CARE’s 2020 program strategy aims to help tackle the underlying causes of poverty and social injustice, as part of global efforts to...
HIN NOU VIVO!
HIN NOU VIVO!
Project Name: HIN NOU VIVO! (translates to “wellbeing of the family”)
Donor: Pfizer Foundation
Partners: Benin Ministry of Health
Objective: HIN NOU VIVO! aims to reduce maternal and child mortality in Benin by integrating immunization and family planning service delivery and creating a supportive environment that encourages sustainable immunization practices while addressing barriers to family planning uptake.
Immunization and family planning services are critical to promoting population health, but both are often lacking in low-income countries. In Benin, West Africa, less than half of children (47%) receive all the vaccinations recommended by the World Health Organization, and at 13% contraceptive prevalence rates are some of the lowest in the world. Women who go through childbirth multiple times in quick succession are at increased risk for complications and premature death. Although most women do not wish to become pregnant again less than a year after giving birth, often they do not know that pregnancy is a possibility while they are breastfeeding, or what family planning methods are available to them.
CARE is responding to the overlapping health issues of mothers and their babies with HIN NOU VIVO!, an integrated approach linking family planning counseling and contraceptive method provision with routine child immunization services in Benin’s Abjohoun-Bonou-Dangbo health zone. The process is simple: a mother visits a health center to get her child immunized and while she is there, the provider asks her about her reproductive health needs and delivers some simple messages about the benefits of family planning. Women who are interested in learning more or accessing contraceptives are then referred to the appropriate services.
HIN NOU VIVO! sets out to address the structural and sociocultural barriers that inhibit uptake of family planning and immunizations by improving health service delivery, and creating a supportive environment where healthy behaviors are accepted and encouraged.
Improving health service delivery. CARE offers ongoing training, support, and supervision to service providers in 20 public health facilities to ensure they have the skills necessary to offer quality family planning counseling and services. Providers receive education on client-centered counseling, quality standards for service provision, contraceptive technology (including long-acting reversible methods), and the criteria for effective protection through breastfeeding. Additionally, providers go through values clarification exercises to help them recognize and eliminate existing biases they may have about certain contraceptive methods, and debunk any misconceptions about the suitability of various methods for certain client groups.
Although educating providers is necessary to improve service quality, it is rarely sufficient on its own. CARE supplements HIN NOU VIVO! capacity-building activities with supply and infrastructure improvements like supply-chain management, data management system support, and quality control.
Creating a supportive environment. HIN NOU VIVO! builds on the Tékponon Jikuagou (TJ) project, a collaborative effort by CARE and Plan International to bring together influential community leaders, social groups, and a cadre of trained “catalyzers” (facilitators) in dialogue and reflection on gender and social norms that affect interest in – and use of – family planning. Through HIN NOU VIVO!, facilitators are trained on the benefits of family planning and child immunization service integration and how to discuss these topics with women and their male partners, health providers, and other community members.
Facilitators then convene reflective dialogue sessions where community members, community leaders, and health providers can ask questions of each other, identify challenges and opportunities for collaboration, and build trust while dispelling myths and misunderstandings about family planning or immunizations. Once people have accurate health information and the support of their family and community, the demand for services increases – and because they received advanced training and supportive supervision through HIN NOU VIVO! And are ready to meet this demand.
Since the project began, more than 50,000 children have been vaccinated and more than 32,000 women were exposed to family planning information or counseling through one of the HIN NOU VIVO! health centers. Under the project, the number of new contraceptive users more than doubled, with over 6,000 women starting a new modern method. Most women chose long-acting reversible methods, which had been difficult or impossible to access in the past. Previously, it was not uncommon for health centers to run out of family planning supplies, but this program ensured they were always in stock and available.
HIN NOU VIVO! is also working to reduce the stigma around family planning discussions. Health center staff have observed more positive attitudes towards contraception among patients seeking services and an apparent increase in willingness to have conversations about family planning methods (between health providers and their clients, and between women and their husbands and other relatives).