Hi Ashley, thanks for the interest in our work. To answer the first question, the idea for the incentive model was based on a similar model used to improve Maternal neonatal and Child Health (MNCH) services amongst women living predominantly in rural Ghana (Continuum of Care card for MNCH). That model was developed by the Ghana EMBRACE Implementation project team of which we were a part. Please find below two links which throw more light on this:
We are now trying to introduce the CoC card into family planning with the hope that it addresses some of the identified challenges in this area. As part of the pilot, we developed with the help of the health workers, a ‘CoC card for family planning’ which we are currently implementing. The impact made by the card will be measured using an end line survey in March, 2018. However we have observed a few key things some of which we have already changed and added to this application (openIDEO)
1. Most women do not like carrying the FP hand book- Unlike the CoC card for MNCH which was placed in the available MNCH hand book and carried by the women to their homes, most of the FP women (young females inclusive) do not want to carry the FP hand books to their homes. There is still some stigmatization related to FP use and most women are not really 'empowered'. They would rather use FP discretely but the FP books are quite bulky. The team with the health workers developed a smaller version of the card, which from observations, has been greatly accepted by the women. The bulky hand book with the main CoC card is therefore kept at the health facility whilst the clients keep the smaller card. Moving forward, we plan on addressing some of the flaws identified with the smaller card and make it better.
2. Possibility of CoC card replacing the FP hand book- The main ‘CoC card ‘ has simplified documentation for the health workers and from observations has been accepted greatly by them. One glance at the CoC card and the health workers can tell if a client has received essential services, counseling etc instead of going through numerous pages of the FP hand book and other available registers. The CoC FP card was designed to complement the hand book, encourage women to come for timely services using stars, reduce discontinuation of services among others. We hope to eventually have a policy where the CoC FP card is printed as a page in the FP hand book as was done for the CoC MNCH study. We however did not take into consideration the possibility of the card replacing the FP hand book primarily as a result of shortages. There were shortages of FP hand books in a few of the communities we are currently working in. In most cases the health workers do not report these shortages because they can use the card instead. Going forward, we plan on looking at ways to strengthen the communication and supply chain channels between the health facilities in the communities, the district health team and the regional team to prevent future shortages of the FP hand book. We would also look at the health workers perception of using the card alone without the inserting it into the hand book as part of our end line survey.
3. Additional incentives as part of ‘Gold star’ women concept- In addition to encouraging women who come for timely services using the stars and classifying them as ‘gold star’ women, we have been looking at other ways of encouraging these ‘gold star’ women. Going forward, one of the options we hope to explore is to register for free ‘gold star’ women (women who come for timely services over a period of time) on Ghana’s NHIS. Ghana has passed a policy to provide free FP services to women under its NHIS. Registration under the NHIS however comes at a 'not-too-expensive' cost (about 1$). The free FP services policy is however yet to be implemented and alternative measures such as providing some specific services (eg urine test) for free are still being looked at.
I am available to answer any more questions or provide clarifications where needed. Thanks