Measuring LDP+ Impacts on PPFP Services in Cameroon

Maeve Conlin

Senior Monitoring & Evaluation Associate

Monita Baba Djara

Principal Advisor, Monitoring, Evaluation, and Research

While effective family planning has tangible impacts on an individual’s or family’s overall sexual and reproductive health, postpartum family planning (PPFP)–the application of family planning methods during the 12 months after childbirth–has a direct relationship to under-five infant mortality. In fact, delaying pregnancy for 24 months after a birth has been found to decrease under-5 mortality by 13 percent (original source; Rutstein, 2008). According to the World Health Organization, not only is the need for PPFP dire, but the consequences of inaction hamstring efforts to end preventable child and maternal deaths around the world. In Cameroon, unmet need for family planning is high, with the modern contraceptive use for all women at only 14 percent (FP2020).

Over the last four years, the U.S. Agency for International Development-funded Leadership, Management, and Governance (LMG) Project has been building the evidence to identify the added-value of improved leadership, management, and governance for health workers, health service delivery organizations, and health governing bodies, while also linking these skillsets directly to service delivery outcomes.

Participants from the LMG Project and Evidence to Action Project collaboration in Cameroon. (Photo: Monita Baba Djara)

Collaborating with the Evidence to Action Project (E2A Project) in Cameroon, we have implemented a research study to evaluate the added-value of the Leadership Development Program Plus (LDP+) on the E2A Project’s existing PPFP intervention in six hospitals in Yaoundé. From February to May 2015, the LMG Project facilitated the LDP+ training for selected hospital staff from two hospitals. During this period, two other facilities received just the E2A Project training and the remaining two serve as controls. During the LDP+, the hospital teams selected increasing PPFP counseling as their challenge.

In July, after the LDP+ workshops had finished, we held a results dissemination meeting with nearly 40 attendees, including high-level representatives from Cameroon’s Ministry of Health, regional Ministries of Health, donors, and hospital administrators. The substantial turnout demonstrated that interest in leadership, management, and governance training is undeniable. From 9am to 2pm, we met in a conference room at a public park, a setting that also allowed curious bystanders to stop by the information stands and learn about family planning, often picking up information about the project, health education, and referrals to services.

LDP+ participants shared important successes and changes they have implemented since the training. The three most-cited behavior changes include:

  • the awareness and ability to handle difficult situations and overcome obstacles;
  • the ability to build a strong support structure and collaborate as a team; and
  • the use of data to track and evaluate progress.

Throughout the LDP+ process, participants tracked three desired measureable result indicators at their hospitals: the number of women receiving PPFP counseling, the number of women counseled who chose an FP method, and the number of women counseled who adopted an immediate PPFP method.

Although it remains too soon to draw conclusions, the preliminary results look promising:

Table of 6 months results in two hospitals in Cameroon. (Table: Maeve Conlin)

After participating in the LDP+, both hospital teams saw increases in the number of postpartum women receiving counseling and the proportion of those who chose a modern FP method. Similarly, the teams saw increases in the number of women who received counseling who adopted a PPFP method.

The dissemination meeting concluded with a discussion of the experience and impact of the LDP+ training. Hospital leaders began to plan how to use the LDP+ participants as mentors for other hospital staff, potentially expanding the reach of LDP+ principles. The Director of Cameroon's Division of Family Planning in the Ministry of Health even mentioned a desire to expand the LDP+ training to other hospitals in the future.

It is essential that we continue to gather more data and evaluate the long-term value added by equipping health workers with stronger leadership and management skills. Around the world, the health workforce drives change, and as evidence continues to mount, the link between effective leadership and tangible improvements in health service delivery will demand greater focus.