Scalability and Scale-Up Readiness of Family Planning High-Impact Practices in Cameroon, Côte d’Ivoire, Mauritania and Togo: A Comparative Cross-Sectional Study
DOI:
https://doi.org/10.68050/JAMS.2026.752Keywords:
family planning, High Impact Practices, scalabilityAbstract
Background: Evidence-based family planning interventions may be effective on a small scale yet remain difficult to expand when health systems lack the resources, organisation or institutional support required for wider delivery.
Objectives: To compare the scale-up readiness of five family planning HIPs in Cameroon, Côte d’Ivoire, Mauritania and Togo and to identify the main factors that may support or hinder their expansion.
Methods: We conducted a comparative cross-sectional study using secondary data from an Excel-based scalability assessment tool developed from the AFROSAF. One sexual and reproductive health and family planning expert in each country completed the online assessment voluntarily. Five HIPs were assessed in four countries, yielding 20 country-practice observations. Fifteen criteria grouped into nine AFROSAF domains were scored on a 0–100 scale. The analysis was descriptive.
Results: PFPP had the highest mean readiness score (87.96), followed by community health workers (87.73), mobile outreach (81.25), postabortion family planning (79.86) and pharmacies/drug shops (63.89). CHW Cowere the only practice rated high in all four countries. The strongest domains were development process and health need, while resource availability, readiness to address access barriers and the scaling setting scored lower.
Conclusions: Four of the five HIPs showed substantial readiness for wider implementation, although important differences remained between countries. Pharmacy- and drug-shop-based family planning was the most context dependent. Decisions to scale up should consider not only evidence of effectiveness, but also financing, access barriers, delivery capacity and long-term sustainability.
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