The Last Mile of Family Planning: Lessons from Lafiya in Nigeria

This transcript was generated by AI and may contain typos and inaccuracies.

Amie Vaccaro: Welcome to High Impact Growth, a podcast from Dimagi for people committed to creating a world where everyone has access to the services they need to thrive. We bring you candid conversations with leaders across global health and development about raising the bar on what’s possible with technology and human creativity.

I’m Amie Vaccaro, VP of CommCare Growth and Strategy at Dimagi, and your co-host, along with Jonathan Jackson, Dimagi’s CEO and co-founder. Today, we explore what it takes to get life-saving contraception into the hands of women in some of the hardest-to-reach communities.

Our guest is Klau Pakos, CEO and co-founder of Lafiya, an organization tackling the family planning delivery gap by meeting women right where they are through trusted local health workers they call Lafiya Sisters. In a single program area, Klau’s team watched contraceptive use climb from two percent to over 70%.

We get into how they built the evidence, why being a true partner to government, not a vendor with a fixed model, has been an unlock, and how they’re thinking about going slow on technology even when the shiny option is tempting. If you’re working to scale anything alongside government, this one’s for you.

Enjoy.

Amie Vaccaro: We’re here today with Jonathan Jackson, my co-host and Dimagi’s co-founder, as always. Hi, Jon. Nice to see you.

Jonathan Jackson: Hey, Amie. Great to see you, as always.

Amie Vaccaro: Yeah. And today we’re really honored to be joined by Klau Pakos. They’re the CEO and co-founder of Lafiya, and we’re really excited to have you here today. So, first of all, welcome.

Klau Pakos: Thank you so much. Yes, great to be here.

Jonathan Jackson: Yeah. So for somebody hearing about Lafiya for the first time, what do you do, and who is it for?

Klau Pakos: So Lafiya solves the family planning data and delivery gap. We’re currently focused on Nigeria, but universal access to family planning is our big vision. At scale, there are highly effective and affordable contraceptives out there, but health systems struggle to consistently deliver services at the last mile. So Lafiya solves this by meeting women where they are with trusted Lafiya Sisters, high-quality family planning counseling, and available stock.

Amie Vaccaro: Awesome. What was it about the women that you met in Northern Nigeria that made this the problem you decided to build your entire life around solving?

Klau Pakos: I started working in Nigeria almost a decade ago on a different project. I was a consultant for the Ministry of Energy, designing a training curriculum for female entrepreneurs so that they could earn some money from selling cleaner cookstoves and use that to start their own micro-businesses, like selling peppers at the market. But the requirement was to undergo a few weeks of a micro-enterprise course at the local school, covering things like taxes, loans, and accounting, basic but very important things for sustainability.

We essentially worked with women living in extreme poverty who were being given free money and a chance to get themselves and their families out of poverty, and they couldn’t join because they told us how difficult it was to commit to a course like this when they had no decision-making power over when they’d next get pregnant. They had the need, but they didn’t have the products or the health workers who could give them that information. That experience was really eye-opening for me, because I realized there are so many exciting global health and development projects out there, but if this fundamental level isn’t fulfilled, it becomes a barrier to every other program being undertaken and scaled.

Amie Vaccaro: Yeah, that’s really well put. That sort of control and autonomy is the starting point for anything else that comes after. I’d love to hear about a client you’ll never forget, and maybe as you share that story, a bit more about the model and how it works in practice.

Klau Pakos: Yeah, different clients, but there’s one I keep coming back to. I was on a community visit last year in Kebbi, one of the states we operate in, and it was a very long day. We talked to so many different health providers and clients to better understand how we can adjust and adapt our program to their needs.

We were almost done when a woman came over and said, “No, please, I really need to share my story with you.” She explained that she’d been pregnant about two years before, had a really difficult labor, and was still recovering when she realized she was pregnant again, only a few months after her last delivery, with her fourth child. She went to a local clinic for a scan with her neighbor, who was a doctor. He saw something on the screen, got really pale and scared, and said, “I can’t tell you what’s going on, but it’s really scary.” The same thing happened with another friend of hers. Finally she went by herself and said, “I don’t know what’s going on. Everyone is scared, I’m anxious, I’m pregnant, and I’m still recovering.”

