From Commitment to Care: Sustaining Integrated Health and Family Planning Services in Burkina Faso

By Idrissa Derra, Community Health Technical Specialist, INSPiRE

Two years ago, the CSPS Urbain de Pô health center in southern Burkina Faso began delivering integrated maternal and child health, nutrition, and family planning services through a model supported by the Gates Foundation-funded INSPiRE project.

Since then, midwife Rachelle Gamba and her team have seen rising trust, greater service use and powerful health gains, including fewer unintended pregnancies and improved outcomes for mothers and infants. This model is part of a broader regional effort led by Global Communities, through its partner IntraHealth International, to transform reproductive health care across Francophone West Africa.

I recently sat down with Madame Gamba to discuss what service integration looks like on the ground — what’s working, what’s still challenging and how communities are responding. Her insights reflect the power of locally-led solutions and the impact of putting women and families at the center of care. The interview below has been translated from French to English and edited for length and clarity.

Idrissa: It’s been two years since you shared your experience and that of the CSPS Urbain de Pô health center, where you work on the integration of maternal, neonatal, and child health services, family planning, and nutrition. What is your assessment of this new approach today?

Madame Gamba: The results have been very positive. Since we integrated immediate postpartum family planning, maternal and child health, and nutrition services, we’ve seen a clear transformation in the quality of care. For example, when a woman comes in for a consultation, providers now proactively identify all her needs, not just the initial reason for her visit, to offer integrated care.

Service use has also increased significantly. Women who benefit from this care share their positive experiences, encouraging others – even from neighboring health areas, to come for consultations here. They appreciate not only receiving the services they sought but also those they hadn’t initially considered.

Our data confirms this momentum. There’s been a marked increase in several indicators: family planning, infant consultations, and more broadly across all service entry points. For example, in 2024, we recorded 1,332 mothers of children aged 0–6 months attending infant consultations — significantly more than in 2023. In terms of postnatal consultations, the most recent data shows that 238 women were seen in 2024, and 175 of them adopted a contraceptive method. These results were much lower in 2023, clearly demonstrating the positive effects of service integration for essential care.

Idrissa: If the experience you just described has been successful, what would you say are the three main factors that have helped sustain these excellent results?

Madame Gamba: First, we must highlight the strong commitment of the providers. They fully embraced the approach, agreed to enhance their skills through training, and demonstrated dedication in implementing the integrated model every day.

Secondly, this commitment was supported by the district’s management team (ECD) through regular supervision, field follow-up, mentoring and coaching.

And finally, community buy-in has been critical. All these combined efforts enabled the approach to yield concrete, visible results in the field. Today, women’s participation is strong — they trust the services and actively support this transformative dynamic.

Idrissa: What are the three main challenges — whether material, human, or social — that you and your colleagues faced during this integration? And how did you overcome them?

Madame Gamba: Initially, we struggled with staff shortages, especially when trained providers were transferred. The district gradually responded by increasing staff.

We also lacked essential equipment like syringes for manual vacuum aspiration and neonatal resuscitation tools. Stockouts of family planning supplies were frequent, which sometimes meant women couldn’t get the method they chose. IntraHealth and other partners helped by supplying equipment, visual aids, and contraceptives. Logistics systems were also strengthened to avoid stockouts.

Another major challenge was sociocultural resistance. In some villages, women were reluctant to adopt contraception due to traditional beliefs or community expectations. We addressed this through education, community outreach and engaging religious and traditional leaders. Today, community support is much stronger.

One challenge that still persists is the limited involvement of men. Most women come alone for care, but male engagement is essential. When men understand the importance of family planning and maternal health, they can support their partners and help shift community attitudes.

Idrissa: Could you share a powerful testimony from a participant that has impacted you since the integration of services?

Madame Gamba: Yes, there are many impactful examples, but one that particularly touched me involved a woman who came to deliver at our health center, after attending prenatal visits elsewhere. She was a grand multipara – someone who has given birth five or more times – and told me that she got pregnant almost every year, usually before she could adopt a contraceptive method.

That day, as soon as she arrived, the midwife examined her and confirmed that labor had begun. The midwife then explained that a long-acting method could be inserted immediately after birth. The woman was surprised — she didn’t know that was possible.

The midwife stayed by her side throughout labor, supported her during all the stages, and once the baby and placenta were delivered, she returned to talk about family planning again. The woman made a choice and a five-year contraceptive method was inserted right then.

She left saying, “I’m really happy. Thanks to this, I’ll be able to rest like other women and let my child grow in good conditions before the next pregnancy.” This testimony moved me deeply — it illustrates the concrete impact of integrating family planning into delivery services and the essential role of timely counseling.

Idrissa: In your opinion, what role do men, husbands, or male partners play in the successful integration and use of reproductive and maternal health services?

Madame Gamba: Men play a crucial role in maternal and reproductive health. When a man accompanies his partner to a prenatal consultation, the couple can receive comprehensive counseling. The midwife can explain both pregnancy monitoring and nutrition — which is essential, as men are often the ones providing food.

Their presence allows them to learn about family planning, especially postpartum methods — an area where men still often lack information. When men attend consultations, whether prenatal, postpartum, for delivery, vaccination, or infant care, they become key messengers who can dispel myths and help break down sociocultural barriers.

When a woman receives counseling alone, it may be hard for her to convince others. But if her partner supports and actively accompanies her, this can lead to real changes in couple and community behaviors in favor of better sexual and reproductive health.

Idrissa: Based on your experience, what are the three main recommendations you would give to other health centers that haven’t yet adopted service integration?

Madame Gamba: First, train providers. Without understanding integration, they can’t implement it effectively. Once skilled, it’s essential to reorganize services based on the four main entry points — prenatal care, postnatal care, immunization, and child health — to allow for efficient, co-located service delivery.

Ensure consistent availability of supplies and medical-technical equipment like contraceptives, vaccines, nutrition products and screening tools. For example, if a woman chooses a method of contraception and it’s not available, trust is lost and the entire system of integrated care falls apart.

And finally, accurate documentation is essential for tracking progress and improving care. Together, these conditions enable successful integration.

Idrissa: What is your greatest pride today as a midwife?

Madame Gamba: First, the satisfaction of the women we serve touches me deeply. Their gratitude is extremely rewarding for the whole team. It’s our main source of motivation. And more women are coming to us, even from other areas, because they know they’ll receive comprehensive, respectful care.

Another point of pride is the increased adoption of family planning. Before integration, many women lacked access to timely information and services. Now, thanks to increased counseling, educational talks and available contraceptive methods, women are better informed and adopt family planning on time.

We’ve also seen a sharp decline in severe malaria cases in pregnant women because of supervised sulfadoxine-pyrimethamine (SP) intake – a malaria-preventing medicine – during antenatal care visits, awareness sessions on mosquito net use and regular preventive messages. As a result, most women give birth without having contracted malaria, reducing anemia, premature births, and serious complications.

Finally, I’m proud to say that since 2018, our clinic has recorded no maternal deaths, and neonatal deaths are also very rare. This demonstrates the real, lasting impact of integrating family planning, maternal, infant and child healthcare, and nutrition services into our daily practice.

In short, we are proud and grateful. Integration is working — it saves lives and positively transforms the way we serve our community.