Conceptual Models for Integration
Because of high unmet need for postpartum family planning and health risks associated with pregnancies spaced too closely together, programs must take advantage of every opportunity to reach mothers with postpartum family planning through antenatal, postnatal, and child health contacts.
Two primary models are being used to integrate family planning and child immunization services:
- Combined service provision, when both services are offered on the same day and at the same location
- Single service provision plus referral, when either family planning or immunization services are provided along with education, screening and/or referrals for the other service, requiring follow-up at a different place or time
The figure below illustrates these two models:
Implementation of these models can vary based on a number of factors:
Type of health provider: Integrated services can be offered by a multi-purpose provider, a dedicated family planning provider or vaccinator, by a community health worker, or by a combination of these. In some settings, a community health worker provides group education or conducts one-on-one screening, and then a multi-purpose or dedicated provider delivers vaccination or contraceptive services.
Location: Integrated family planning and immunization services can be offered at fixed facilities or through community-based mobile or outreach programs. Routine immunizations are not typically offered through household visits because of cold chain requirements and limited human resources, but community-based programs that offer family planning door-to-door can integrate education and referrals for immunization services.
Type of Referrals: At the facility level, making referrals for off-site services or for services offered at the same location but on a different day can create barriers to access. However, in some settings, a referral model might be the only feasible service delivery option. Referrals are often made without any active follow-up. In other cases, referrals might involve active support for follow-up (sometimes called "facilitated referrals") and/or monitoring of women's subsequent use of services. Facilitated referrals with follow-up are ideal when it is not possible to offer services during the same visit.
Type of Client Education and Screening: Client education and demand creation can occur in group settings or one-on-one. Simple screening questions about women's family planning needs should be included in routine child immunization visits. Likewise, when a postpartum woman accesses family planning services, a rapid screening should be conducted to ensure that her child is immunized. Systematic screening is an evidence-based approach to comprehensively capture clients' health needs.
Experts recommend that integration models should be designed to offer family planning services during routine immunization services offered at fixed facilities or through community outreach programs. Service integration during mass immunization campaigns is not recommended.
View a technical brief for more information about integration models, a summary of available evidence, and tips for implementation.
For examples of how services are being integrated in the field, please visit the Country Experiences section of the Toolkit.
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