Structuring Complex Choices Facilitate Sustainable Decision Making Among Family Planning Clients
Summary:
Enabling clients to take a decision on adoption of family planning is always challenging. Recognizing these challenges, The Challenge Initiative for Healthy Cities in India introduced coaching of frontline health workers and enabled them to adhere to a communication messaging structure based on the Behaviour Economics concept of Choice Architecture. Choice Architecture refers to the practice of influencing choice by organizing the context in which people make decisions (Thaler et al., 2013, p. 428). The innovative messaging structure enabled health workers to facilitate family planning decision and chose a method of their choice instead of prescribing a method by the health worker. PSI enabled 6000 ASHAs to learn the messaging structure with coaching and mentoring support. Health Management Information System Data, managed by the public health system revealed 80% increase in family planning acceptance compared with previous year at Urban Primary Health Center (UPHC) level.
Background/Objectives:
Population Services International with support from Bill & Melinda Gates Foundation through the Gates Institute for Population & Reproductive Health is leading The Challenge Initiative for Healthy Cities (TCIHC) in India. TCIHC is an exciting Business Unusual approach that seeks to scale up high impact approaches pertaining to family planning. In 31 Cities of three states in India, the use-over-need gap of modern contraceptives in these Cities is approximately 479,000. In these Cities, State National Health Mission has partnered with the Initiative to enhance performance of around 6000 community health workers, Accredited Social Health Activists (ASHA).
Description of Intervention and/or Methods/Design:
The Challenge Initiative structured messaging and made it consumer powered decision making that includes rapport building, need establishment (should I choose family planning?), discussing solutions (which method best suits me?) and call to action (when should I get the method?). Need establishment is key to driving the decision-making where three questions are discussed with the client :know age of youngest child; if the child is young, when does she/couple plan for next child; if she is planning not to have child now, what is she doing to avoid unwanted pregnancy. Once the women/couple realize chances of unwanted pregnancy, discuss range of contraceptives with the help of a communication job aid, Choice basket. Finally, call to action is discussed with a discussion around chances of becoming pregnant tonight.
Results/Lessons Learned:
With coaching support to over 6000 ASHAs, family planning acceptance has increased by 80% at Urban Primary Health Centre (UPCH) level compared with previous year. This coaching also helped ASHAs to reach 600,000 women with informed choice counselling. Successes of such impressive results depend on making health workers learn the skills of asking specified questions and lead the discussion accordingly. Therefore, training and coaching support of health workers is key for its success.
Discussion/Implications for the Field:
The messaging structure anecdotally has proved to be promising given its strengths. Health workers have learnt the skills of facilitating the decision by the woman/ couple. If women take the decision on her own, chances of complains are reduced leading to adhering to the decision. On the other hand, health worker provides effective counselling vis a vis reducing her/ his time and energy. This also helped health to structure their answers on the critical questions asked by clients during counselling sessions.
Abstract submitted by:
Dawood Alam - PSI India
K. Laxmikant Rao - PSI India
Mukesh Sharma - PSI India
Vivek Sharma - PSI India
Enabling clients to take a decision on adoption of family planning is always challenging. Recognizing these challenges, The Challenge Initiative for Healthy Cities in India introduced coaching of frontline health workers and enabled them to adhere to a communication messaging structure based on the Behaviour Economics concept of Choice Architecture. Choice Architecture refers to the practice of influencing choice by organizing the context in which people make decisions (Thaler et al., 2013, p. 428). The innovative messaging structure enabled health workers to facilitate family planning decision and chose a method of their choice instead of prescribing a method by the health worker. PSI enabled 6000 ASHAs to learn the messaging structure with coaching and mentoring support. Health Management Information System Data, managed by the public health system revealed 80% increase in family planning acceptance compared with previous year at Urban Primary Health Center (UPHC) level.
Background/Objectives:
Population Services International with support from Bill & Melinda Gates Foundation through the Gates Institute for Population & Reproductive Health is leading The Challenge Initiative for Healthy Cities (TCIHC) in India. TCIHC is an exciting Business Unusual approach that seeks to scale up high impact approaches pertaining to family planning. In 31 Cities of three states in India, the use-over-need gap of modern contraceptives in these Cities is approximately 479,000. In these Cities, State National Health Mission has partnered with the Initiative to enhance performance of around 6000 community health workers, Accredited Social Health Activists (ASHA).
Description of Intervention and/or Methods/Design:
The Challenge Initiative structured messaging and made it consumer powered decision making that includes rapport building, need establishment (should I choose family planning?), discussing solutions (which method best suits me?) and call to action (when should I get the method?). Need establishment is key to driving the decision-making where three questions are discussed with the client :know age of youngest child; if the child is young, when does she/couple plan for next child; if she is planning not to have child now, what is she doing to avoid unwanted pregnancy. Once the women/couple realize chances of unwanted pregnancy, discuss range of contraceptives with the help of a communication job aid, Choice basket. Finally, call to action is discussed with a discussion around chances of becoming pregnant tonight.
Results/Lessons Learned:
With coaching support to over 6000 ASHAs, family planning acceptance has increased by 80% at Urban Primary Health Centre (UPCH) level compared with previous year. This coaching also helped ASHAs to reach 600,000 women with informed choice counselling. Successes of such impressive results depend on making health workers learn the skills of asking specified questions and lead the discussion accordingly. Therefore, training and coaching support of health workers is key for its success.
Discussion/Implications for the Field:
The messaging structure anecdotally has proved to be promising given its strengths. Health workers have learnt the skills of facilitating the decision by the woman/ couple. If women take the decision on her own, chances of complains are reduced leading to adhering to the decision. On the other hand, health worker provides effective counselling vis a vis reducing her/ his time and energy. This also helped health to structure their answers on the critical questions asked by clients during counselling sessions.
Abstract submitted by:
Dawood Alam - PSI India
K. Laxmikant Rao - PSI India
Mukesh Sharma - PSI India
Vivek Sharma - PSI India
Source
Approved abstract for the postponed 2020 SBCC Summit in Marrakech, Morocco. Provided by the International Steering Committee for the Summit. Image credit: The Challenge Initiative