Designing, Implementing, and Evaluating Evidence-Based, Holistic Programs :
Applying SEED :
Scale-Up: Bangladesh, Togo, Burkina Faso, and Tanzania :


Holistic Approach Enhances Family Planning Programs: RESPOND’s Experience with the SEED Programming Model™ (Project Brief No. 27)
The Supply–Enabling Environment–Demand (SEED™) Programming Model is a holistic model developed by EngenderHealth to apply globally and locally to guide the design, implementation, and evaluation of family planning programs. RESPOND designed and implemented its activities using the SEED model as its principal programming and conceptual framework. This paper describes how SEED was used to frame global initiatives to advocate, promote, and support family planning as an essential primary health care intervention. It also presents specific country examples of how SEED enhanced and improved the outcomes of family planning programming, especially when all three elements worked in synergy.
Available in English (PDF, 3.1 MB)

Improving and Sustaining Contraceptive Security in Tanzania (Project Brief No. 20)
For contraceptive security to exist (i.e., when people are able to choose, obtain, and use the contraceptive methods and services they desire from among a full range of methods), three basic elements are needed at a service delivery point: contraceptives themselves; necessary medical equipment, instruments, and supplies; and trained staff. EngenderHealth’s COPE® for Contraceptive Security was tested in Newala and Meru districts in Tanzania, to document its impact on districts’ and facilities’ capacity to forecast, budget, requisition, and manage their inventory and to test the tool’s effectiveness in increasing access to all family planning methods. The tool helped facility staff to identify and resolve challenges to contraceptive security. Its use both increased contraceptive availability at the participating facilities and boosted providers’ and clients’ confidence that methods would be available.
Available in English (PDF, 3.3 MB)

Breaking Down Barriers to Contraceptive Choice in the Public Health Sector in Burkina Faso and Togo (Project Brief No. 19)
Married women in Burkina Faso and Togo have very low rates of contraceptive use (particularly long-acting methods) and comparatively high rates of unmet need for family planning. Between 2010 and 2013, the RESPOND Project worked to build public-sector capacity in Burkina Faso and Togo to overcome barriers to contraceptive choice. The Ministry of Health in each country received technical assistance to strengthen the supply of family planning services, foster an enabling environment, and cultivate demand for services. Access to a wide range of methods increased dramatically in the areas of the intervention. Clients came in large numbers for long-acting methods: By the end of the intervention, facilities in the two countries had provided more than twice as many implants per month as they had in the same month of the prior year.
Available in English (PDF, 3.5 MB)

Reaching Young Married Couples in Bangladesh: An Underserved Population for Long-Acting Methods of Contraception (Project Brief No. 18)
In Bangladesh, more than 70% of married adolescents become pregnant before their first anniversary, and the mean age at first pregnancy is 16.4. Young couples rarely use contraception before the birth of their first child. An 18-month project to provide young married couples with better information and services on family planning trained peers to be the main source of information for young men and women in the community and to serve as a link between the community and a facility. An evaluation revealed a small increase in contraceptive use and a shift to more effective methods (the intrauterine device [IUD] and hormonal implants), as well as higher levels of communication about family planning between spouses.
Available in English (PDF, 3.4 MB)

Introducing Postpartum Family Planning in Maternal Health Services in Low-Performing Areas of Bangladesh (Project Brief No. 17)
A holistic programming effort to mainstream postpartum family planning services through the public-sector health care system was implemented between June 2009 and September 2013 in 21 disadvantaged project districts in Barisal, Chittagong, and Sylhet divisions in Bangladesh. A total of 111 facilities introduced postpartum family planning services where these were previously not available. Overall, uptake of these services increased over time (particularly for tubal ligation), due both to increased demand and to greater availability at more facilities. Integrating postpartum family planning with maternal health services can contribute significantly to increasing postpartum contraceptive use.
Available in English (PDF, 3.3 MB)

