scholarly journals “… the way we welcome them is how we will lead them to love family planning.”: family planning providers in Rwanda foster compassionate relationships with clients despite workplace challenges

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hilary M. Schwandt ◽  
Angel Boulware ◽  
Julia Corey ◽  
Ana Herrera ◽  
Ethan Hudler ◽  
...  
Keyword(s):  
Data Analysis ◽  
Family Planning ◽  
Contraceptive Use ◽  
Health Workers ◽  
Government Support ◽  
Modern Contraceptive ◽  
Group Discussions ◽  
Short Period ◽  
Study Participants ◽  
Depth Interviews

Abstract Background Rwanda has markedly increased the nation’s contraceptive use in a short period of time, tripling contraceptive prevalence in just 5 years between 2005 and 2010. An integral aspect of family planning programs is the interactions between family planning providers and clients. This study aims to understand the client-provider relationship in the Rwandan family planning program and to also examine barriers to those relationships. Methods This qualitative study in Rwanda utilized convenience sampling to include eight focus group discussions with family planning providers, both family planning nurses and community health workers, as well as in-depth interviews with 32 experienced modern contraceptive users. Study participants were drawn from the two districts in Rwanda with the highest and lowest modern contraceptive rates, Musanze and Nyamasheke, respectively Data analysis was guided by the thematic content approach, Atlas.ti 8 was utilized for coding the transcripts and collating the coding results, and Microsoft Excel for analyzing the data within code. Results Data analysis revealed that, despite workplace related challenges – including inadequate staffing, training, and resources, relationships between providers and clients are strong. Family planning providers work hard to understand, learn from, and support clients in their initiation and sustained use of contraceptives. Conclusion Given the existing context of purposeful efforts on the part of family planning providers to build relationships with their clients, if the current level of government support for family planning service provision is enhanced, Rwanda will likely sustain many current users of contraception and engage even more Rwandans in contraceptive services in the future.

scholarly journals “…The Way We Welcome Them Is How We Will Lead Them to Love Family Planning.”: Family Planning Providers in Rwanda Foster Compassionate Relationships With Clients Despite Workplace Challenges

2020 ◽  
Author(s):  
Hilary Schwandt ◽  
Angel Boulware ◽  
Julia Corey ◽  
Ana Herrera ◽  
Ethan Hudler ◽  
...  
Keyword(s):  
Family Planning ◽  
Contraceptive Use ◽  
Government Support ◽  
Group Discussions ◽  
Short Period ◽  
Contraceptive Services ◽  
Sustained Use ◽  
Workplace Challenges ◽  
Contraceptive Prevalence ◽  
Depth Interviews

Abstract Background: Rwanda has markedly increased the nation’s contraceptive use in a short period of time, tripling contraceptive prevalence in just five years between 2005 and 2010. An integral aspect of family planning programs is the interactions between family planning providers and clients. Methods: This study aims to understand the client-provider relationship in the Rwandan family planning program and to also examine barriers to those relationships. The data used for this study come from eight focus group discussions with family planning providers and 32 in-depth interviews with family planning users. Results: Data analysis revealed that, despite workplace related challenges – including inadequate staffing, training, and resources, relationships between providers and clients are strong – and that providers work hard to understand, learn from, and support clients in their initiation and sustained use of contraceptives. Conclusion: Via continued and strengthened government support of family planning providers in health facilities and communities, Rwanda will likely sustain many current users of contraception and engage even more Rwandans in contraceptive services in the future.

Young Married Women’s Perceptions On The Maeanings And Motivations For Their Husbands’ Opposition To Their Modern Contraceptive Use In Malawi

2017 ◽  
Vol 14 (1) ◽  
pp. 9-17 ◽  
Author(s):  
Benjamin Kaneka ◽  
Akim J. Mturi
Keyword(s):  
Contraceptive Use ◽  
Health Workers ◽  
Married Women ◽  
Modern Contraceptive ◽  
Group Discussions ◽  
The Family ◽  
Women’S Perceptions ◽  
Modern Contraceptive Use ◽  
Depth Interviews ◽  
Programme Delivery

