Introduction: Maternal mortality remains a major public health challenge globally, particularly in low-income countries. Among the key prevention strategies, family planning plays a critical role by promoting adequate birth spacing, which helps reduce maternal complications and deaths. In particular, postpartum family planning (PPFP) is essential in preventing closely spaced pregnanciesa known risk factor for maternal morbidity and mortality. In Togo, while efforts have been made to integrate PPFP into national health policies, significant barriers persist, including limited access to services and sociocultural obstacles. The study aimed to analyze accountability mechanisms, existing synergies, and the scale-up level of postpartum family planning (PPFP), based on the core components developed by the High Impact Practices (HIP) Family Planning Secretariat. Methodology: This qualitative study of 40 key stakeholders in the healthcare system assesses the status of the institutionalisation of PFPP. Data were collected via semi-structured interviews and analysed using Excel and SPSS v2021 software. Results: The results reveal a high availability of contraceptive products and equipment (82%), an efficient monitoring system (86%), but also highlight weaknesses in training (79%) and community involvement (67%). The sustainability of the initiative will depend on better institutional anchoring, multi-sectoral integration, and sustainable funding. Conclusion: The scale-up of postpartum family planning (PPFP) in Togo shows significant promise; however, critical improvements are still needed in provider training, effective service integration, and meaningful community engagement. The long-term sustainability of this initiative will rely on strong political commitment, sufficient and sustained funding, and the implementation of a genuinely integrated approach. Furthermore, addressing sociocultural barriers remains essential to maximizing the reach and effectiveness of PPFP interventions.
Published in | American Journal of Health Research (Volume 13, Issue 4) |
DOI | 10.11648/j.ajhr.20251304.12 |
Page(s) | 210-225 |
Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
Copyright |
Copyright © The Author(s), 2025. Published by Science Publishing Group |
Family Planning, Postpartum, Maternal Health, Scalability, Community Engagement
Components | Description | Variables | Application Modalities |
---|---|---|---|
Availability of supplies, equipment, and methods within the health facility | Refers to the availability of services, equipment, and methods within the facility for all clients seeking a method during the immediate postpartum period. | 1. Availability of FP services 2. Availability of contraceptive products 3. Availability of equipment for administering FP methods 4. Availability of tools for administering FP methods 5. Availability of guidelines | - Yes - No |
Availability of personnel for PPFP service delivery | Takes into account the training and availability of staff to ensure the functioning of the PPFP service at all times. | 1. Availability of trained FP personnel 2. Availability of a schedule for PPFP services | - Yes - No |
Continuous training | Concerns the training of various healthcare provider cadres in delivering and counseling on PPFP services. | 3. Availability of a capacity-building plan for PPFP 4. Ongoing training of providers in PPFP 5. Quarterly & semi-annual supervision of PPFP providers | - Yes - No |
Monitoring & evaluation | Establishment of a monitoring and evaluation system and reporting on counseling and method uptake among immediate postpartum clients. | 1. Availability of monthly activity report templates and health information documentation tools 2. Production of monthly activity reports 3. Training on DHIS2 4. Organization of review and monitoring meetings | - Yes - No |
Governance | Commitment of health facility leadership and staff to promote PPFP. | 1. PPFP included in the facility’s work plan 2. Allocation of resources for PPFP 3. Integration of PPFP into the health service package | - Yes - No |
Community engagement | Strengthening links with community programs to promote awareness of ANC and postpartum options (including immediate contraceptives). | 1. Community dialogue 2. Guided visits 3. Awareness campaigns 4. Local radio broadcasts 5. Suggestion box for client feedback | - Yes - No |
Criteria | Proportion of « Yes » Responses (%); n/N | Scale-up Index |