It turned out she had twins, and one of them was dying in the womb. She had to have an emergency C-section six months into that pregnancy and almost didn’t survive. She survived, her other baby survived, and now she’s at very high risk if she gets pregnant again before she’s had time to properly recover. She came with her husband, who said he was grateful for services like this because they saved his wife, the woman he loves and the mother of his children, so she can go on caring for their five children.

The story itself felt so visceral. It was probably around six in the evening after a very long, hot day, and she said, “I really want you to hear my story. I’m so grateful for this program, and I really don’t want it to go away. So when you’re deciding where you’re going to expand, where you’re going to work, please don’t leave this.” That story has stayed with me for a very long time.

Jonathan Jackson: That’s amazing. We hear about so many challenges where obviously life-saving technologies and interventions would do a lot of good in hard-to-reach areas. And one of the things you’ve solved for with the Lafiya Sisters is that you’re working in some extremely difficult regions to deliver any intervention, much less family planning. So I’d love to hear: what do the Lafiya Sisters do, and how did you land on that model? At Dimagi, and I know in your work too, everybody knows the root of these programs is amazing community-based workers, but it’s really challenging to run effective programming with them, and you’ve cracked it. So tell us more about the model in general, and how you’ve evolved over the last five years to get to what you have now.

Klau Pakos: Yeah. So the Lafiya model came from a very simple thought: you’d trust your sister more than you’d trust a stranger, especially with something so sensitive as family planning, because you’re deciding about your body, your family, your future, and it’s hard to rely on outside information, whether from a doctor, online, or the radio. You need someone who understands you, who you can trust. That’s exactly where the Lafiya model comes from. So we first identify left-behind communities with high unmet need for family planning, that often have no access to health services, to family planning products, to the information. We work really closely with government to first identify which regions in the country are the most underserved, and then go a lot more granular, down to the local government area level, and even further, to individual communities.

From there, we recruit and train existing female health workers who already work in health facilities, with additional family planning training, so that they become the person sharing this information rather than someone brought in from outside. We find people who already sit at the nexus between the health system and the community, and then they’re called Lafiya Sisters. They deliver proactive, app-enabled family planning counseling and services, and they meet women where they are: at home, in communities, at local weddings and celebrations, at markets. That’s where the women are, and that’s where communication and trust are easiest to build. Lafiya Sisters counsel on all methods of family planning, making sure a woman can make the decision that works best for her. They also leverage the existing stock in health facilities for community-based products, things like pills, condoms, different types of injectables. Whatever is available, they can provide and bring into communities.

But the issue we kept seeing is very big stockouts. Women are often sent home empty-handed, and I think that’s so heartbreaking. Imagine finding something that works, being told about the benefits of this incredible solution, and then hearing, “I’m sorry, we don’t have anything for you, maybe come back in a few months,” after they’ve traveled a long way to get there. So we decided to also ensure there’s at least one product always available, so no one is sent home empty-handed. The product that’s most popular in our communities is DMPA-SC, also known under the marketing name Sayana Press. It’s a really interesting contraceptive that can be self-injected, so it doesn’t require a health worker to mix the solution, just training once, and you can do it at home. It looks like an insulin shot, lasts for three months, costs 90 cents, and doesn’t require a cold chain. It also has fewer side effects than a lot of other contraceptives out there.

The fact that it lasts three months means it doesn’t require weekly or even monthly visits, and it’s perfectly suited to what our communities are mainly looking for, which isn’t necessarily to stop having children altogether, but to have a break between pregnancies, enough time to rest, usually a year, two, or three years. A Lafiya Sister can teach a woman who’s interested in self-injection and leave her with three additional doses at home, so for the next year she’s protected, which reduces visits and transport costs. It’s also very discreet, again, like an insulin shot, so in more conservative environments it’s entirely up to her whether she wants to share it with her community, since it becomes her personal fertility decision, unlike implants, which can be more visible, or pills or condoms, which are easier to spot.

