. 2022 Oct 31;10(5):e2200023. doi: 10.9745/GHSP-D-22-00023

TABLE 2.

Key Findings From Assessment of Potential for Institutionalization

Approach	Immediate PPFP	Predischarge	Targeted Home Visits	KMC/SCANU	PPFP/EPI Integration
Service delivery (System 1)	Most providers trained in PPFP and provide integrated services; few upskilling needs^a	Most providers trained in PPFP and provide integrated services; few upskilling needs^a Limited observation and discussion during busy discharge times^b Increased workload^b	FWA JDs included HVs^a High FWA vacancies, infeasible HV targets^b	Nurses in KMC/SCANU not trained in PPFP^b	No integration by EPI or FP providers^b Negative impact on provider workload^b Facility infrastructure unconducive to private FP counseling^b
Coordination (System 2)	Existing monthly coordination meetings^a Needed coordination of counseling beginning from ANC, documenting and following up on clients’ PPFP intentions^b	Existing coordination meetings^a Poor referral coordination^b Needed internal coordination during busy discharge times, support for additional tasks^b	Existing coordination meeting of supervisors, service providers, and FWAs^a Needed coordination of facility referrals^b	No existing coordination or referrals between KMC/SCANU and FP units^b	Needed coordination to ensure FP providers present in EPI sessions^b Needed coordination of intra- and inter-facility referrals^b
Supervision, management, oversight, control (System 3)	Existing supervision mechanisms^a	Monthly supervision visits planned^a Little follow-up after supervision^b	Monthly supervision visits planned^a Little supportive supervision, HVs rarely observed^b	Monthly supervision visits planned^a PPFP not included in provider supervision^b	Integrated services not included in supervision^b
Higher-level systems (System 4)	National stakeholder commitment to PPIUD^a Existing (underutilized) fund to offset PPFP expenses^a^,b			Different managers in KMC/SCANU and FP units, increasing coordination needs^b	Stakeholder commitment to FP/EPI integration^a
Support systems/supply chain	FP commodity supply generally sufficient^a			FP commodities would need to be supplied in units^b
Support systems/information systems	Existing processes to counsel and document PPFP preferences in ANC card^a Inconsistent documentation of PPFP preferences in ANC^b	FTMs identifiable in delivery, MNC registers^a No system of documenting status at discharge^b	FTMs identifiable in community pregnancy registration systems^a No mechanism prompted FWA HV after delivery^b	FTMs not identifiable in KMC/SCANU registers^b	FTMs identifiable in EPI registers or screening^a EPI and FP registers not linked or harmonized^b
Decision	Combined as final selected approaches, with risk mitigation efforts			Determined to have deal-breakers in the context

Abbreviations: ANC, antenatal care; EPI, Expanded Programme on Immunization; FP, family planning; FTM, first-time mother; FWA, family welfare assistant; HV, home visit; JD, job description; KMC, kangaroo mother care; MNC, maternal and newborn care; PPFP, postpartum family planning; PPIUD, postpartum intrauterine device; SCANU, Special Care Newborn Unit.

^aDenotes opportunities.

^bDenotes potential risks to viability based on current system characteristics.