---|---|---|
Availability of contraceptive products | 80% (32/40) | Very satisfactory |
Availability of supplies for administering FP methods | 80% (32/40) | Very satisfactory |
Availability of equipment for administering FP methods | 80% (32/40) | Very satisfactory |
Availability of FP guidelines | 70% (28/40) | Satisfactory |
Counseling and provision of PPFP services | 100% (40/40) | Very satisfactory |
Total | 82% (164/200) | Very satisfactory |
Criteria | Proportion of «Yes» Responses (%); n/N | Scale-up Index |
---|---|---|
Availability of trained personnel | 70% (28/40) | Satisfactory |
Availability of a PPFP service schedule | 75% (30/40) | Satisfactory |
Total | 72% (58/80) | Satisfactory |
Criteria | Proportion of «Yes» Responses (%); n/N | Scale-up Index |
---|---|---|
Training of providers in PPFP & contraceptive technology | 70% (28/40) | Satisfactory |
Providers receive quarterly & semiannual supervision | 87% (35/40) | Very satisfactory |
Total | 79% (63/80) | Satisfactory |
Criteria | Proportion of «Yes» Responses (%); n/N | Scale-up Index |
---|---|---|
Availability of physical & digital tools for health information documentation | 100% (40/40) | Satisfactory |
Training on DHIS2 | 50% (20/40) | Less satisfactory |
Production of monthly activity reports | 100% (40/40) | Very satisfactory |
Review and monitoring organization | 95% (38/40) | Very satisfactory |
Total | 86% (138/160) | Very satisfactory |
Criteria | Proportion of «Yes» Responses (%); n/N | Scale-up Index |
---|---|---|
The facility includes PPFP in its work plan | 75% (30/40) | Satisfactory |
Resource allocation for PPFP | 95% (38/40) | Very satisfactory |
Integration of PPFP into health services | 75% (30/40) | Satisfactory |
Total | 81% (98/120) | Very satisfactory |
Criteria | Proportion of «Yes» Responses (%); n/N | Scale-up Index |
---|---|---|
Client opinion suggestion box | 50% (20/40) | Not satisfactory |
Community dialogue | 70% (30/40) | Satisfactory |
Guided visit | 37% (15/40) | Not satisfactory |
Awareness-raising | 95% (38/40) | Very satisfactory |
IEC & CCC | 95% (38/40) | Very satisfactory |
Local radio broadcasts | 50% (20/40) | Not satisfactory |
Total | 67% (161/240) | Satisfactory |
Components | Overall Scale-Up Score (%) n/N | Scale-up Index |
---|---|---|
Availability of supplies, equipment, and methods in health facilities | 82% (164/200) | Very satisfactory |
Availability of personnel for PPFP service delivery | 72% (58/80) | Satisfactory |
Ongoing staff training | 79% (63/80) | Satisfactory |
Monitoring & evaluation mechanism | 86% (138/160) | Very satisfactory |
Governance | 81% (98/120) | Very satisfactory |
Community engagement | 67% (161/240) | Satisfactory |
Total | 77.5% (682/880) | Satisfactory |
Components | Reported Shortcomings |
---|---|
Availability of supplies, equipment, and methods in health facilities | Stock-outs, lack of certain equipment, and absence of some methods limiting full access to a range of choices for postpartum women. The high cost of certain family planning methods remains a major barrier to accessibility. |
Availability of personnel for PPFP service delivery | An insufficient number of trained staff present in services, especially outside regular working hours, compromises the continuous and quality provision of PPFP. The absence or unavailability of personnel during non-standard hours is a major obstacle to uninterrupted postpartum family planning services, limiting continuous access. |
Ongoing staff training | Irregular capacity-building sessions and updates on technical skills reduce service quality and adherence to the latest clinical guidelines. |
Monitoring & evaluation mechanism | The absence of systematic mechanisms to monitor PPFP indicators limits the ability to improve performance and report on progress. |
Governance | The lack of an integrated approach between PPFP, RMNCH, and nutrition hinders coordinated service delivery, reducing intervention effectiveness and beneficiary coverage. Policy silos and lack of coordination between programs (e.g., PPFP, MNCH, nutrition, HIV, immunization) lead to fragmented interventions and undermine overall health system effectiveness. Low involvement of local decision-makers and poor coordination among local institutions (health, decentralization and traditional leadership, social action, education) impede coherent implementation of PPFP interventions. |