That was the heart of the model from the start. Our pilot took place five years ago and cost us $6,000, because we had a very small budget, so we had to be extremely cost-effective. We originally thought demand would be low, that there’d be some skepticism and misconceptions. But no, we went through our stock very fast, within two months, and had to buy more, because women kept coming back, knocking on our Lafiya Sisters’ doors, saying, “I heard about this from my friend, from my sister, I want to use family planning too.” Demand was a lot higher than we, or the research, had anticipated. I think that’s partly because a lot of programs had already built awareness through radio, TV, and in-person outreach. The gap was that a woman had heard about family planning and its benefits, but was struggling to figure out which option was right for her, given side effects, eligibility, and her fertility plans, and then to actually connect with the product itself. Making it convenient, at her own doorstep, from someone she already trusts because they grew up in the same community, makes it such an easy way in. That’s why over half our users are first-time users, women who’d never used contraception before, but this was a good starting point for them to overcome their initial skepticism.

You asked how we’ve evolved. Nigeria is a very big country, and Sub-Saharan Africa is even bigger. The demand for family planning is really high, we’re talking about one in four women in Sub-Saharan Africa who’d like to use contraception and don’t have access to it.

That’s 70 million women. Lafiya is doing well and growing fast, but that’s a lot of people to reach at once. Realistically, the main actor that can lead to scale is the government, and we’ve designed for governmental implementation from the very beginning. Our training is provided by the family planning department, and the health workers, the Lafiya Sisters, are already on the government payroll. We pay them an additional stipend for the extra work they do with us in communities, but they’re already government health workers.

A big gap is accurately forecasting demand. If a health facility assumes it needs 200 injections over a quarter, but doesn’t see the 2,000 women who came for a visit and went home empty-handed, and never hears about the women in communities who don’t even bother making the trip, that underestimation compounds over the years. That creates a very big gap in understanding what the Federal Ministry of Health realistically needs to procure to meet the needs of women in their communities. So our work continues in the communities, but also works closely with government to solve for its gaps in demand forecasting and supply planning.

Jonathan Jackson: That’s great, and such a cool journey. You mentioned getting this going with $6,000, which isn’t a lot. Remind me, did you come through an incubator, some kind of peer startup community for impact-focused people?

Klau Pakos: We got our first grant from D-Prize, the Distribution Prize. That first grant was $15,000, plus 13 health workers and a lot of can-do attitude. That was the starting point. About a year and a half in, we also took part in the Charity Entrepreneurship Incubator, which helped us go from a pilot to an actual project and then to an organization. Charity Entrepreneurship usually identifies highly cost-effective opportunities for charities to be started by entrepreneurs. Lafiya took a different path than most of them, because we came in with an existing model and program, and our pilot results were cost-effective enough to compete with some of their top charity ideas. That’s why we joined the incubator, and it was very helpful for our journey.

Jonathan Jackson: That’s great. We’ve had the pleasure of talking to a lot of amazing founders who’ve gone through that program, and the innovation and cost-effectiveness of the charities that come out of it is phenomenal. On the cost-effectiveness side, you mentioned you’re leveraging government workers and just topping up their salary, but you’re delivering something that costs 90 cents a dose to hard-to-reach communities. I imagine the cost-effectiveness of your program is pretty amazing.

Klau Pakos: Yes, we’re really trying to leverage existing investment. On top of leveraging existing government staff salaries, the product itself, Sayana Press, costs 90 cents because it’s already subsidized by philanthropic partners like the Gates Foundation and the Children’s Investment Fund Foundation. So we’re building on investment that already exists, and that really helps keep our costs low. We also work with women who are already in these communities, so we’re very decentralized, which helps us closely connect and cut down logistics and supply chain costs significantly.

On cost-effectiveness, we had the pleasure of working with Rethink Priorities a year ago on our modeling. Their assessment found it costs us around $38 to avert one maternal DALY and $2,451 to save a maternal life. In terms of providing one woman with contraceptive coverage for a year, it’s $5.60. That covers the cost of the health workers, our monitoring and evaluation systems, the cost of the commodity itself, which is the vast majority (roughly 90 cents times four doses), additional logistics, supervision of health workers, transportation, and communication allowances. That’s realistically what it would cost the government to cover a woman with protection from unwanted pregnancy for a year under our model as it stands right now.