Abstract The aim of the study was to examine the perceptions of young married women on meanings and motivations of partner opposition to their contraceptive use. Qualitative data was collected from focus group discussions and individual in-depth interviews with young married women and key informant interviews with health workers and traditional leaders in the districts of Ntcheu, Mangochi and Zomba in Malawi. Thematic data analysis was done using ATLAS ti software version 7. The results show that partners’ opposition to young married women’s use of contraceptives was perceived to be principally motivated by their husbands’ quest to control the sexual and reproductive lives of their spouses. Related to this aspect are the fears and misconceptions that use of modern contraceptives would relieve young married women of the fear of engaging in extra marital affairs as they would no longer be afraid of being discovered through pregnancy. Hence, the opposition was perceived to safeguard their marriages from instability and dissolution. The paper asserts that there should be a shift in the family planning programme delivery in the country aimed at reducing or eliminating partner opposition to young married women’s contraceptive use through involvement and inclusion of partners in the designing and implementation of contraceptive information and service provision interventions.

scholarly journals Family planning providers and contraceptive users in Rwanda employ strategies to prevent discontinuation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hilary Schwandt ◽  
Angel Boulware ◽  
Julia Corey ◽  
Ana Herrera ◽  
Ethan Hudler ◽  
...  
Keyword(s):  
Family Planning ◽  
Side Effects ◽  
Contraceptive Use ◽  
First Year ◽  
Modern Contraceptive ◽  
Group Discussions ◽  
Program Success ◽  
Family Planning Programs ◽  
Contraceptive Discontinuation

Abstract Background In Rwanda, nearly a third of contraceptive users discontinue within the first year of use. Family planning programs often focus more on recruitment of new users as opposed to maintaining use among current users. A focus on sustaining users and minimizing discontinuation is imperative for long-term family planning program success. This study explores the efforts providers and contraceptive users in Rwanda employ to prevent one of the greatest challenges to family planning programs: contraceptive discontinuation. Methods This was a qualitative study conducted in Rwanda between February and July 2018. It included eight focus group discussions with 88 family planning providers and 32 in-depth interviews with experienced modern contraceptive users. Data were collected in two districts with the highest (Musanze) and lowest (Nyamasheke) rates of contraceptive use. Data were analyzed using thematic content approach. Results Family planning providers in this study used the following strategies to prevent discontinuation: counseling new users on the potential for side effects and switching, reminding clients about appointments for resupply, as well as supporting dissatisfied users by providing counseling, medicine for side effects, and discussing options for switching methods. Users, on the other hand, employed the following strategies to prevent discontinuation: having an understanding that experiences of side effects vary by individuals, supporting peers to sustain use, persisting with use despite experiences of side effects, and switching methods. Conclusions The strategies used by family planning providers and users in Rwanda to prevent discontinuation suggest the possibility of long-term sustained use of contraception in the country. Harnessing and supporting such strategies could contribute to sustaining or improving further contraceptive use in the country.

scholarly journals Needs Assessment of Community Health Workers to enhance efficient delivery of their services for Community Case Management of Malaria in Kenya

2021 ◽  
Author(s):  
Michelle D. S. Boakye ◽  
Collins J. Owek ◽  
Elizabeth Oluoch ◽  
Sefa Bonsu Atakora ◽  
Juddy Wachira ◽  
...  
Keyword(s):  
Case Management ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Community Case Management ◽  
Group Discussions ◽  
Key Informants ◽  
Efficient Delivery ◽  
Study Participants ◽  
Depth Interviews