Community engagement | Low community involvement, persistent myths, taboos, and rumors about contraception, and the absence of targeted awareness strategies limit demand and acceptability of PPFP services. High levels of dissatisfaction among users of maternal and child health services. |
AFROSAF | African Francophone Network for Sexual and Reproductive Health and Rights Advocacy |
ATBEF | Association Togolaise Pour le Bien-être Familial |
CoP | Community of Practice |
CSOs | Civil Society Organizations |
DC | District of Columbia |
DHIS2 | District Health Information Software 2 |
EPI | Expanded Programme on Immunization |
FP2030 | Family Planning 2030 |
GTT PAGE | Groupe Technique de Travaille et de Passage à Grande échelle |
HIPs | High-Impact Practices in Family Planning |
HIV | Human Immunodeficiency Virus |
INSPiRE | Nutrition Integration, Essential Newborn Care, Postpartum Family Planning/ Reproductive Health |
IUD | Intrauterine Device |
LSTM | Liverpool School of Tropical Medicine |
MNCH | Maternal, Newborn, and Child Health |
NGO | Non-Governmental Organization |
NHIS | National Health Information System |
PMTCT | Prevention of Mother-To-Child Transmission of HIV |
PPFP | Postpartum Family Planning |
ROSCI SR/PF | Réseau Des Organisations de la Société Civile Intervenant En Santé Reproductive / Planification Familiale |
SPSS | Statistical Package for the Social Sciences |
TFP | Technical and Financial Partners |
UCPO | Coordination Unit for Ouagadougou Partnership |
UNFPA | United Nations Population Fund |
USAID | United States Agency for International Development |
WAHO | West African Health Organization |
WHO | World Health Organization |
No | Document Title | Method of Access |
---|---|---|
01 | Outil d’évaluation de la scalabilité des Pratiques à Haut Impact (PHI) de l’OMS - Bureau AFRO. | Online |
02 | Key implementation components for four service delivery HIPs | Online |
03 | Rapport annuel de suivi des données sanitaires 2021 | Online |
04 | Bilan des engagements nationaux pour la PF dans les pays du Partenariat de Ouagadougou. | Online |
05 | Planification familiale 2030: Feuille de route pour l’Afrique de l’Ouest francophone. | Online |
06 | Compte rendu des réunions du Groupe Technique de Travail pour le Passage à Grande Échelle (GTT PAGE) Document de synthèse interne détaillant les activités de plaidoyer, de mobilisation des ressources et de coordination technique. | Online |
07 | Politique nationale de santé horizon 2030 | physical |
08 | Plan national de développement sanitaire 2023-2027 | physical |
09 | Plan d’action national budgétisé de planification familiale au Togo 2023-2026 | physical |
10 | Document de programme WEZOU | physical |
11 | DSMI PF Rapport 2022 | physical |
12 | Document du projet Sahel Women’s Empowerment and Demographic Dividend (SWEDD) | physical |
13 | Rapport d’évaluation de la politique nationale de santé 2012-2022 | physical |
14 | Rapport d’évaluation du plan national de développement sanitaire 2017-2022 | physical |
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APA Style
Gmakouba, W., Azianu, K. A., Bini, M., Bantakpa, S., Deabalo, P., et al. (2025). Progress and Prospects for the Institutionalization and Scale-Up of Postpartum Family Planning in Togo. American Journal of Health Research, 13(4), 210-225. https://doi.org/10.11648/j.ajhr.20251304.12
ACS Style
Gmakouba, W.; Azianu, K. A.; Bini, M.; Bantakpa, S.; Deabalo, P., et al. Progress and Prospects for the Institutionalization and Scale-Up of Postpartum Family Planning in Togo. Am. J. Health Res. 2025, 13(4), 210-225. doi: 10.11648/j.ajhr.20251304.12
@article{10.11648/j.ajhr.20251304.12, author = {Wankpaouyare Gmakouba and Komi Ameko Azianu and Mazabalo Bini and Salaraga Bantakpa and Pitabinawè Deabalo and Labaguibe Gangak}, title = {Progress and Prospects for the Institutionalization and Scale-Up of Postpartum Family Planning in Togo }, journal = {American Journal of Health Research}, volume = {13}, number = {4}, pages = {210-225}, doi = {10.11648/j.ajhr.20251304.12}, url = {https://doi.org/10.11648/j.ajhr.20251304.12}, eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajhr.20251304.12}, abstract = {Introduction: Maternal mortality remains a major public health challenge globally, particularly in low-income countries. Among the key prevention strategies, family planning plays a critical role by promoting adequate birth