Jonathan Jackson: That’s amazing, I’ve seen some other models where that cost is extremely high. As you think about both government adoption and expanding to new countries, I’m curious how you think about scale, because one of the challenges we see a lot of really effective enterprises face at the stage you’re at (and we’ve talked about this in the context of us trying to sell you on Connect as well) is: how do you scale? You’ve obviously put a ton of your own personal time into this, and your team is amazing, but that’s not necessarily replicable when you hand this off to government. So you can deliver it at $5.60—

—do you think the government can achieve that cost? Can the next country achieve it? And what are some of the concerns your team is discussing as you choose the next country to scale to, and as you expand within Nigeria? I’d love to hear how you’re thinking about that. And obviously, you should just be using Connect while you do it.

Klau Pakos: Mm-hmm.

Klau Pakos: Yes, thank you for that plug. The good thing about Nigeria is that it’s a decentralized, federal country, so we get the chance to see how our model works across very different contexts. Every state is different. We’re currently operating in four states, and we just expanded into a fifth, Bauchi. We had our inception meeting there yesterday, so that’s very exciting, and we’ll be expanding to one more state in Nigeria over the next few months.

That experience gives us a lot of insight into what needs to change and what stays the same: what are the core pieces of the Lafiya Sister model, and what needs to be adjusted? For a family planning program to be effective, it needs to be hyper-localized to community needs, because it’s such a sensitive conversation that even the wording matters. If the message doesn’t land, you can’t have an honest, informed conversation. For example, in Northern Nigeria we use the phrase “child spacing” rather than “family planning.” That’s just one illustrative example of the hyper-localization we do from state to state.

In terms of scaling, the key elements that stay constant are ensuring there’s stock, and ensuring the Lafiya Sisters are from the community and that we’re working where no one else is working, in the contraceptive deserts, with the poorest of the poor who have no other connection to the healthcare system. That’s core to our mission of universal access to family planning: we want to be part of a bigger puzzle, covering where the private sector, public sector, or other NGOs may not go.

Sustainability is another crucial part of this. Even though Lafiya has a very cost-effective model, we’re also working toward having government take on more of the implementation, which they’ve already done a lot of through recruitment, training, and supervision, and more of the cost. In two of the four states we currently work in, we’ve gotten commitments to increase spending on family planning. We think about it as a kind of matching solution: states in Nigeria can use their own domestic budget to buy more contraceptives and cover the same stockout gaps I mentioned earlier, and Lafiya can incentivize that further, for example by offering $100,000 worth of Sayana Press if the state also commits $100,000 to family planning commodities. We don’t specify which products, because they have the data to know what their communities actually need, and we want to make sure there’s an expanded method mix so a woman can choose whichever method works for her, rather than promoting one specific product. That’s part of the scaling conversation from the very beginning now, with any state we expand to, rather than something we bring up only after we’ve proven our impact.

Country expansion is very exciting, and it’s still in the works, we have a shortlist now. One key thing that will change between our new-country model and this one is that we’ll disaggregate the two things we’re currently solving for at once: stockouts, and getting that stock to hard-to-reach communities through the Lafiya Sister model. We had a study done a few months ago that showed uptake in our treatment area increased from 2% at baseline to 56% at midline, at eight months, to 72% at endline, at 18 months. So we went from almost no one using contraception in that area to three-quarters of women using it, a 39-percentage-point increase over the counterfactual as well. That number is much bigger than we were even hoping for, and I think it’s because we’re solving both problems at once. With country expansion, we want to leverage the stock that’s already in the health system and just test the Lafiya Sister model on its own: what’s the impact of making whatever is available in the health facility accessible at home, in the community, through women from the same villages? That’s the main change we’re making to the model.

Fingers crossed. Right now, figuring out exactly how much stock there is in the system and how much is needed is honestly a pretty challenging task, and we’re currently hiring a few more staff members to help us with this transition and scale process.

Jonathan Jackson: That’s amazing. You mentioned two things: these amazing results on coverage and the counterfactual, and the fact that you’re getting governments to buy in on communities and states you’re already in, as well as new regions. I think getting government adoption is the goal of a lot of social enterprise models. So I’m curious: was the challenge you faced in getting governments to contribute funding an evidence problem that you’ve now solved with this 18-month study? Was it an advocacy challenge? Can you walk us through how you successfully engaged government in those discussions? So many of our listeners have that same goal, and it’s really hard to actually get a government to write the check. What do you think unlocked it? Was it the evidence?

