Needs Assessment and Scale-Up Recommendations for Integrated HIV and Family Planning Services in Rural Rwanda Open Access

Mazzei, Amelia (2017)

Permanent URL:


Projet San Francisco (PSF), the Rwanda branch of the Rwanda Zambia HIV Research Group (RZHRG), has pioneered effective and culturally appropriate behavioral health interventions for HIV prevention and family planning in Rwanda. Since August of 2015, PSF has been implementing an NIH-funded operations research study of HIV and family planning service integration that emphasizes long-acting reversible contraceptive (LARC) methods. The intervention includes community-based family planning counseling and referral via community health workers (Animateurs de Sante or ADS) and seeks to engage couples, as well as individuals, whenever possible. In its first year, this new fertility goal-based (Couples) Family Planning Counseling ((C)FPC) intervention was scaled up to 8 different government clinic catchment areas in Kigali, and served over 3000 new LARC clients.

PSF is now considering further expansion of (C)FPC to areas beyond Kigali. Building on formative research conducted by the Rwanda Zambia HIV Research Group, I examined the compatibility of PSF's Kigali-based (C)FPC program with the needs and capacities of rural Rwandan public health centers (HC). I conducted a multi-step process of (C)FPC program evaluation and rural HC clinical needs assessment in order to inform decision-making around future expansion of (C)FPC to rural Rwandan health centers. This work has resulted in a final report that provides updated information on service provision and promotion as well as preliminary recommendations to inform the expansion of PSF's (C)FPC services to non-urban populations in Rwanda. This report, which argues for the desirability and feasibility of (C)FPC service expansion to rural Rwanda, forms the basis for a new NIH grant proposal. The proposal, to be submitted in May 2017, will seek funding for a new operations research study regarding (C)FPC program expansion.

Table of Contents

Chapter 1: Introduction 1
Background and Significance 1
Project Overview and Report Components 3
Adequacy Evaluation and Review of Program User Demographics
Rural Clinical Needs Assessments Report
Expansion Desirability and Feasibility Report 5
Ethical Considerations 5

Chapter 2: Adequacy Evaluation and Review of Program User Demographics 7
Description of Program to be Evaluated 7
Adequacy Evaluation Methods and Limitations 7
Adequacy Evaluation Findings and Discussion 9
LARC Uptake among (C)FPC Participants 9
Changes to LARC Provision at Participating HCs
Demographic Factors Associated with LARC Uptake 13
Framework for Future Evaluation 16

Chapter 3: Rural Clinical Needs Assessments 17
The Need for Rural Clinical Needs Assessments 17
Needs Assessments Methods and Limitations 17
Needs Assessments Findings 19
The Current State of Rural LARC Provision 19
Rural LARC Provision Capacity
Rural LARC Promotion Capacity
Needs Assessment Key Lessons and Discussion 27

Chapter 4: Research Implications with Recommendations for CFPC Expansion 31
Translating Research into Practice 31
Review and Interpretation of Key Research Findings 31
Compatibility of (C)FPC with Rural Setting 33
Recommendations on Next Steps for (C)FPC Expansion 34

Annex A: Evalutation Data Tables
Annex B: Needs Assessment Map and Itinerary
Annex C: Needs Assessment Tool
Annex D: Action Areas
Annex E: Health Center Contact List
Annex F: Health Center Contact Letter

About this Master's Thesis

Rights statement
  • Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.
  • English
Research Field
Committee Chair / Thesis Advisor
Committee Members
Partnering Agencies
Last modified

Primary PDF

Supplemental Files