In 2011–2012, FHI 360’s PROGRESS project collaborated with the Network of Entrepreneurship & Economic Development (NEED), a local microfinance organization, to deliver basic family planning information to groups receiving NEED's microfinance services in Uttar Pradesh, India. FHI 360 worked with the Institute for Reproductive Health (IRH), which trained and supervised 35 NEED outreach workers called village health guides (VHGs). Since the training, the VHGs have met monthly with NEED group members and the larger community in the 70 villages they serve to discuss the benefits of family planning and specific contraceptive options and to link interested couples to providers of family planning services.

Project Results

An evaluation of the project showed that it increased family planning use and decreased unmet need for family planning services. Among 628 of the women who were exposed to the intervention, family planning use increased from 40 percent before the intervention to 69 percent after the intervention. Unmet need decreased from 42 percent to 12 percent. A research brief summarizing the project and the research findings is available here [PDF, 583 KB].

Project Implementation Tools

A video about the project, background information, and project implementation tools are available below. These materials may be useful to others seeking to introduce family planning information and links to services in microfinance and other programs in the non-health sector. The implementation materials were designed for low-skilled health outreach workers or peer educators, who work with microfinance or development organizations to complement their other services. Please acknowledge FHI 360, IRH and NEED if you use or adapt the materials.

Video — A Healthy Investment: Linking Family Planning and Microfinance
Background Information on the Project
Training Manual for Health Outreach Workers
Job Aids

Video — A Healthy Investment: Linking Family Planning and Microfinance
This 12-minute video demonstrates how this project operated and how, as a result, women who were barely aware of family planning can now make informed choices about using family planning methods to space or limit the number of children they have. The video is designed primarily to expand awareness of the project within the broader health sector and within the microfinance and other non-health sectors.

Background Information on the Project
The project seeks to build on the existing relationships between the VHGs and the women in the NEED microfinance groups to introduce and reinforce messages about family planning and overcome hesitancy to discuss sensitive topics. The goal is to facilitate informed decision-making about family planning use. The messages by the VHGs stress three key themes: 1) family planning can benefit the couple and the family, 2) different couples have different family planning goals, and 3) there are options for each family planning goal.

A village health guide conducts an information session in a village in Uttar Pradesh (photo from NEED).

The messages are designed to complement the activities of the government-employed community health workers serving these same villages, who in India are called accredited social health activists (ASHAs) and auxiliary nurse midwives. The VHGs, who have repeated contact with NEED members, invite the ASHAs to attend the family planning information sessions to strengthen the linkage between information and family planning service provision. The women exposed to the messages have already made an effort to participate in the microfinance activities and therefore are likely to be receptive to messages about how family planning can benefit couples and families. VHGs work with about 45 members compared with ASHAs who support about 1,000 people.

Building on NEED's existing microfinance program, the additional activities needed to implement this family planning intervention include:

• Developing simple messages, training materials and job aids (available below)
• Meeting with government health facilities to secure their health outreach workers’ participation in the program, and inviting them to meetings throughout the intervention
• Training the VHGs and district coordinators to deliver the messages with the use of job aids and to link recipients to family planning service providers
• Developing a “Referral Resource Directory” for each village and updating it every 6–12 months
• Incorporating family planning messages into the meetings of VHGs with microfinance clients and other community members, and conducting household visits, as needed, to reach husbands and mothers-in-law
• Providing ongoing supportive supervision and refresher trainings, as needed, for the VHGs

Training Manual for Health Outreach Workers
This training manual, available here in English [PDF, 1.8 MB] and here in Hindi [PDF, 691 KB], includes 12 sessions with objectives, materials, methodology and duration available for each session. The sessions cover the benefits of family planning and healthy timing and spacing of pregnancies, health service provider linkages, and seven contraceptive methods: male condoms, the Lactational Amenorrhea Method, the Standard Days Method, oral contraceptive pills, injectables, intrauterine devices and sterilization. While developed for lay health workers, the training manual can be simplified for other types of development workers. FHI 360 and IRH jointly developed the manual.

Job Aids
Reference Guides for Health Outreach Workers: These one-page sheets (front/back) for outreach workers, available here in English [PDF, 1.6 MB] and here in Hindi [PDF, 1.8 MB], summarize all of the key information from the training manual. There are separate guides for each of the seven contraceptive methods, one guide on family planning in general and one on contraceptive methods in general. In the NEED project, these reference guides were laminated on heavy paper and linked together on a large key ring for easy access and reference.

Flipchart for Use with Clients: This flipchart, available here in English [PDF, 4.5 MB] and here in Hindi [PDF, 6.2 MB], contains general information on family planning and information on the separate contraceptive methods covered in the training manual. In this project, the material was printed like a heavy booklet so that one side, with mostly photos and graphics, faces the clients during a discussion and the other side, with summary information, faces the outreach worker.

Chetna Aprons: Chetna aprons have cloth layers of graphics and are used to facilitate discussions on reproductive anatomy and fertilization. An apron was given to each health outreach worker for this purpose. For more information about the aprons and how to order them, please contact [email protected].

Please contact FHI 360 at [email protected] for more information on how to replicate the project in other settings.

PROGRESS (Program Research for Strengthening Services) was a five-year project awarded to FHI 360 by the U.S. Agency for International Development (USAID) in June 2008. The project sought to improve access to family planning among underserved populations by providing global technical leadership and working in selected countries.