On the sustainability of a family planning program in Nigeria when funding ends

Autoři: Ilene S. Speizer aff001;  David K. Guilkey aff001;  Veronica Escamilla aff001;  Peter M. Lance aff001;  Lisa M. Calhoun aff001;  Osifo T. Ojogun aff004;  David Fasiku aff004
Působiště autorů: Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America aff001;  Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America aff002;  Department of Economics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America aff003;  Data Research and Mapping Corporation, Abuja, Nigeria aff004
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: 10.1371/journal.pone.0222790


Few studies have examined the sustainability of family planning program outcomes in the post-program period. This article presents the results of a natural experiment where the Nigerian Urban Reproductive Health Initiative Phase I programming ended in early 2015 and Phase II activities continued in a subset of cities. Using data collected in 2015 and 2017, we compare contraceptive ideation and modern family planning use in two cities: Ilorin where program activities concluded in 2015 and Kaduna where program activities continued. The results demonstrate that exposure to program activities decreased in Ilorin but for those individuals reporting continuing exposure, the effect size of exposure on modern family planning use remained the same and was not significantly different from Kaduna. Modern family planning use continued to increase in both cites but at a lower rate than during Phase I. The results are useful for designing family planning programs that sustain beyond the life of the program.

Klíčová slova:

Census – Language – Mass media – Nigeria – principal component analysis – Religion – Contraceptives – Female contraception


1. Iwelunmor J, Blackstone S, Veira D, Nwaozuru U, Airhihenbuwa C, Munodawafa D, Kalipeni E, Jutal A, Shelley D, Ogedegbe G. Toward the sustainability of health interventions implemented in sub-Saharan Africa: a systematic review and conceptual framework. Implement. Sci. 2016; 11: 43. doi: 10.1186/s13012-016-0392-8 27005280

2. Schell SF, Luke DA, Schooley MW, Elliott MB, Herbers SH, Mueller NB, Bunger AC. Public health program capacity for sustainability: a new framework. Implement. Sci. 2013; 8: 1. doi: 10.1186/1748-5908-8-1

3. Stephenson R, Tsui AO, Knight R. Measuring family planning sustainability at the outcome and programme levels. Health Policy Plan. 2004; 19: 88–100. doi: 10.1093/heapol/czh011 14982887

4. Stirman SW, Kimberly J, Cook N, Calloway A, Castro F, Charns M. The sustainability of new programs and innovations: a review of the empirical literature and recommendations for future research. Implement. Sci. 2012; 7: 17. doi: 10.1186/1748-5908-7-17 22417162

5. Scheirer MA. Is sustainability possible? A review and commentary on empirical studies of program sustainability. Am. J. Eval. 2005; 26: 320–347.

6. Tibbits MK, Bumbarger BK, Kyler SJ, Perkins DF. Sustaining evidence-based interventions under real-world conditions: Results from a large-scale diffusion project. Prev. Sci. 2010; 11: 252–262. doi: 10.1007/s11121-010-0170-9 20229358

7. Bao J, Rodriguez DC, Paina L, Ozawa S, Bennett S. Monitoring and evaluating the transition of large-scale programs in global health. Glob. Health Sci. Pract. 2015; 3: 591–605. doi: 10.9745/GHSP-D-15-00221 26681706

8. Helzner JF. Transforming family planning services in the Latin American and Caribbean region. Stud. Fam. Plann. 2002; 33: 49–60. 11974419

9. Scheirer MA, Dearing JW. An agenda for research on the sustainability of public health programs. Am. J. Public Health 2011; 101: 2059–2067. doi: 10.2105/AJPH.2011.300193 21940916

10. Bennett S, Ozawa S, Rodriguez D, Paul A, Singh K, Singh S. Monitoring and evaluating transition and sustainability of donor-funded programs: Reflections on the Avahan experience. Eval. Program Plann. 2015; 52: 148–158. doi: 10.1016/j.evalprogplan.2015.05.003 26099560

11. Eder C, Khatiwada LK, Schooley J. Sustainability of a community-based CHOICE program to improve the health and nutrition status of mothers and infants in Indonesia. Matern. Child Health J. 2018; 22: 903–912. doi: 10.1007/s10995-018-2465-6 29429132

12. Ozawa S, Singh S, Singh K, Chhabra V, Bennett S. The Avahan transition: effects of transition readiness on program institutionalization and sustained outcomes. PloS One 2016; 11: e0158659. doi: 10.1371/journal.pone.0158659 27434542

13. Sarriot EG, Jahan S, Kouletio M, Sardar M, Ali KL, Saha S, Rasul I. The end of magical thinking: Sustainability evaluation three years after the end of the Saidpur and Parbatipur urban health project. Final Rep. 2008. https://www.measureevaluation.org/resources/networks/datausenet/dashboards-and-data-use-forum-may-2010/end-magical-thinking.pdf (accessed April 26, 2019)

14. Thilakavathi S, Boopathi K, Kumar CG, Santhakumar A, Senthilkumar R, Eswaramurthy C, Bharathy VI, Ramakrishnan L, Thongamba G, Adhikary R. Assessment of the scale, coverage and outcomes of the Avahan HIV prevention program for female sex workers in Tamil Nadu, India: is there evidence of an effect? BMC Public Health 2011; 11: S3.

15. Savaya R, Spiro S, Elran-Barak R. Sustainability of social programs: a comparative case study analysis. Am. J. Eval. 2008; 29: 478–493.