Klau Pakos: What unlocked it? It’s a great question, and one I’ve discussed with a lot of other practitioners and implementers, trying to learn from their experience too. The Nigerian government has been dedicated to family planning for years, an FP2030 contributor for ten or fifteen years or so, so there’s no issue with prioritization. I think the main challenge has been, and to some extent still is, capacity. There are so many competing priorities that are all important. It’s very hard to say, “Let’s prioritize the conversation about family planning,” when there’s also malaria, or births happening outside health facilities, to talk about. Honestly, I think that’s the biggest challenge, especially for a country as big as Nigeria: 220 million people, growing very fast, over four children per woman right now. The burden on the healthcare system is enormous, and implementation falls on the states, which makes it even harder.

Something that’s worked well for us is truly living what we say, which is that we want to be a partner to government: understanding the gaps they identify and helping them solve for those. If they need capacity, if they need an NGO to do field work, gather data, or do analysis, we’re the partner for that. We really want to be a co-creator rather than showing up with an existing model and saying, “This is it, please adopt it.” We have a really strong programs and advocacy team that’s been working alongside our government partners for years, at both the national and state level, which helps build the personal trust that’s part of these conversations.

Evidence has mattered too. I remember working with one state government that had already committed resources, Sokoto, which also has a very high maternal and infant mortality rate, and sharing results from a study that took place there. Their reaction was, “This is great, we want this. If it works and you can show it, we’d absolutely like to be part of it. How can we best work together?” And they’d get specific: there are issues with data accuracy, there are stockout issues, what can you do to support that? So rather than pushing a model forward, being a listening partner and a co-creative partner has been so important.

Something unexpected has come out of this: a few months ago, the Federal Ministry of Health asked us to lead development of an electronic family planning counseling tool for the entire country. We already have rigorous monitoring and evaluation built into every counseling session a Lafiya Sister does, a short survey in her app with guided prompts that improve counseling quality and help us better understand our users, so we can target the most under-resourced communities. After we shared this with the Federal Ministry of Health last year, they came back and said, “This works really well for us. It’s available offline, it’s low touch, and we’ve been thinking about digitizing our health records for a long time. Can you work with other partners, see what they’re doing, and run a pilot so we can test whether this could work across our own system?”

It’s still early days, only a couple of months in, and between aligning all the tools, piloting, getting sign-off, and implementing, it’s a long journey ahead. But I think it’s a good illustration of how, when there’s a specific gap, we’re glad to help fill it.

Amie Vaccaro: That’s awesome. Listening to you, there are so many great best practices in what you’re sharing. It would be so much easier to just say, “Look, this is our model, we’re going to implement it here.” But instead, you’re saying, “Let me come alongside you as a government and understand your gaps, your pain points, and how we can help solve them, and by the way, I also have this incredible model.” And you’re seeing the rewards from that in governments wanting to partner more deeply with you, and even scaling some of the tools you’ve developed. That’s really cool to see.

Klau Pakos: That’s exactly why it’s harder to say precisely what scaling will look like. It’s more challenging to lay out a clear five-year strategic plan of exactly what we’ll be doing when, because we don’t fully know how community needs will change, what will happen with other partners, or what will happen with the donor landscape. It’s very hard for us to anticipate all of that. We obviously have goals for where we want to get to and at what pace, but realistically we need to stay agile and adjust to wherever we can provide the most impact and the most long-lasting support.

Amie Vaccaro: I’m curious, with this idea of transitioning a lot of this to government, what does wild success look like for Lafiya in five years? What would you want government to be running? What do you imagine that handoff looking like once government takes over more?

Klau Pakos: The wild dream would be a gradual transition of the Lafiya model, both implementation and financing, across multiple states. From there we’d have a lot of lessons to scale even further and even faster, and we could share best practices with other organizations. We prioritize this based on what the biggest cost item is that Lafiya is currently paying for, and right now that’s commodities. So the focus is on increasing the amount of commodities in the system and covering the stockout gap; that’s our primary focus in conversations about cost-sharing.

