kids.

3 What factors do women take into consideration when making decisions

• Women health condition and number of kids and gender of kids (if she only has females)

• Employment status (if women work, they would be motivated to use FP method)

• Economic situation: if they have more money, then they are willing to have more kids. Yet, in some cases women decide to have more kids even if their economic situation is poor.

4 Who participates in women's discussions and decisions about family

Husband and mother-in-law are the decision makers.

In some cases, women decide for themselves.

Mothers and friends think with the woman but not a decision maker.

- Family and friends mainly (not necessarily accurate information)

- Service providers like RRs who corrects their wrong information about the FP. And private doctors who sometimes provide not accurate information about the FP methods (contribute to the negative rumors about the FP methods). Women trust the private doctors more as they are paid service

- Media such as TV

- Internet (even illiterate they watch videos) mainly

YouTube/TikTok

7 What barriers or challenges do women face in accessing family planning

- Distance of the HCU and absent of some methods

- Rumors of other women in the HCU about methods side effects

- Service providers role to meet women and offer alternatives/proper counseling and ask for her feedback to encourage other women in the HCU about the FP they used.

- Offer privacy to the women and build trust with the women like post-partum women.

In one case, 11 women left the HCU in Suhag without using a FP method after they requested the implant, and the doctor clarified that the HCU only had 4 implants and already used by other women – Nurses supervisor in Suhag.

Implants removal is not possible in HCU due to the high cost of its insertion, which demotivates women from using the method – Nurse – Suhag.

It is the doctor’s responsibility to convince women with other methods and offer alternatives to them – Suhag – nurse supervisor.

Friendly treatment and Proper counselling can solve a lot of problems like fear of FP methods side effects – HCU Media representative – Suhag.

FP need to be integrated into other macro-health care campaigns like chronic diseases and breast cancer campaigns – Suhag.

Doctor: male doctor is not offering FP services in the HCU due to the culture in Suhag. The training is not necessarily relevant to him. Yet, in other cases some male doctors are specialized in FP. So training targeting need to be better.

Nurse: task sharing training is important and needed by nurses not to lose any beneficiaries.

“Task sharing will enable us (FP service providers) not to lose any beneficiary” – Nurse supervisor – Suhag.

Need continuous follow-up on nurses and updated training.

Doctor: the equipment and tools in the HCU (gloves/ etc.)

Nurse: equipment maintenance in the HCU and laptop/tablet to follow up on patients faster.

RR: all services in the HCU need to be available. Sonar one month after the IUD insertion is not possible so women lose trust in the HCU. The scale for weight and sugar levels.

The long wait time can be managed by better organization of patients and allocation of nurses to service women faster.

Equipment like sonar.

Keep the women safe.

10 Looking to the future, what changes or improvements would you like to see in family planning services or policies to better meet the needs of

We need more HCUs that are accessible to all women. Have a full-time doctor in the HCU.

In some cases, doctors are there and trained in the HCU, but they refuse to work! Need follow-up and enforcement of law. They wait for the visiting doctor to do the work in the HCU.

Without incentive and discipline or monthly evaluation the doctors will choose not to work. Salaries are too low for the doctors. There is a need for procedures and enforcement.

The medicine for FP side effects needs to be available for women.

The screens in the HCU need to be used with awareness material on FP among other messages.

One RR use WhatsApp for a few women (20 out of 500 beneficiaries).

They use the WhatsApp group to share info about the doctor’s availability in the HCU, dates of medical convoys.

They advise women to search on YouTube about the methods! They did not know about the MoHP FP page حقك تعرفى . this can be added to the hotline posters in the HCU.

They are not aware of the hotline usage by women. The service providers do not know about the hotline. The service providers ask women to call them directly in case of questions/emergency. Service providers are afraid that the women will use the hotline to complain about the received service in the HCU.

Posters are not necessarily the most attractive tool to women. They prefer the one-on-one counseling.

Communications and Behavior

Change

Digital communication tools are increasingly important and play an important role in family planning services. Based on your experiences...:

11 Have you ever used any technology to provide family planning services?

One RR use WhatsApp to answer questions of women. Women ask questions about FP and other topics like their kid’s vaccinations.

13 If so, have you faced any challenges or obstacles when using this

Only 10-15 women mainly educated women. Some women do not have smart phone/phone.

Slow response from the service provider to questions on the WhatsApp group.

Women cannot log into Facebook. They prefer to call their known service providers.

In your opinion, how accurate and reliable is technology-based

On YouTube there are a lot of wrong information. Not dedicated page with trusted content. That information need to be validated with the service providers in the HCU.

15 In your opinion, in what ways can technology be improved to better

Smaller WhatsApp groups with educated selected women who can act as community leaders/ambassadors to the nurses/RR in their communities.

The group need to be managed by a team of service providers to distribute the burden of addressing the women questions and doctor can ensure shared information is accurate. Women would love those groups development. This can solve the accessibility constrain for some women.

The service providers might have some capacity/time to respond to the women.

FP pages with trusted content. Yet the response rate is low (2-3 women).

TikTok can be a new channel that will attract women especially younger age groups. Use general health topics and integrate the FP messages into those wider topics.

Media officer additions:

Communication methods:

HCU and communities’ awareness campaigns like in youth clubs (same audience) so not very effective. The HCU is better as I get to meet new beneficiaries. I organize small groups sessions for women in the HCU.

Most effective: using messages related to breastfeeding and 15-20 women.

Husbands if they are at the HCU she talks to them, and they respond well.

Mothers-in-law are not responding well to consultations, yet they have very high influence.

Facebook: not really. Only few posts with low interactions.

Challenges and Needs of Media officers:

Media officers are pressured by the number of HCUs they support.

