Designing for Impact and Institutionalization: Applying Systems Thinking to Sustainable Postpartum Family Planning Approaches for First-Time Mothers in Bangladesh

Most providers trained in PPFP and provide integrated services; few upskilling needs^a

Most providers trained in PPFP and provide integrated services; few upskilling needs^a

Limited observation and discussion during busy discharge times^b

Increased workload^b

FWA JDs included HVs^a

High FWA vacancies, infeasible HV targets^b

Nurses in KMC/SCANU not trained in PPFP^b

No integration by EPI or FP providers^b

Negative impact on provider workload^b

Facility infrastructure unconducive to private FP counseling^b

Existing monthly coordination meetings^a

Needed coordination of counseling beginning from ANC, documenting and following up on clients’ PPFP intentions^b

Existing coordination meetings^a

Poor referral coordination^b

Needed internal coordination during busy discharge times, support for additional tasks^b

Existing coordination meeting of supervisors, service providers, and FWAs^a

Needed coordination of facility referrals^b

No existing coordination or referrals between KMC/SCANU and FP units^b

Needed coordination to ensure FP providers present in EPI sessions^b

Needed coordination of intra- and inter-facility referrals^b

Existing supervision mechanisms^a

Monthly supervision visits planned^a

Little follow-up after supervision^b

Monthly supervision visits planned^a

Little supportive supervision, HVs rarely observed^b

Monthly supervision visits planned^a

PPFP not included in provider supervision^b

Integrated services not included in supervision^b

National stakeholder commitment to PPIUD^a

Existing (underutilized) fund to offset PPFP expenses^a,b

Different managers in KMC/SCANU and FP units, increasing coordination needs^b

Stakeholder commitment to FP/EPI integration^a

FP commodity supply generally sufficient^a

FP commodities would need to be supplied in units^b

Existing processes to counsel and document PPFP preferences in ANC card^a

Inconsistent documentation of PPFP preferences in ANC^b

FTMs identifiable in delivery, MNC registers^a

No system of documenting status at discharge^b

FTMs identifiable in community pregnancy registration systems^a

No mechanism prompted FWA HV after delivery^b

FTMs not identifiable in KMC/SCANU registers^b

FTMs identifiable in EPI registers or screening^a

EPI and FP registers not linked or harmonized^b

Combined as final selected approaches, with risk mitigation efforts

Determined to have deal-breakers in the context