16. Zulu JM, Goicolea I, Kinsman J, Sandøy IF, Blystad A, Mulubwa C, Makasa MC, Michelo C, Musonda P, Hurtig AK. Community based interventions for strengthening adolescent sexual reproductive health and rights: how can they be integrated and sustained? A realist evaluation protocol from Zambia. Reprod. Health. 2018; 15: 145. doi: 10.1186/s12978-018-0590-8 30153839

17. Hirschhorn LR, Talbot JR, Irwin AC, May MA, Dhavan N, Shady R, Ellner AL, Weintraub RL. From scaling up to sustainability in HIV: potential lessons for moving forward. Glob. Health 2013; 9: 57.

18. Subramanian L, Simon C, Daniel EE. Increasing contraceptive use among young married couples in Bihar, India: Evidence from a decade of implementation of the PRACHAR Project. Glob. Health Sci. Pract. 2018; 6: 330–344. doi: 10.9745/GHSP-D-17-00440 29959273

19. Daniel EE, Masilamani R, Rahman M. The effect of community-based reproductive health communication interventions on contraceptive use among young married couples in Bihar, India. Int. Fam. Plan. Perspect. 2008; 189–197. doi: 10.1363/ifpp.34.189.08 19201679

20. Jejeebhoy SJ, Prakash R, Acharya R, Singh SK, Daniel E. Meeting contraceptive needs: Long-term associations of the PRACHAR Project with married women’s awareness and behavior in Bihar. Int. Perspect. Sex. Reprod. Health. 2015; 41: 115–125. doi: 10.1363/4111515 26600565

21. Pandey N, Jejeebhoy SJ, Acharya R, Singh SK, Srinivas M. Effects of the PRACHAR Project’s reproductive health training programme for adolescents: Findings from a longitudinal study. Population Council. 2016.

22. Levitt-Dayal M, Motihar R. Adolescent girls in India choose a better future: an impact assessment. In: Towards adulthood: exploring the sexual and reproductive health of adolescents in South Asia, edited by Bott S, Jejeebhoy S, Shah I, Puri C. Geneva, Switzerland, World Health Organization [WHO], Department of Reproductive Health and Research. 2003.

23. Krenn S, Cobb L, Babalola S, Odeku M, Kusemiju B. Using behavior change communication to lead a comprehensive family planning program: the Nigerian Urban Reproductive Health Initiative. Glob. Health Sci. Pract. 2014; 2: 427–443. doi: 10.9745/GHSP-D-14-00009 25611477

24. Measurement, Learning & Evaluation (MLE) Project Nigeria Team. Evaluation of the Nigerian Urban Reproductive Health Initiative (NURHI) Program. Stud. Fam. Plann. 2017; 448: 253–268. https://doi.org/doi:10.1111/sifp.12027

25. Fabic MS, Choi Y. Assessing the quality of data regarding use of the lactational amenorrhea method. Stud. Fam. Plann. 2013; 44: 205–221. doi: 10.1111/j.1728-4465.2013.00353.x 23720003

26. Babalola S. Changes in ideational profiles of women of reproductive age in urban Nigeria: The role of health communication. Health Educ. Behav. 2017; 44: 907–917. doi: 10.1177/1090198117699510 28387572

27. Speizer IS, Calhoun LM, McGuire C, Lance PM, Heller C, Guilkey DK. Assessing sustainability of N Urban Reproductive Health Initiative programming: longitudinal analysis of service quality. BMC Health Services Research 2019: 559. doi: 10.1186/s12913-019-4388-3 31399085

28. Montgomery MR, Kiros GE, Agyeman D, Casterline JB, Aglobitse P, Hewett PC. Social networks and contraceptive dynamics in Southern Ghana. Policy Res. Div. Work. Pap. 153. 2001.

29. Wooldridge JM. Econometrics: Panel Data Methods, in: Complex systems in finance and econometrics. Springer, pp. 215–237. 2009.

30. Schunck R. Within and between estimates in random-effects models: Advantages and drawbacks of correlated random effects and hybrid models. Stata J. 2013; 13: 65–76.

31. Schunck R, Perales F. Within-and between-cluster effects in generalized linear mixed models: A discussion of approaches and the xthybrid command. Stata J. 2017; 17: 89–115.

32. Mundlak Y. On the pooling of time series and cross section data. Econom. J. Econom. Soc. 1978: 69–85.

33. Guilkey DK, Escamilla V, Calhoun LM, Speizer IS. The Examination of Diffusion Effects on Modern Contraceptive Use in Nigeria. Technical Working Paper, Chapel Hill, NC. 2019.

Článek vyšel v časopise


2019 Číslo 9

Nejčtenější v tomto čísle

Tomuto tématu se dále věnují…


Zvyšte si kvalifikaci online z pohodlí domova

Antiseptika a prevence ve stomatologii
nový kurz
Autoři: MUDr. Ladislav Korábek, CSc., MBA

Citikolin v neuroprotekci a neuroregeneraci: od výzkumu do klinické praxe nejen očních lékařů
Autoři: MUDr. Petr Výborný, CSc., FEBO

Zánětlivá bolest zad a axiální spondylartritida – Diagnostika a referenční strategie
Autoři: MUDr. Monika Gregová, Ph.D., MUDr. Kristýna Bubová

Diagnostika a léčba deprese pro ambulantní praxi
Autoři: MUDr. Jan Hubeňák, Ph.D

Význam nemocničního alert systému v době SARS-CoV-2
Autoři: doc. MUDr. Helena Lahoda Brodská, Ph.D., prim. MUDr. Václava Adámková

Všechny kurzy
Kurzy Doporučená témata