In Francophone West Africa, significant efforts are underway to meet national commitments and targets to improve maternal, newborn, and child health (MNCH) and increase family planning uptake. Two investment programs funded by the Bill & Melinda Gates Foundation that we support—The Challenge Initiative (TCI) and INSPiRE—are working together to advance integration of family planning and MNCH health services in the region to achieve greater impact. 

TCI works to rapidly and sustainably expand proven reproductive health solutions among the urban poor. Its demand-driven model enables local governments to lead family planning program implementation with TCI support and coaching. IntraHealth leads TCI’s Francophone West Africa hub, which has helped cities in Benin, Burkina Faso, Benin, Côte d’Ivoire, Niger, Senegal, and Togo add over 380,000 family planning users in the last five years. IntraHealth also leads INSPiRE, which focuses on reducing maternal and neonatal mortality by scaling up integration of postpartum family planning, MNCH, and nutrition (PPFP-MNCH-N) services in the nine Ouagadougou Partnership countries of West Africa. Since 2019, INSPiRE has seen a 123% increase in new family planning users and a 275% increase in postpartum family planning use at supported health facilities.

TCI and INSPiRE initiated collaboration in early 2023 in four cities in Burkina Faso and Senegal. 

Recognizing shared geographical focus and complementary approaches, the two programs initiated collaboration in early 2023 to leverage strengths, capitalize on synergies, harness best practices, and pool resources, starting in four cities in two countries: Koudougou and Po in Burkina Faso, and Pikine and Touba in Senegal. 

TCI’s role is to empower municipalities to prioritize family planning high-impact practices and other interventions (HIPs & HIIs) at both institutional and implementation levels. At the institutional level, TCI facilitates municipalities’ self-reliance in family planning scale-up, encouraging budget allocation for family planning initiatives. At the implementation level, TCI emphasizes systematic family planning needs identification and provision of integrated services during pre- and postnatal care.

INSPiRE’s role is to promote the provision of client-centered PPFP-MNCH-N services through the systematic offering of a package of integrated services in a “one-stop shop.” The INSPiRE Integration Model focuses on the four essential points of contact between mothers and children and the health system: prenatal consultation, delivery, postnatal care, and monitoring of children's growth and vaccination. INSPiRE promotes identification of family planning as well as other health needs, such as maternal and newborn nutrition practices, vaccinations, and screening for cervical and breast cancer. Implementation is coordinated through a technical working group in each country, encouraging ownership and sustainability of the approach.

Collaboration results so far

Together TCI and INSPiRE have achieved significant milestones for furthering integration, including the coaching of health providers in TCI and INSPiRE approaches, enhancing providers’ capacity in family planning and maternal health, establishing coordination units and steering committees in partner cities to guide program implementation, and securing financial commitments from city leaders.

All four city mayors have made financial commitments, with dedicated budget lines, to family planning and MNCH.

Key achievements so far include:

• Municipal and health authorities in the target cities have shown support for both TCI and INSPiRE strategies by contributing financially and by developing and implementing a family planning strengthening program in their locality.
• All four city mayors made political and financial commitments, with dedicated budget lines, to family planning and MNCH.
• 151 health facilities in the four cities have implemented HIPs and the INSPiRE Integration Model. 
• In Pikine and Touba, Senegal, 157 nurses and midwives at facilities received training in both TCI and INSPIRE approaches, enhancing their capacity to deliver integrated services. In addition, 285 community health workers received training and coaching to promote contraceptive use within their communities and facilitate referrals to health facilities.
• In Koudougou and Po, Burkina Faso, 119 nurses and midwives received training on integrated approaches; 63 head nurses in Koudougou received training in data collection and entry of integrated services into the district health information system (DHIS2).
• Health facilities in all targeted cities received medical and technical equipment to provide integrated services, including IUD insertion boxes, implant insertion and removal boxes, delivery tables, standard newborn care corners, newborn resuscitation equipment, and more.

151 health facilities in the four cities have implemented the INSPiRE Integration Model.

The joint TCI-INSPiRE collaboration has enabled a package of services at each of the four mother-child entry points at the supported health facilities. At prenatal care appointments, for example, almost all women received PPFP counseling and nutritional advice. This enabled them to prepare properly for childbirth and take steps to use family planning after delivery.

An analysis of services provided in Koudougou facilities shows uptake of family planning, and particularly of PPFP, has improved since joint implementation began. Koudougou facilities have registered 17,921 additional family planning users during the collaboration period. The use of family planning within 48 hours of childbirth rose considerably before and during the joint intervention, an increase of 287% (see graph above). Additional analyses are forthcoming.

Koudougou facilities have registered 17,921 additional family planning users. 

This collaboration and the results so far exemplify the importance of strategic partnerships in achieving sustainable improvements in family planning and maternal and child health outcomes.

Ownership of the complementary approaches by local stakeholders is essential to accelerate progress of integrated services and ensure sustainability. TCI and INSPiRE will keep working toward this goal. Contact us at intrahealth@intrahealth.org if you would like to partner with us.