Abstract BackgroundMalaria continues to be the leading cause of morbidity and mortality in Africa. Community Case Management of malaria (CCMm) through engaging Community Health Workers (CHWs) to effectively address management of malaria cases in some endemic communities was explored in this study. We assessed the needs of CHWs that would help sustain and retain their services to enhance the efficient delivery of CCMm. MethodsData on the needs of CHWs was gathered through a qualitative study consisting of in-depth interviews and focus group discussions (FGDs) conducted among study participants in five districts in western Kenya using a semi-structured questionnaire. The study participants comprised of 100 CHWs, 100 mothers of children under five years and 25 key informants made up of public health officers and clinicians involved in the CCMm. The interviews were conducted in English and Swahili or Dholuo, the local language. The recorded audio interviews were transcribed later. The analysis was done using NVivo version 7 software and transcripts were coded after which themes related to the objectives of the study were identified.ResultsAll the study participants recognized the need to train and update CHWs on their work as well as remunerating them for their services to enhance efficient delivery of services. The CHWs on their part perceived the provision of gloves, RDTs, lancets, cotton wool and ethanol, bins (to dispose of RDTs and lancets), together with drugs for treating clients as their essential needs to undertake CCMm in the communities. Other logistical needs and incentives mentioned by CHWs and key informants for the successful delivery of CCMm included: gumboots, raincoats, torch lights, mobile phones, means of transportation (bicycles and motorbikes), uniforms and ID cards for identification. ConclusionCHWs would perform tasks better and their services retained for a sustainable CCMm if properly incentivized, offered refresher trainings (and updates) on malaria and equipped with the requisite tools identified in this study.

scholarly journals An examination of the barriers to and benefits from collaborative couple contraceptive use in Rwanda

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Hilary Schwandt ◽  
Angel Boulware ◽  
Julia Corey ◽  
Ana Herrera ◽  
Ethan Hudler ◽  
...  
Keyword(s):  
Family Planning ◽  
Contraceptive Use ◽  
Health Workers ◽  
Male Partner ◽  
Male Involvement ◽  
Modern Contraceptive ◽  
Strongly Correlated ◽  
Male Partners ◽  
Information Share

Abstract Background Supportive male involvement is strongly correlated with contraceptive use. In Rwanda, where the contraceptive prevalence rate among married women increased from 17 to 52% from 2005 to 2010, and stagnated at 53% in 2015, understanding the role of male partners in collaborative couple contraceptive use can help inform programs designed to further increase the use of contraception in Rwanda. Methods This study utilized qualitative methods in 2018, specifically 32 in-depth interviewers with mostly current users of modern contraceptive methods and eight focus group discussions with family planning providers—both family planning nurses and community health workers (CHWs). Respondents were from Musanze and Nyamasheke Districts, the districts with the highest and lowest modern contraceptive use, respectively, to explore the role of couple collaboration in family planning use in Rwanda. Data were analyzed using the thematic content approach in Atlas.ti (8). Results Findings demonstrate that some men are opposed to use of male methods of contraception, and some are opposed to any contraceptive use, which can lead to covert use. Women and providers prefer collaborative couple contraceptive use—as a result, providers advocate for and encourage male partner participation in contraceptive use. Women are most often burdened with seeking out information, initiating discussions, and sharing information discovered about contraceptive use with partners. Decision-making about contraceptive use, once discussed, can be collaborative and motivated by financial considerations. When couple contraceptive use is collaborative, benefits range from marital harmony to husband’s support of sustained use through reminders about appointments, joint counseling, and support in managing side effects. Conclusion Family planning providers at the community and clinic levels encourage collaborative contraceptive use among couples and some Rwandan couples communicate well about family planning use. Despite the positives, women are expected to source family planning information, share that information with their male partners, seek out family planning services, and use family planning. If more Rwandan male partners accepted use, used male methods of contraception, and participated even more in the work it takes to use family planning, the potential for sustained, and even enhanced, contraceptive use in Rwanda could be realized.

scholarly journals The Intention on Modern Contraceptive Use and Associated Factors among Postpartum Women in Public Health Institutions of Sodo Town, Southern Ethiopia 2019: An Institutional-Based Cross-Sectional Study

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Natnael Atnafu Gebeyehu ◽  
Eyasu Alem Lake ◽  
Kelemu Abebe Gelaw ◽  
Gedion Asnake Azeze
Keyword(s):  
Family Planning ◽  
Contraceptive Use ◽  
Cross Sectional Study ◽  
Postpartum Women ◽  
Modern Contraceptive ◽  
Sectional Study ◽  
Cross Sectional ◽  
Care Visit ◽  
Modern Contraceptive Use ◽  
Study Participants