Strengthening National Family Planning Information Systems through Data Quality Assessment: Lessons from Bangladesh (Project Brief No. 16)
Data quality assessment (DQA) was used in Bangladesh to strengthen the public-sector management information system (MIS). An auditing process for assessing the quality of the reported data/statistics, DQA identified duplication of LA/PM performance reporting; transcription errors and data inconsistencies; and weak record keeping and reporting of drop-out. DQA also revealed that the MIS underreported use of long-acting and permanent methods. EngenderHealth provided technical assistance to help strengthen the capacity of Directorate General of Family Planning staff to manage and report data.
Available in English (PDF, 3.4 MB)

Using a Quality Improvement Approach to Improve Contraceptive Security in Tanzania (Project Brief No. 14)
The Tanzanian health ministry has made great strides toward achieving contraceptive security at the national and regional levels, but contraceptive security is weaker at lower-level health facilities, due to stock-outs of contraceptives and their related supplies, as well as human resource constraints. RESPOND developed a variation of EngenderHealth’s COPE® tools and approach focused on contraceptive security, with self-assessment guides and facility checklists to guide facility staff in thinking through all of the necessary elements to support contraceptive security. An assessment showed that COPE for Contraceptive Security was an effective and low-resource intervention to mobilize facility staff to identify and to begin to resolve challenges to contraceptive security.
Available in English (PDF, 3.4 MB)

Preventing Postpartum Hemorrhage: Community-Based Distribution of Misoprostol in Tangail District, Bangladesh (Project Brief No. 2)
Deaths related to postpartum hemorrhage (PPH) present a major challenge to health systems, particularly in rural areas of Bangladesh, where infrastructure is poor and health care facilities often lack skilled staff, drugs, and equipment. Misoprostol is a proven uterotonic drug that is increasingly used in clinical and home delivery settings to prevent and manage PPH. This project brief discusses the implementation of a pilot project in the Tangail District of Bangladesh to determine the effectiveness of using government and nongovernmental field workers at the community level to distribute misoprostol tablets and ensure that women take the drug immediately postpartum. In addition to the programmatic intervention strategies, it looks at health outcomes, women's views and experiences, as well as lessons learned and recommendations for moving forward.
Available in English (PDF, 3.3 MB)

Achieving Positive Policy Changes for Family Planning in Bangladesh (Project Brief No. 8)
While contraceptive prevalence in Bangladesh has increased nearly eight-fold over the past 30 years and the total fertility rate has fallen, policy barriers and outdated medical eligibility criteria still sometimes impede clients' access to the method of their choice—particularly long-acting and permanent methods. Using EngenderHealth's Supply-Enabling Environment-Demand (SEED) programming model, the RESPOND/Mayer Hashi project worked with the Directorate General of Family Planning to improve the policy environment around LA/PM use, through a careful, structured process that relied heavily on consultation with local partners about critical obstacles in the field. Regulations on access to tubal sterilization and to implants were loosened, clinic registration procedures were streamlined, and postpartum family planning services were introduced into private facilities.
Available in English (PDF, 3.2 MB)

Acceptability of Sino-Implant (II) in Bangladesh: Six-Month Findings from a Prospective Study (Project Brief No. 7)
Bangladeshi women's interest in hormonal implants appears to have risen in recent years. The RESPOND Project and Mayer Hashi were asked by Bangladesh's Directorate General of Family Planning to conduct an acceptability trial of one implant, Sino-implant (II), to inform the decision on whether to introduce this implant into the national family planning program. As of the midpoint of the one-year study, users of Sino-implant (II) appear to have found it acceptable, with relatively few discontinuing its use and most users reporting their general satisfaction with the method.
Available in English (PDF, 3.2 MB)

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COPE, Men As Partners, and MAP are registered trademarks of EngenderHealth. SEED is a trademark of EngenderHealth.
Photo credits: M. Tuschman/EngenderHealth; A. Fiorente/EngenderHealth; C. Svingen/EngenderHealth.

This web site was made possible by the generous support of the American people through the U.S. Agency for International Development (USAID), under the terms of the cooperative agreement GPO-A-000-08-00007-00. The information provided on this web site is not official U.S. Government information and does not represent the views or positions of the USAID or the U.S. Government.

The RESPOND Project Digital Archive, Version 2.0