A multi-component intervention to reduce bias during family planning visits: qualitative insights on implementation from Burkina Faso, Pakistan and Tanzania

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Résumé

Beyond Bias was an intervention introduced in Burkina Faso, Pakistan and Tanzania, with the aim of reducing health
worker bias toward young, unmarried and nulliparous women seeking family planning services. This study used
qualitative methods – based on interviews with health workers who participated in the intervention, managers
at health facilities that participated in the intervention, and policy and program stakeholders at the national level
– to understand implementation experiences with the intervention. The results offer insights for organizations or
countries seeking to implement Beyond Bias or similar programs, and point to some other key implementation
challenges for multi-component interventions in lower-resource settings. The intervention, developed using
a human-centered design approach, was seen as key for successful implementation but there were logistical
challenges. The digital intervention was disruptive and distracting to many. In addition, the non-financial rewards
intervention was perceived as complex, and some participants expressed feeling discouraged when they did
not receive a reward. Beyond Bias did not sufficiently attend to the “outer setting,” and this was perceived as a
major implementation barrier as it limited individuals’ capacity to fully achieve the desired behavior change; for
example, space constraints meant that some health facilities could not ensure private services for all clients. There
were scalability concerns related to cost, and there is uncertainty whether diversity of contexts (within and across
countries) might constrain implementation of Beyond Bias at scale.

Mots-clés

Contraception, Qualitative research, Implementation science, Intervention, Burkina Faso, Pakistan, Tanzania