ABSTRACT
Background: The Consumer's Market for Family Planning (CM4FP) project was designed to address limitations of existing family planning (FP) data sources that prevent a full understanding of the total FP market. CM4FP data provide a picture of the complete supply environment and how consumers experience it. Study objectives were to 1) test a ring-fenced census approach consisting of an outlet census in a defined geographical area and a household survey in a smaller inner ring, to comprehensively map the total FP market in a local geography; 2) explore FP supply market dynamism through longitudinal data collection from contraceptive outlets; and 3) test a methodology for directly linking household and outlet data to measure the relationship between contraceptive demand and supply. Methods: Data were collected from study sites in Nigeria, Kenya, and Uganda from 2019 to 2020. Longitudinal outlet census data and repeated cross-sectional household survey data from women ages 18-49 were collected at three quarterly time points. Outlets were located in an outer ring geography to encompass locations likely visited by women sampled from a smaller inner ring. Data from women who received a contraceptive method in the past 12 months were linked to data for the outlet from which they received the method. Results: Datasets include product audits for 22,380 individual FP products, collected from a total of 1,836 outlets across 12 study sites. The datasets also contain data from 11,536 female respondents, of whom 1,975 were successfully matched to the outlet where they most recently obtained their method. Conclusions: CM4FP data are available at www.cm4fp.org. This unique dataset enables in-depth exploration of the family planning supply market in addition to interactions between the market and consumer perspectives and behaviors within each study site. The data can also be used to explore novel methodologies to inform future study designs.
ABSTRACT
BACKGROUND: Marie Stopes Tanzania works with a voluntary cadre of 66 community-based mobilizers (CBMs), who are tasked with raising awareness, generating demand and providing referral to potential clients for family planning, comprehensive post-abortion care and cervical cancer screening. CBMs extend the reach of urban clinics to peri-urban communities, enhancing access to sexual and reproductive health services. In an effort to optimize performance of CBMs, a study was conducted to explore the drivers of CBM motivation and inform the design of an incentive scheme. METHODS: Three focus group discussions with 17 CBMs and 11 interviews with CBM supervisors and managers were conducted in three clinics and the head office. After thematic analysis of transcripts, findings on motivational factors were discussed in a reflection workshop and informed the development of a discrete choice experiment (DCE) involving 61 CBMs as respondents. The DCE included eight choice questions on two incentive schemes, each consisting of five attributes related to remuneration, training, supervision, benefits and identification. For each attribute, different incentive options were presented, based on the outcomes of the qualitative assessment. The DCE results were analysed using conditional logistic regression. RESULTS: A variety of factors motivated CBMs. Most CBMs were motivated to conduct their work because of an intrinsic desire to serve their community. The most mentioned extrinsic motivational factors were recognition from the community and supervisors, monthly allowance, availability of supporting materials and identification, trainings, supervision and feedback on performance. Recommendations for improvement were translated into the DCE. Incentive attributes that were found to be significant in DCE analysis (p < 0.05), in preference order, were carrying an ID card, bi-monthly training, supervision conducted via both monthly meetings at clinics and visits from the head office, and a monthly flat rate remuneration (over pay for performance). CONCLUSION: Despite the recognition that being a CBM is voluntary, incentives, especially those of non-financial nature, are important motivators. Incentive schemes should include basic compensation with a mix of other incentives to facilitate CBMs' work and enhance their motivation. Programme designs need to take into account the voices of community-based workers, to optimize their performance and service delivery to communities they serve.