Get social media training and promote for the MoHP FP page (?) and utilize the screens in the HCU (everyone comes to vaccine their kids).

2- Fayoum - 2

Discussion session to guide and advise upcoming activities related to family planning projects

1.07.2024 Date

Fayoum Location

MoHP and SEFPP Moderators

11:26 – 12:40 PM Duration

2 Doctors

3 Nurses

3 RR

SEFPP Note taker

1 What are the main reasons behind women not using family planning

1- Influence of family members (mother-in-law / husband). Norms on larger size families believes or having a boy influence the women as well

2- Women does not have the knowledge about the FP benefits. Did not get enough counseling. Or have wrong information about methods needed.

3- HCU location can be a factor. Far HCU and the quality of the

HCU services. (Mobile clinic if offered for those remote areas).

The cost of commuting to the HCU is high.

4- Rumors about the side effects of methods and believes of the women on those wrong rumors about the methods.

5- Private sector doctors offer negative rumors about the HCU methods. (this information is difficult for the nurse/RR to change the women belief).

Inquiry area 1:

Perceptions, motivations and beliefs of people who are not users of

2 What are the main reasons why women who used contraception stop

1- Women fear of side effects. Especially for the post-partum

2- Methods failure

3- Women facing side effects (even with good or bad counseling)

4- Having on child so they change their mind to have more kids

(younger age groups)

5- Husband travel (high number of beneficiaries)

Younger age groups have higher discontinuation percentage (want to have more kids and get scared easily of the side effects)

3 What factors do women take into consideration when making decisions

1- Women health

2- Economic status (the poorer women the higher chance they will get a method)

3- Fear from the FP method side effects or methods rumor.

4- Fear of the weight gain by women (methods cause weight gain)

5- Religious belief (all agreed that is decreased now) – saturated.

Awareness sessions by religious leaders made a difference.

“Awareness of women on FP is improving and that is reflected in the women visits to the HCU” – Nurse – Fayoum.

Who participates in women's discussions and decisions about family

Mother, mother-in-law, husband

Decision maker: Mother-in-law (mainly) and husband

“Mothers-in-law decide on the type of FP method and the duration to use this method especially for young females.” Doctor- female - Fayoum

Close circle (family members and neighbour)

Pharmacy / private doctors/ HCU service providers

HCU patients as well share information with the woman. HCU posters attracts women attention as well and get information from it.

Awareness raising events in the community/ flyers distributed.

Internet (search on google) – but that is not for all women.

FB groups not formal groups

WhatsApp messages on vaccinations (alarms and reminders)

7 What barriers or challenges do women face in accessing family planning

1- Absence of female doctor

2- One FP nurse is a limitation as it stop the service in case of absence. This is solved by high level decision that the FP room need to be always open.

3- Busy HCUs with a lot of patients (long wait time)

4- Far HCU from beneficiaries.

Task-sharing reduced the unmet need as all women visiting the HCU now can get a FP method during their visit after receiving the needed counselling – Task-sharing nurse - Fayoum.

RR: home visits and awareness of women and refer women to the HCU

Nurse: offer counselling to females in the HCU, handling and answering questions of women, Doctor: counselling and addressing women questions, provide the method to women. We have heavy load of work and do mobile clinics besides our clinic work and no financial incentive as well to compensate for the heavy workload.

RR: no requests we had enough training. Maybe reduce the number of families (currently 1000 family for each RR). Need more RRs. Better distribution of RR. New awareness tools (flip charts, etc.)

Nurse: updated knowledge and training already delivered by the MoHP.

Refresher training is already offered to the nurses. Equipment is need for the HCU.

Doctor: we need more doctors. We are severely struggling on the FP speciality. Incentives for doctors to specialize in FP. The heavy load of work demotivates new doctors from joining the FP.

1 Looking to the future, what changes or improvements would you like to see in family planning services or policies to better meet the needs of

Financial compensation is the key issue.

More FP female doctors

We take so much time to do data entry. We need to use the PC in the

HCU in registering the beneficiaries and fill in their information and follow-

up. Media officers can use the PC to do awareness activities.

More RRs to support families.

Beneficiaries are too many and their recorded phones could be their mother-in-law or husband. Women prefer to share her husband’s phone number.

Not all beneficiaries have smart phones

Nurse: know about a FP group that share messages on FP.

3 participants know about (it is your right to know) but it create conflicts and rumours among the comments. None of the participants referred the

FP MOHP FP page to their beneficiaries.

One RR have a WhatsApp group with 100 women (out of 1000 families) and share updates on the doctor’s visits.

RR visit each woman each 3 months + Busy schedule

Communications and Behavior

Change

Digital communication tools are increasingly important and play an important role in family planning services. Based on your experiences...:

1 Have you ever used any technology to provide family planning services?

They did not offer FP services digitally.

It should not be the nurse role (we don’t have time to do that)

13 If so, have you faced any challenges or obstacles when using this

Beneficiaries are too many and their recorded phones could be their mother-in-law or husband. Women prefer to share her husband’s phone number.

Not all beneficiaries have smart phones

In your opinion, how accurate and reliable is technology-based

Currently available information online is mostly wrong from non-specialized FP pages. The info is mainly other women practices not medical information.

15 In your opinion, in what ways can technology be improved to better

Mass Media campaigns on TV

Hotline of MoHP is not well promoted among the beneficiaries.

Beneficiaries sometime don’t trust the info offered on the Hotline.

Screen on the waiting area with key FP messages would be helpful for women to attract their attention while waiting for other services (like vaccination)

Awareness needs to be targeting husbands and mother-in-law. RR try and invite them to awareness sessions by religious leaders. OSRA is covering this already.