Qualitative research for family planning programs in Africa.
BACKGROUND TO STUDY
The case studies discussed in this paper illustrate the use of information gathered from focus groups and in-depth interviews for developing IEC (information education and communication) materials aimed at changing health attitudes and behavior. The case studies include IEC in Burkina Faso family planning awareness in the Cameroon adolescent outreach in Cote dIvoire print and radio materials in Kenya and songs in Nigeria. Methods for conducting focus groups and in-depth interviews and obstacles encountered are explained in each case. Findings reveal that audience participation in planning of programs is key to the success of IEC activities and family planning programs.
Use of focus groups is helpful when speed in reaching people is necessary and trained interviewers are not available. The ideal number of focus groups is 10-12 for small projects. The number is subject to the constraints of time personnel geographic location and money. Analysis may be delayed if the number exceeds 20 groups. Focus groups should represent all relevant demographic sociocultural and economic groups. Ethnic representation is important for national campaigns. Local factors may include number of children contraceptive status socioeconomic status education and employment. Participants should be randomly selected. Participants should not know each other but small village settings may prevent this. The moderators should be trained personnel who can stimulate discussion. Jobs should be clearly defined with money and time commitments understood. Sensitive topics may be addressed better in in-depth interviews. Research aims should be clearly communicated. Tape recording is optional. Reports require qualitative analysis in a timely fashion with user-friendly language which will appeal to a wide audience. Information may be appropriate for new program development evaluation of existing programs or problem identification.
The increase in demand suggests that family planning has essentially become a cultural norm in all three countries. The remaining unmet need, while still sizeable, can be seen not only as an indicator of “challenge” to a family planning program but also as an indicator of “success” because so much demand for family planning has been generated.
The leadership of the Federal Ministry of Health, and especially that of Minister Tedros, is a major factor in the success of the Ethiopian Family Planning Program. The broad plans are set in the Health Sector Development Program, and resources are decentralized to the regions. The FMOH and regions coordinate with the development partners to ensure that support goes where needed without duplicating resource allocation. Partners collaborate on regional and national task forces under the leadership of the FMOH.
Key informants noted that perhaps the greatest contribution to the success of the family planning program is the culture of acceptance for family planning at the community level. As Figure 2 (page 5) shows, close to three-quarters of married women reported a demand for family planning in 2010, which strongly suggests that family planning is increasingly becoming a social norm in Malawi. In explaining this shift, a senior MOH official said that in recent years the Government of Malawi had made concerted efforts to disseminate the benefits of modern family planning to all communities with emphasis on the idea that “modern contraception can help mothers avoid pregnancies that may be too early, too frequent, too many, and too late.”
In addition to the strong champions and policies that support the national vision, several other factors have contributed to the National Family Planning Program’s success. Since 2005, Rwanda has diligently been working towards a decentralized health system. The country expanded the number of health centers at the sector level and hospitals at district level, strengthened overall training of medical personnel, and improved the availability of data for decision making. Ministries are also integrating family planning into all health services to ensure no missed opportunities, for example integration of family planning into immunization and HIV/AIDS programs.
In 2005, 73% of women received their contraceptive methods from government services, according to DHS. In 2010 this figure jumped to 92%. Table 2 (page 24) illustrates an even more important aspect of this shift to public services, the shifting of service delivery closer to the client, away from hospitals to health centers, health posts, and the community. The 2005 and 2010 comparison clearly indicates the transfer of family planning services to lower levels of the health care system, which reflects a dramatic shift in provider training, commodity logistics, and client demand in rural areas – reflecting the strengthening and expansion of health systems and service delivery approaches.
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