Long Read

How family planning can be improved by effectively using community scoring cards

Loan Liem, senior programme officer SRHR at Simavi, shared the promising results of one of our projects in India at the International Conference on Family Planning. In the project area, at the initial baseline measurement, more than 30% of women did not know any method of contraception. After 2 years this came down to 20% and after 4 years this was reduced to less than 4%. Family planning uptake almost doubled, from 1700 to more than 320. The secret: effective use of community scoring cards to empower communities to demand the services and supplies needed from their government.

In India, family planning coverage is poor and mostly focuses on female sterilization. Although a broad range of contraceptives is supposed to be available in health clinics and during outreach activities, this is rarely the case.

The project

In the state of Odisha, Simavi and our local partner Voluntary Health Association of India (VHAI) use community scoring cards (see photo) to improve the community’s ability to understand and identify their health needs. The scoring card identifies priority Sexual and Reproductive Health and Rights (SRHR) issues, including the availability of different contraceptive methods and counselling services. This way, the access to and effectiveness of family planning services is measured. Mother Support Groups use the scoring card to discuss bottlenecks in service provision and this information is shared every month at village level. Plans for action to address the gap areas are shared with all relevant stakeholders. Once a year the results and the tool are discussed in a broader group of influential stakeholders.

scoring cards social accountability india

Methodology

The issues mentioned on the scoring card were developed in consultation with community groups, and aligned to the work of local administrators and health care providers. At the start of the programme in 2012, baseline data were collected on availability of family planning methods, counselling services, and other SRHR issues in 16 health facilities. Group interviews took place with couples. The baseline figures on the use of contraceptives were compared with 2014 data. Additionally, VHAI staff members documented case studies on family planning uptake in the intervention area.

Results

Comparison of the scoring cards at the start of the intervention (2012) and the end of 2014 showed that in 11 of the 16 facilities the choice of different contraceptive methods increased. While family planning counselling activities initially were not part of the package, all 16 health facilities included it in their outreach package. Health facility data that was monitored by VHAI showed a 90% increase in the use of contraceptives compared to baseline. Furthermore, at baseline one third of women did not know any method of contraception, which was reduced to less than 20% in 2 years. Figures from 2015 showed it has now decreased to 4%. Initially more than 40% of the eligible couples were not aware about the availability of contraceptives, which decreased to less than 30% within two years. Another important result is that Muslim women joined the mother support groups and became able to discuss family planning and interested to use modern methods.

Lessons learned

The community scoring card is an effective tool to trigger and monitor improvement of SRHR and family planning issues. Since the issues are identified by the community and relevant key stakeholders do work together, all groups strive toward overcoming bottlenecks. The strength of the tool is to convince stakeholders at different levels, it supports to identify gaps and triggers discussion on how to solve problems. Access to services was constraint due to societal barriers, especially in Muslim communities; male involvement and working with religious leaders were identified as next steps to strengthen the programme.

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