Qualitative Assessment of Family Planning and Immunization Service Integration in Malawi

To optimize health contacts and reduce missed opportunities for care, the Maternal and Child Survival Program (MCSP) supported Malawi's government in testing the systematic integration of family planning and routine infant immunization services in all facilities and associated outreach sites in the Dowa and Ntchisi districts. The intervention took place between July 2016 and November 2017. The study used a mixed-methods process evaluation approach, with a qualitative component assessing how integration affects service provision, utilization, and perceptions of quality at MCSP sites in the two districts. In-depth interviews were conducted with health workers and program managers, and focus group discussions were held with mothers of children under 1 year of age who accepted family planning and immunization referrals, as well as those who refused family planning referrals. The findings show that there are substantial perceived benefits associated with family planning and immunization service integration. Clients reported that they could now access both services in one day at the same place, unlike in the past when they had to visit the health facility twice. Health care workers noted that integration has reduced their workload, as they can now provide both services at the same time. However, lack of adequate resources such as staff, commodities, and transportation are thought to pose difficulties in the effective implementation of the integrated approach. The program should consider addressing the cited challenges and barriers to effective continuation and scale-up of integrated services. The integration of family planning and immunization services has been implemented in all facilities and associated outreach sites in the Dowa and Ntchisi districts. The intervention aimed to optimize health contacts and reduce missed opportunities for care. The study found that clients reported benefits such as time-savings and improved health indicators, while health care workers noted reduced workloads. The study included in-depth interviews with health workers and program managers, and focus group discussions with mothers of children under 1 year of age. The findings highlight the importance of addressing challenges and barriers to effective implementation and scale-up of integrated services. The program should consider addressing issues such as staff, commodities, and transportation to ensure the effective continuation and scale-up of integrated services. The integration of family planning and immunization services has been implemented in the Dowa and Ntchisi districts, with the aim of optimizing health contacts and reducing missed opportunities for care. The study found that clients reported benefits such as time-savings and improved health indicators, while health care workers noted reduced workloads. However, the study also highlighted the challenges and barriers to effective implementation and scale-up of integrated services, including lack of adequate resources such as staff, commodities, and transportation.