Background. The postpartum period is an important transitional time for couples to put the decision on family planning utilization. However, women in Ethiopia are usually uncertain about the use of family planning during this period. This cross-sectional study was, therefore, aimed at determining the intention of modern contraceptive use and associated factors among postpartum women attending the immunization clinic in Sodo town, Ethiopia. Method. This institution-based cross-sectional study was conducted among 416 study participants from May 25 to June 20, 2019. The data were collected by using a systematic random sampling technique of interviewer-administered questionnaires. Descriptive analysis was done, and results were presented in texts and tables. Variables at bivariate analysis with a p value < 0.2 were moved to the multivariate logistic regression model to control potential confounding variables. Statistical tests at p value < 0.05 during multivariate analysis were considered as a cutoff point to determine statistical significance. Results. A total of 416 postpartum women participated in the study yielding a response rate of 98.1%. The prevalence of intention on modern contraceptive use among study participants was 70%. The odds of intention on modern contraceptive use was higher among study participants who had secondary school education (AOR=2.052, 95% CI: 1.064-3.958), antenatal care visit (AOR=1.74; 95% CI: 1.02-2.95), knowledge on modern contraceptive use (AOR=2.54; 95% CI: 1.50-4.28), menses resumption (AOR=2.05; 95% CI: 1.14-3.68), and husband approval to use contraceptives (AOR=2.395, 95% CI: 1.501-5.458). Conclusion. The intention of modern contraceptive use among postpartum women was low. Family planning providers should emphasize reducing barriers of intention like lack of education, knowledge, male partner approval, antenatal care visit, and advise the impact of menses on fertility.

scholarly journals “…the availability of contraceptives is everywhere.”: Coordinated and Integrated Family Planning Service Delivery in Rwanda

2020 ◽  
Author(s):  
Adriana Scanteianu ◽  
Hilary M. Schwandt ◽  
Angel Boulware ◽  
Julia Corey ◽  
Ana Herrera ◽  
...  
Keyword(s):  
Family Planning ◽  
Service Delivery ◽  
Contraceptive Use ◽  
Health Workers ◽  
Family Planning Service ◽  
Local Level ◽  
Child Health Services ◽  
Planning Service ◽  
Group Discussions ◽  
Potential Applications

Abstract BackgroundContraceptive use in Rwanda tripled since 2005. This study aims to understand the role of coordinated and integrated family planning service delivery in achieving this increase in contraceptive use in Rwanda.MethodsThis qualitative study in 2018 included eight focus group discussions with family planning providers and 32 in-depth interviews with experienced family planning users.ResultsResults indicate a well-coordinated family planning service delivery system with community health workers and nurses filling different and complementary roles in meeting family planning client needs at the local level. In addition, integration of family planning into other maternal and child health services is the norm.ConclusionsThe coordination and integration of family planning across both providers and services may help explain the rapid increase in Rwanda’s contraceptive use and has potential applications for enhancing family planning service delivery in other settings.

scholarly journals Side Effect Concerns and their Impact on Women’s Uptake of Modern Family Planning Methods in Rural Ghana: A Mixed Methods Study

2020 ◽  
Author(s):  
Leah A. Schrumpf ◽  
Maya J. Stephens ◽  
Nathaniel E. Nsarko ◽  
Eric Akosah ◽  
Joy Noel Baumgartner ◽  
...  
Keyword(s):  
Family Planning ◽  
Side Effects ◽  
Contraceptive Use ◽  
Unmet Need ◽  
Mixed Methods Study ◽  
Modern Contraceptive ◽  
Modern Family ◽  
Depth Interviews ◽  
Modern Family Planning

