What Are High Impact Practices in Family Planning (HIPs)?
High Impact Practices (HIPs) are effective service delivery or systems interventions that when scaled up and institutionalized, will maximize investments in a comprehensive family planning strategy. HIPs help family planning programs focus their resources and efforts to ensure they have the broadest reach and greatest impact.
The list of HIPs is not intended to constitute or replace a comprehensive family planning strategy, which should be informed by the Elements of Success in Family Planning Programming and driven by country context.
How Are Practices Identified and Selected?
HIPs are identified based on demonstration and magnitude of impact on contraceptive use and continuation and potential application in wide range of settings. Consideration is also given to evidence on replicability, scalability, sustainability and cost-effectiveness. The HIP Technical Advisory Group (TAG), made up of international experts in family planning research, programming, and implementation, provides a peer review process to ensure that HIPs meet these criteria.
HIPs are grouped into two interrelated categories: (1) creating an enabling environment and (2) high impact practices in service delivery. Creating an enabling environment facilitates implementation of high impact practices in service delivery.
Programs invest in an enabling environment at a national or community level to create a positive environment for family planning programs, such as fostering norms that support sexual and reproductive health. Managers also invest in systems that facilitate implementation and institutionalization of specific service delivery HIPs, such as enacting policy changes that allow task sharing and creating supply chains that place commodities closer to potential clients. Enabling environment HIPs are identified based on expert opinion and demonstrate correlation with improved health behaviors and/or outcomes. These outcomes include improvements in unintended pregnancy, fertility, or one of the primary proximate determinants of fertility (increased modern contraceptive use, delay of marriage, birth spacing, and breast feeding).
- Galvanize commitment to family planning through advocacy and policy development.
- Develop, implement, and monitor supportive government policies.
- Support financing for family planning commodities and services at the national and local levels.
- Develop an effective supply chain management system for family planning so that women and men can choose, obtain, and use the contraceptive methods they want throughout their reproductive life.
- Implement a systematic, evidence-based health communication strategy that includes communication through multiple channels to enable people to make voluntary and informed health care decisions.
- Develop in-country capacity to lead and manage family planning programs.
- Keep girls in school to improve health and development.
HIPs in service delivery are identified based on demonstration and magnitude of impact on service utilization, including contraceptive use and continuation; and potential application in a wide range of settings. Consideration is also given to the evidence on replicability, scalability, and sustainability. The TAG recognizes the importance of cost-effectiveness and notes the lack of data on cost and cost-effectiveness. The TAG recommends this area as a high priority for future research.
The TAG also categorizes service delivery practices based on the strength and consistency of the evidence-base. The categories (Proven, Promising, Emerging) are adapted from criteria used by the World Health Organization Department of Child and Adolescent Health as part of a similar exercise.
Proven practices in service delivery are those where sufficient evidence exists to recommend widespread implementation, provided that there is careful monitoring of coverage, quality and cost, and implementation research to help understand how to improve implementation.
- Train, equip, and support community health workers (CHWs) to provide a wide range of family planning methods.
- Postabortion family planning: Provide family planning counseling and services at the same time and location where women receive services related to spontaneous or induced abortion.
- Provide a wide range of family planning methods through mobile outreach services.
- Support distribution of a wide range of family planning methods and promotion of healthy contraceptive behaviors through social marketing.
Promising practices in service delivery are those where good evidence exists that these interventions can lead to impact; more information is needed to fully document implementation experience and impact. These interventions should be promoted widely, provided that they are implemented within the context of research and are being carefully evaluated both in terms of impact and process.
- Train and support drug shop and pharmacy staff to provide a wide range of family planning methods and information.
- Integrate family planning and immunization: Offer family planning information and services proactively to women in the extended postpartum period during routine child immunization contacts.
Emerging practices: Although emerging HIPs have a strong theoretical basis, they have limited evidence to assess impact. Therefore, emerging HIPs should be implemented within the context of research or an impact evaluation.