Health workers at Nemataba Health Center in Senegal's Kolda region discuss the array of family planning options with a mother who is breastfeeding. Photo by Clement Tardif for IntraHealth International.

With funding from the Bill & Melinda Gates Foundation, IntraHealth International has launched INSPiRE: Women's & Newborn Health, the third phase of a successful, cost-effective initiative to integrate health services in Francophone West Africa and save and improve the lives of mothers and babies. Providing a comprehensive package of essential health services—including family planning, nutrition, and maternal and infant care—during a single visit avoids missed opportunities and makes services more accessible, especially for women who live in rural and remote areas and must carry their babies long distances to reach a health facility. 

The World Health Organization (WHO) promotes people-centered, integrated primary health care services to address unmet needs and promote universal access. Postpartum family planning has been identified as a priority high-impact practice to include as it presents one of the greatest opportunities to increase modern contraceptive use and reduce unintended pregnancies and pregnancies that are too closely spaced, which are associated with increased maternal, newborn, and child morbidity and mortality. 

“The INSPiRE initiative has already helped double new family planning users and triple uptake of postpartum family planning."

“The INSPiRE initiative has already helped double new family planning users, triple uptake of postpartum family planning, and nearly quadruple well-baby visits. But we have an unfinished agenda and opportunity for moms and babies,” says Marguerite Ndour, INSPiRE director. “We’re grateful for renewed funding and support from the Bill & Melinda Gates Foundation. This work is not only critical for progress in the region, but it’s also a model to achieve greater impact around the world." 

INSPIRE III will further accelerate adoption of family planning methods and improve maternal and child health indicators by scaling up the integration of postpartum family planning; maternal, neonatal, and child health; and nutrition (PPFP-MNCH-N) services in the nine Ouagadougou Partnership countries, with potential to expand to other countries in West Africa. 

Building on previous progress and strong evidence

INSPiRE began in 2017 in 11 centers of excellence in Burkina Faso, Côte d’Ivoire, and Niger. IntraHealth and partners worked with national stakeholders to design and develop the INSPiRE Integration Model for providing PPFP-MNCH-N services at all levels of the health system and during four critical entry points: antenatal care, delivery, postpartum care, and infant care. The model defines eight essential steps to introduce and scale up service integration including the training and mentoring of health workers.

During INSPiRE I and INSPiRE II IntraHealth and partners also:

• Generated evidence on the effectiveness and cost savings of service integration in the centers of excellence, while providing technical and financial assistance to countries to introduce and evolve the integration model.
• Supported the establishment of national stakeholder-led technical working groups (TWGs) to optimize country ownership.
• Facilitated the set-up of a regional Integration Community of Practice (CoP), chaired on a rotating basis by WHO/Regional Office for Africa (AFRO) and currently by the West African Health Organization (WAHO), to provide technical assistance, advocacy, coordination, and resource mobilization to the national TWGs. The CoP has promoted the development and implementation of Evidence-based National Scale-Up Plans (called PAGE Plans) in six countries.
• Supported countries to establish and adopt indicators of integration consistent across the region.
• Supported development of a series of eLearning modules for providers that are paired with on-the-job mentoring to reduce the cost of PAGE Plans, allow for training more health workers, and encourage retention of information.
• Built capacity of professional associations, civil society, community members, and local health officials to use evidence to strengthen advocacy for integration.

“We leveraged the Ouagadougou Partnership and the Community of Practice for their regional convening power and potential for economies of scale across the nine countries,” says Robert Bambara, INSPiRE's monitoring, evaluation, and learning manager. “These countries are eager to improve maternal and child health, adapt successful integration models, learn from one another, and hold one another accountable.”

“We leveraged the Ouagadougou Partnership and the Community of Practice for their regional convening power and potential for economies of scale."

Governments, implementers, and donors in the region have aligned around the INSPiRE integration model, and it is now being implemented in 607 health facilities in eight of the nine Ouagadougou Partnership countries: Burkina Faso, Côte d’Ivoire, Guinea, Mali, Mauritania, Niger, Senegal, and Togo. More than 95% of these health facilities are located in rural and disadvantaged areas. 

Between 2019 and 2023, INSPiRE saw an overall 123% increase in new family planning users, a 275% increase in postpartum family planning use at supported health facilities, and a 380% increase in well-baby visits for growth monitoring. Among the children who were monitored, fewer than 1 child in 100 presented with acute malnutrition in 2023. 

The biggest challenge is the lack of financial resources, and many competing financial demands. However, progress has been made in mobilizing resources and in aligning technical and financial partners to support scale-up of the Integration Model. Under the impetus of the CoP and the support of INSPiRE, the six countries with PAGE plans have already mobilized more than 10 billion West African francs ($16 million) and are organizing national roundtables to continue resource mobilization and further engage stakeholders to fill gaps.

INSPiRE III: Women’s and Newborn Health

Over the next four years, INSPiRE III will drive additional scale-up and impact of integrated client-centered services in the region by: 

• Providing technical support and ensuring the secretariat role to the regional CoP for integration advocacy, monitoring of progress in countries, and extension to other countries.  
• Leveraging evidence to advocate for additional resources to support PAGE Plans.  
• Supporting national leadership and established TWGs for continuous scaling up at the national and district levels and assessing impact across countries, including on use of antenatal, postnatal, newborn, and PPFP services.  
• Assisting TWGs to meaningfully engage civil society organizations, including youth and women’s associations, and utilize their platforms to amplify integration advocacy, particularly bringing more attention to rural districts. 
• Conducting gender equality and social inclusion assessments of implementation of the integration model in districts in Burkina Faso and Mali, and using findings to inform gender transformative approaches to advocacy, provider training, and community mobilization and identify specific factors affecting women, youth, and marginalized populations’ access to and use of integrated services.
• Increasing adoption and implementation of policies that advance family planning high-impact practices.
• Evaluate the effectiveness of the hybrid training approach and use results to update the modules and to advocate for inclusion of the approach in PAGE Plans.
• Evaluate the effectiveness of the hybrid training approach and use results to update the modules and to advocate for inclusion of the approach in PAGE Plans.
• Collaborating with the Baobab Institute on 2NIBA, a new catalytic fund grant mechanism to support scale up. 

INSPiRE is funded by the Bill & Melinda Gates Foundation. Partners on INSPiRE I and II included Helen Keller International, PATH, and Institut de Recherche en Sciences de la Santé (IRSS). Partners on INSPiRE III include IRSS.