Designing for Impact and Institutionalization: Applying Systems Thinking to Sustainable Postpartum Family Planning Approaches for First-Time Mothers in Bangladesh

Many promising interventions with demonstrated impact at small scale have failed to produce the same results when scaled beyond small geographic areas, or have proven infeasible to institutionalize. To achieve lasting impact, an approach must be both effective (able to produce the desired impact) and able to be institutionalized. Yet, considerations for whether and how approaches can be institutionalized within existing health systems are often underrepresented in program design. The Connect project developed a design process that aimed to move beyond considering “does this approach have potential to produce the desired impact?” to also consider, with equal weight, “does this approach have potential to be institutionalized within the health system in this particular context?”. We applied this process to design postpartum family planning approaches for first-time parents in Bangladesh and Tanzania. This paper details the process, which is applicable to other technical areas and populations, and includes the tools as supplements.