Improve women’s access to mobile family planning services
Cash-strapped NGOs could reach more clients in rural areas – at no additional cost – by basing their visit frequency on data rather than habit.
Put yourself in the place of Maïly, a fictitious local manager working for an NGO. In charge of the management of mobile family planning clinics in Kenya, it can deploy 12 medical teams. Each of them can only set up about one mobile clinic per (working) day because the villages are often far from each other and difficult to access. In some places, a driver with a megaphone announcing that the team is there is enough to attract crowds. In others, filling the clinic requires more advanced marketing through radio spots or posters.
Maïly’s problem is: Which villages should her teams visit and how often, given their various needs? With limited resources, it might be tempting to stick to busy places. But over time, frequent visits to the same sites may become less successful, as family planning needs may be met. Also, for the sake of equity, it cannot neglect the other villages. If clinic visits become too remote and infrequent, patients will stop trusting the NGO – or simply turn to other solutions. In addition, it would be unethical to deny patients the possibility of regular follow-up after certain medical procedures, such as implantation of an intrauterine device.
To study this problem of optimal allocation of resources, Harwin de Vries, Lisa swinkels and I * partnered with Marie Stopes International (MSI, renamed MSI Reproductive Choices in 2020), an NGO that gave us access to a large dataset on mobile family planning visits in Madagascar, Uganda and Zimbabwe. This allowed us to model the relationship between the number of patients seen during a team visit and the time since the last visit. We were able to develop simple frequency policies that showed a potential increase in the number of patients of between 7 and 10 percent. In the context of MSI’s work, an increase of just 7 percent would mean more than 175,000 additional families to whom family planning services could be provided globally, per year.
This is important because access to family planning plays a crucial role in achieving many United Nations Sustainable Development Goals (SDGs). In addition to reducing unwanted pregnancies, universal access to contraception is estimated to reduce maternal deaths by 25 percent and infant mortality by 10 percent. By allowing women to postpone the birth of their first child, it also helps them advance their education. In all, family planning supports four United Nations SDGs: good health and well-being (3), no poverty (1), quality education (4) and gender equality (5). Unfortunately, in many rural areas of the world, access to these services is limited or non-existent. In a context of declining funding, it is essential to optimize the reach of the NGOs providing these services.
Simple policies can go a long way
Often, NGOs develop organically. They start with a few outposts, perhaps based on the founders’ networks. As they grow up, their leaders are reluctant to impose policies because of a culture that favors decentralized decisions. There are indeed several factors that support this decentralization. Who better than those in the field to know the weather and road conditions, market days and other local variables? But over time, it can lead to spaghetti-like growth. Decisions can become based on sheer force of habit, more than logic.
The good news is that, according to our research, simple rules are enough. We found that simply dividing visit sites into two different categories (based on historical visit data) and assigning a specific visit frequency to each category would increase the number of patients served by up to 10%. . In most cases, going from two to three categories – and thus complicating the frequency rules – would only improve the range by an additional 1%. Simple rules correspond to the organizational culture of NGOs, which value flexibility and empowerment of local staff.
While our study focused on a family planning NGO operating in Africa, our findings apply to mobile health access initiatives in general. Whether health needs are linked to Covid, tuberculosis or dengue, for example, and whether mobile health teams intervene in Africa, Asia or South America, devising simple rules to streamline advocacy efforts could yield profound results.
The impact is often difficult to measure. It is far from being a numbers game. Reaching fewer people can be useful if these people could not otherwise dream of accessing health services. But whatever the goals of an NGO, it is important to start with certain data, such as the number of clients or patients served and the number of visits.
Managers of outreach teams like Maïly should receive basic analytical training. The frequency of sensitization is important and should be reviewed periodically, with a critical eye. Equally important, however, leaders need to know how to get their teams to adhere to simple policies. There may be valid reasons for them to deviate from the recommended visit frequency – such as weather, accessibility, or safety – but overall, simple rules, when followed, can help. to expand access without additional investment.
* Our paper, “Site visit frequency policies for mobile family planning services“, was published in Production and operations management.
Luk Van Wassenhove is Professor Emeritus of Technology and Operations Management and Henry Ford Professor of Manufacturing Emeritus at INSEAD. He is co-author of Humanitarian logistics and the director of INSEAD Humanitarian Research Group, supported by the Hoffmann Global Institute for Business and Society.
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