spacing, which helps reduce maternal complications and deaths. In particular, postpartum family planning (PPFP) is essential in preventing closely spaced pregnanciesa known risk factor for maternal morbidity and mortality. In Togo, while efforts have been made to integrate PPFP into national health policies, significant barriers persist, including limited access to services and sociocultural obstacles. The study aimed to analyze accountability mechanisms, existing synergies, and the scale-up level of postpartum family planning (PPFP), based on the core components developed by the High Impact Practices (HIP) Family Planning Secretariat. Methodology: This qualitative study of 40 key stakeholders in the healthcare system assesses the status of the institutionalisation of PFPP. Data were collected via semi-structured interviews and analysed using Excel and SPSS v2021 software. Results: The results reveal a high availability of contraceptive products and equipment (82%), an efficient monitoring system (86%), but also highlight weaknesses in training (79%) and community involvement (67%). The sustainability of the initiative will depend on better institutional anchoring, multi-sectoral integration, and sustainable funding. Conclusion: The scale-up of postpartum family planning (PPFP) in Togo shows significant promise; however, critical improvements are still needed in provider training, effective service integration, and meaningful community engagement. The long-term sustainability of this initiative will rely on strong political commitment, sufficient and sustained funding, and the implementation of a genuinely integrated approach. Furthermore, addressing sociocultural barriers remains essential to maximizing the reach and effectiveness of PPFP interventions.}, year = {2025} }
TY - JOUR T1 - Progress and Prospects for the Institutionalization and Scale-Up of Postpartum Family Planning in Togo AU - Wankpaouyare Gmakouba AU - Komi Ameko Azianu AU - Mazabalo Bini AU - Salaraga Bantakpa AU - Pitabinawè Deabalo AU - Labaguibe Gangak Y1 - 2025/07/07 PY - 2025 N1 - https://doi.org/10.11648/j.ajhr.20251304.12 DO - 10.11648/j.ajhr.20251304.12 T2 - American Journal of Health Research JF - American Journal of Health Research JO - American Journal of Health Research SP - 210 EP - 225 PB - Science Publishing Group SN - 2330-8796 UR - https://doi.org/10.11648/j.ajhr.20251304.12 AB - Introduction: Maternal mortality remains a major public health challenge globally, particularly in low-income countries. Among the key prevention strategies, family planning plays a critical role by promoting adequate birth spacing, which helps reduce maternal complications and deaths. In particular, postpartum family planning (PPFP) is essential in preventing closely spaced pregnanciesa known risk factor for maternal morbidity and mortality. In Togo, while efforts have been made to integrate PPFP into national health policies, significant barriers persist, including limited access to services and sociocultural obstacles. The study aimed to analyze accountability mechanisms, existing synergies, and the scale-up level of postpartum family planning (PPFP), based on the core components developed by the High Impact Practices (HIP) Family Planning Secretariat. Methodology: This qualitative study of 40 key stakeholders in the healthcare system assesses the status of the institutionalisation of PFPP. Data were collected via semi-structured interviews and analysed using Excel and SPSS v2021 software. Results: The results reveal a high availability of contraceptive products and equipment (82%), an efficient monitoring system (86%), but also highlight weaknesses in training (79%) and community involvement (67%). The sustainability of the initiative will depend on better institutional anchoring, multi-sectoral integration, and sustainable funding. Conclusion: The scale-up of postpartum family planning (PPFP) in Togo shows significant promise; however, critical improvements are still needed in provider training, effective service integration, and meaningful community engagement. The long-term sustainability of this initiative will rely on strong political commitment, sufficient and sustained funding, and the implementation of a genuinely integrated approach. Furthermore, addressing sociocultural barriers remains essential to maximizing the reach and effectiveness of PPFP interventions. VL - 13 IS - 4 ER -