Abstract Background: Despite availability of modern contraceptive methods and documented unmet need for family planning in Ghana, many women still report forgoing modern contraceptive use due to anticipated side effects. The goal of this study was to examine the use of modern family planning, in particular hormonal methods, in one district in rural Ghana, and to understand the role that side effects play in women’s decisions to start or continue use. Methods: This exploratory mixed-methods study included 281 surveys and 33 in-depth interviews of women 18-49 years old in the Amansie West District of Ghana between May and July 2018. The survey assessed contraceptive use and potential predictors of use. In-depth interviews examined the context around uptake and continuation of contraceptive use, with a particular focus on the role of perceived and experienced side effects. Results: The prevalence of unmet need for modern family planning among sexually active women who wanted to avoid pregnancy (n=135) was 68.9%. No factors were found to be significantly different in comparing those with a met need and unmet for modern family planning. Qualitative interviews revealed significant concerns about side effects stemming from previous method experiences and/or rumors regarding short-term impacts and perceived long-term consequences of family planning use. Side effects mentioned include menstrual changes (heavier bleeding, amenorrhea or oligomenorrhea), infertility and childbirth complications. Conclusion: As programs have improved women’s ability to access modern family planning, it is paramount to address patient-level barriers to uptake, in particular information about side effects and misconceptions about long-term use. Unintended pregnancies can be reduced through comprehensive counseling about contraceptive options including accurate information about side effects, and the development of new contraceptive technologies that meet women’s needs in low-income countries.

scholarly journals “…the availability of contraceptives is everywhere.”: Coordinated and Integrated Family Planning Service Delivery in Rwanda

2021 ◽  
Author(s):  
Adriana Scanteianu ◽  
Hilary M. Schwandt ◽  
Angel Boulware ◽  
Julia Corey ◽  
Ana Herrera ◽  
...  
Keyword(s):  
Family Planning ◽  
Service Delivery ◽  
Contraceptive Use ◽  
Health Workers ◽  
Family Planning Service ◽  
Local Level ◽  
Child Health Services ◽  
Planning Service ◽  
Group Discussions ◽  
Potential Applications

Abstract Background Contraceptive use in Rwanda tripled since 2005. This study aims to understand the role of coordinated and integrated family planning service delivery in achieving this increase in contraceptive use in Rwanda. Methods This qualitative study in 2018 included eight focus group discussions with family planning providers and 32 in-depth interviews with experienced family planning users. Results Results indicate a well-coordinated family planning service delivery system with community health workers and nurses filling different and complementary roles in meeting family planning client needs at the local level. In addition, integration of family planning into other maternal and child health services is the norm. Conclusions The coordination and integration of family planning across both providers and services may help explain the rapid increase in Rwanda’s contraceptive use and has potential applications for enhancing family planning service delivery in other settings.

scholarly journals The influence of incentives on community health worker motivation in the provision of family planning. A case of Msalala and Shinyanga Districts, Tanzania

2021 ◽  
Vol 12 (2) ◽  
Author(s):  
Maryse Kok ◽  
Scholastica Lucas ◽  
Josiah Otege ◽  
Zando Mkwazu ◽  
Ingrid Zuleta ◽  
...  
Keyword(s):  
Family Planning ◽  
Community Health ◽  
Financial Incentives ◽  
Health Workers ◽  
Group Discussions ◽  
Policy Makers ◽  
Governmental Organizations ◽  
Non Governmental Organizations ◽  
Wide Range ◽  
Depth Interviews

Community health workers (CHWs) are essential in the provision of a wide range of services, including family planning. In Tanzania, deployment of CHWs has largely been supported by non-governmental organizations (NGOs) who often determine their incentives. A mix of incentives is required to increase CHW motivation and, ultimately, performance. This qualitative study aimed to explore how incentives influence CHW motivation in the provision of family planning services in Msalala and Shinyanga districts. The study included focus group discussions and in-depth interviews with 21 CHWs, 12 supervisors and eight policy makers and NGO representatives. Transcripts were coded and narratives were written on types of incentives, motivating and demotivating factors. The study revealed that although CHW motivation was related to feelings of accomplishment and respect from the community, financial incentives were found equally important for motivation. While most CHWs received non-financial incentives, CHWs had unequal access to financial incentives. Key informants confirmed that there was no coordination on incentives at district level. Some CHWs reported demotivation because of misconceptions and unacceptance of family planning in the community and irregular supply of contraceptives. Results from this study show that motivation of voluntary CHWs in Msalala and Shinyanga districts is currently sub-optimal, because of inequity in access to (financial) incentives. There is a need for better coordination and standardization of CHW incentives. Advocacy is needed to increase funding for CHWs’ deployment and remuneration. This would increase CHW motimotivation and ultimately performance, also in the field of family planning.

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