Family planning high impact practices in Francophone West Africa: ownership, strategies and use for programming

In the last 15 years, the High Impact Practices (HIPs) initiative has been designing and disseminating family planning (FP) HIPs, a collection of evidence-based practices. Evidence on implementation at the country level, when it exists, does not specifically reflect the West and Central Africa region. The objectives of this study are to 1) examine the extent to which FP HIPs are an integral part of FP programming in the region, 2) identify strategies being used for implementation and monitoring of HIPs and the associated challenges, and 3) examine paths to sustainability and scaling-up of HIPs. We used a mixed-methods approach consisting of a document review and key informant interviews (KIIs) to assess HIP implementation in the nine countries of the Ouagadougou Partnership (OP). We sought to interview three key informants representing government, non-governmental organizations, and donors, in each country. The interviews were conducted remotely via Zoom in French. Use of HIP briefs is not very common, partly because their content is not tailored to specific contexts. Immediate Postpartum Family Planning (IPPFP), Community Health Workers (CHWs), and Mass Media (MM) stand out as the most widely implemented HIPs, with some level of adoption in almost every country, while Postabortion Family Planning (PAFP) and Pharmacies and Drug Shops (PDS) HIPs are less common. A lack of adequate training for providers and CHWs at both health facilities and pharmacies emerged as a significant barrier to the effective implementation of HIPs. Regarding sustainability, some countries are making efforts to integrate CHWs into the government payroll system. Efforts to raise awareness on HIPs should continue, engaging and supporting regional institutions to own and tailor HIPs products to regional contexts. As integration into the health systems and sustainability efforts continue, attention should be directed towards scale-up, so that the benefits of these practices can be expanded to more people and more equitably.