The aggregate effect of implementation strength of family planning programs on modern contraceptive use at the health systems level in rural Malawi.

To explore the association between the strength of implementation of family planning (FP) programs on the use of modern contraceptives. Specifically, how strongly these programs are being implemented across a health facility's catchment area in Malawi and the odds of a woman in that catchment a...

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Autores principales:	Anooj Pattnaik, Diwakar Mohan, Amy Tsui, Sam Chipokosa, Hans Katengeza, Jameson Ndawala, Melissa A Marx
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/afa564cb06734784b7012af520ae62b1
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spelling	oai:doaj.org-article:afa564cb06734784b7012af520ae62b12021-12-02T20:13:09ZThe aggregate effect of implementation strength of family planning programs on modern contraceptive use at the health systems level in rural Malawi.1932-620310.1371/journal.pone.0232504https://doaj.org/article/afa564cb06734784b7012af520ae62b12021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0232504https://doaj.org/toc/1932-6203To explore the association between the strength of implementation of family planning (FP) programs on the use of modern contraceptives. Specifically, how strongly these programs are being implemented across a health facility's catchment area in Malawi and the odds of a woman in that catchment area is using modern contraceptives. This information can be used to assess whether the combined impact of multiple large-scale FP programs is leading to change in the health outcomes they aim to improve. We used data from the 2017 Implementation Strength Assessment (ISA) that quantified how much of family planning programs at the health facility and community health worker levels were being implemented across every district of Malawi. We used a summary measure developed in a previous study that employs quantitative methods to combine data across FP domains and health system levels. We tested the association of this summary measure for implementation strength with household data from the 2015 Malawi Demographic Health Survey (DHS). We found that areas with stronger implementation of FP programs had higher odds of women using modern contraceptives compared with areas with weaker implementation. The association of ISA with use of modern contraception was different by education, marital status, and geography. After controlling for these factors, we found that the adjusted odds of using a modern contraceptive was three times higher in catchment areas with high implementation strength compared to those with lower strength. Metrics that summarize how strongly FP programs are being implemented were used to show a statistically significantly positive relationship between increasing implementation strength and higher rates of modern contraceptive use. Decisionmakers at the various levels of health authority can use this type of summary measure to better understand the combined impact of their diverse FP programming and inform future programmatic and policy decisions. The findings also reinforce the idea that having a well-supported and supplied cadre of community health workers supplementing FP provision at the health facility can be an important health systems mechanism, especially in rural settings and to target youth populations.Anooj PattnaikDiwakar MohanAmy TsuiSam ChipokosaHans KatengezaJameson NdawalaMelissa A MarxPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 11, p e0232504 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Anooj Pattnaik Diwakar Mohan Amy Tsui Sam Chipokosa Hans Katengeza Jameson Ndawala Melissa A Marx The aggregate effect of implementation strength of family planning programs on modern contraceptive use at the health systems level in rural Malawi.
description	To explore the association between the strength of implementation of family planning (FP) programs on the use of modern contraceptives. Specifically, how strongly these programs are being implemented across a health facility's catchment area in Malawi and the odds of a woman in that catchment area is using modern contraceptives. This information can be used to assess whether the combined impact of multiple large-scale FP programs is leading to change in the health outcomes they aim to improve. We used data from the 2017 Implementation Strength Assessment (ISA) that quantified how much of family planning programs at the health facility and community health worker levels were being implemented across every district of Malawi. We used a summary measure developed in a previous study that employs quantitative methods to combine data across FP domains and health system levels. We tested the association of this summary measure for implementation strength with household data from the 2015 Malawi Demographic Health Survey (DHS). We found that areas with stronger implementation of FP programs had higher odds of women using modern contraceptives compared with areas with weaker implementation. The association of ISA with use of modern contraception was different by education, marital status, and geography. After controlling for these factors, we found that the adjusted odds of using a modern contraceptive was three times higher in catchment areas with high implementation strength compared to those with lower strength. Metrics that summarize how strongly FP programs are being implemented were used to show a statistically significantly positive relationship between increasing implementation strength and higher rates of modern contraceptive use. Decisionmakers at the various levels of health authority can use this type of summary measure to better understand the combined impact of their diverse FP programming and inform future programmatic and policy decisions. The findings also reinforce the idea that having a well-supported and supplied cadre of community health workers supplementing FP provision at the health facility can be an important health systems mechanism, especially in rural settings and to target youth populations.
format	article
author	Anooj Pattnaik Diwakar Mohan Amy Tsui Sam Chipokosa Hans Katengeza Jameson Ndawala Melissa A Marx
author_facet	Anooj Pattnaik Diwakar Mohan Amy Tsui Sam Chipokosa Hans Katengeza Jameson Ndawala Melissa A Marx
author_sort	Anooj Pattnaik
title	The aggregate effect of implementation strength of family planning programs on modern contraceptive use at the health systems level in rural Malawi.
title_short	The aggregate effect of implementation strength of family planning programs on modern contraceptive use at the health systems level in rural Malawi.
title_full	The aggregate effect of implementation strength of family planning programs on modern contraceptive use at the health systems level in rural Malawi.
title_fullStr	The aggregate effect of implementation strength of family planning programs on modern contraceptive use at the health systems level in rural Malawi.
title_full_unstemmed	The aggregate effect of implementation strength of family planning programs on modern contraceptive use at the health systems level in rural Malawi.
title_sort	aggregate effect of implementation strength of family planning programs on modern contraceptive use at the health systems level in rural malawi.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/afa564cb06734784b7012af520ae62b1
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The aggregate effect of implementation strength of family planning programs on modern contraceptive use at the health systems level in rural Malawi.

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