This section of the Toolkit offers examples of country experiences with integrating family planning and immunization services, and highlights the various strategies used, challenges faced, and lessons learned.
USAID also maintains a map and inventory list of countries implementing FP and immunization integration activities through their Family Planning High Impact Practices site.
Perhaps the most frequently cited country experience with family planning and immunization integration is a study which took place in Togo in the early nineties. The Togo study used a "combined service provision" model, whereby immunization providers delivered simple messages to mothers of children being immunized, encouraging them to take advantage of same-day family planning services available in the clinic. Findings from this study, which include reported effects of integration on both family planning and immunization indicators, were documented in an article by Dale Huntington and Aristide Aplogan. A similar approach was also used in a demonstration project in Liberia.
Country experiences in Ghana, Zambia, Rwanda, and Nigeria also applied a combined service provision model, but with the specific use of a screening tool to refer for same day, co-located family planning services. In Ghana, Zambia, and Rwanda, vaccinators used a job aid to screen women for pregnancy risk, and provide FP referrals. In Nigeria, a postpartum systematic screening tool was used by multipurpose service providers to offer information and referrals for family planning, immunization, and other relevant services to postpartum women.
In Mali, dedicated family planning providers offered same-day family planning services during a weekly immunization event at urban health centers.
A “single service provision plus referral” model was applied in the Philippines. Family planning information was offered to women awaiting immunization services and those who accepted received an appointment to return for a family planning consultation on a different day.
In some countries, integration of family planning and immunization is built into a package of services delivered through a health system platform. A strong and efficient health system sustains services over time, is dynamic and adjusts to the changing needs of the population it serves. An example of integration built into the health system is through the Village Health and Nutrition days of the National Rural Health Mission in India. A cross-sectional descriptive study of family planning and immunization as part of health center and village outreach days in Jharkhand is reported here. This approach is similar to an NGO-implemented model in Liberia, whereby a provider/CHW team offers both the immunization and family planning services. In Senegal and Nigeria, a similar integration effort is taking place during immunization days at the health post (Senegal) or dispensary (Nigeria) level. A bilateral program in Uganda has also carried out activities to strengthen integration within health systems.
The country experiences show that:
Child immunization services offer a promising opportunity to offer family planning information and services.
The impact of integration on both services should be monitored to measure its effect on service delivery and health outcomes.
Functioning health systems are needed to support integrated service delivery.
Clear and effective referral systems should be in place.
Political and community buy-in are critical to building a supportive environment for integration.
If vaccinators provide family planning education, screening, or referrals during immunization contacts, keep messages simple and reinforce provider communication skills.
Context is important and must figure prominently in designing an integration model that is likely to be effective. Existing service delivery strategies, health infrastructure, health worker capacity, availability of vaccines and contraceptives, community acceptance of family planning and immunization, and high level support for integrated service delivery must all be taken into account.
We hope this small repository of country experiences provides useful insights into implementation challenges and lessons learned. As more partners and programs are engaging in this area, we encourage any organization that has developed materials, including provider job aids, tools, and briefs, on integration of family planning with EPI to contribute to the Toolkit.
To suggest an additional resource or share your perspective on advocating for integration of family planning and immunization services, please fill out our feedback form.