Examining the effectiveness and impact of integrating comprehensive family planning into community-based primary health care services in three rural districts of Tanzania: The Connect Project

The Connect Project in Tanzania a strategy for scaling-up a field trial to become a national program. It operationalizes and evaluates the impact of a community-health worker program aimed at reducing child mortality through community-based primary healthcare services, including case management of childhood diarrhea, pneumonia and malaria. It commenced in 2011 as a randomized controlled trial with features to study the effects of implementation on health systems strength. Faced with high unmet need for contraception in the study population, Connect has integrated family planning into its primary health care operation. This is scaling up the program in phases guided by evidence. In the current paper, findings from a formative micro-pilot and qualitative case study impart lessons learned and clarify the determinants and processes of successfully integrating family planning into the Connect service system. Evidence from operations research demonstrates the relative quality, productivity and coverage achieved by the intervention in settings where family planning has been integrated and not. An end of project multi-level impact analysis is presented that projects the impact of distance to service point on fertility in areas exposed and unexposed to Connect services, forecasting fertility impact if results are extended to scale.