There are other cost items too: the additional stipend for Lafiya Sisters, which one state government has actually expressed interest in covering, which is very cool, so we’ll see how that conversation goes. There’s the additional monitoring and evaluation cost, though a lot of that overlaps with spot checks the government already does, or with the digital family planning tool I mentioned, so if the national government adopts that, it’s one more item off our list. Those are the four main things. The fifth is supervision, which is already built into the health system, since the health workers already have supervisors.

Increasing the amount of commodities in the system is also a bit of a self-fulfilling prophecy: if we dramatically increase supply, we can better understand true demand, and by solving that, government can keep improving its demand forecasting. It’s really about getting that initial push of product into the system to see whether there’s still a gap. Lafiya also tracks not just how many clients we counsel and how many people receive different products, but what method a client first asked for and whether it was actually available. So if a client asks for an IUD and it’s not available at the health facility, we keep that information, which is an important input for future demand forecasting.

So in five years: more product in the system, fewer stockouts, better data accuracy, and figuring out how to bridge that last mile beyond the health facilities, into the really remote, rural communities that are so difficult to reach. That’s the wild dream in Nigeria, and I’d love to see the model tested in other countries too.

Jonathan Jackson: I’m curious whether you feel a tension as you grow and get traction. You’ve said the model has to be hyperlocal, but then government says, “Great, you solved it, now build a national system,” and by definition that doesn’t quite work, right? You didn’t hear what I just said. And there’s also the question of the Lafiya Sisters doing this amazing family planning work while the clinic does other work: how does it all integrate together? One thing we see a lot of our customers and partners struggle with is that when they control everything, they can be extremely cost-effective, innovative, responsive, and hyperlocal. But when you think about a government owning this, they have limited capacity, they can’t be hyper-tuning the system all the time. How do you see that? Is that a tension you’re feeling right now, or does it feel pretty aligned, between the innovation and localization Lafiya can do, and what a government can do as it takes this over and scales it?

Klau Pakos: I think you’re anticipating some of the tensions we’ll be feeling soon. The biggest one we’re seeing right now: communities that aren’t very receptive to family planning are often also not very receptive to vaccines, to in-facility births, to health systems in general. So can you do more, provide more services? That kind of further integration is definitely on our minds, especially if we can find a cost-effective way to respond to community needs. But we’re very careful about this, we’re slow to commit to anything, because building expertise takes time, and we want to do at least one thing very well before committing to three, four, or five more things. We’re focusing on partnerships instead.

That’s part of why, as we scale into the South, a different cultural, religious, and language region than our previous work, we want to bring those learnings on board from the start. For example, our electronic family planning tool lets you switch language, and we want to make sure the language used isn’t the national language, English, but whatever local language people are most comfortable in. If people in rural Jigawa don’t speak English, why would the counseling tool be in English, forcing the health worker to translate? Let’s make it in Hausa. In the South, let’s make it in Yoruba, let’s make it in Igbo. Let’s make it the exact language the conversation is actually happening in.

There are already lessons learned, but everything comes down to implementation. To some extent we support the federal government, but our primary partners in these conversations are state governments, because they’re the ones tasked with implementing guidelines, policies, and laws. That’s also what we do, we’re the implementers too, so we work with them hand in hand and try to bring their practices on board.

Amie Vaccaro: I’m so curious, Klau, you’ve mentioned an app, a digital family planning tool, in a number of your answers, it sounds like you’re pretty tech-forward. I’d love to hear more about your journey with technology as you’ve built this organization. How is it helping? What are the stumbling blocks? How are you approaching it now?

Klau Pakos: The main thing I’ve learned is not to get excited about tech too early or too much. There are a lot of really cool solutions out there, and I like tech a lot, it’s a great way to automate processes and solve problems we used to really struggle with. But you really have to understand what’s needed versus what’s just shiny. Our communities often have very poor network connectivity, sometimes almost none, so a lot of the really cool AI tools I’d love to use would realistically be too heavy, too difficult, and only available online, which would take away a lot of functionality.

For example, we have voice and text reminders for women using contraception, to help them remember when they need their next injection. About 15% of our users really like and appreciate that feature and wouldn’t want to go without it, but only 15% can use it, because it requires being the sole owner of a phone, not sharing a family phone. So we’re really trying to understand what solves a problem versus what creates new ones, and we’re very slow and steady with any technology changes.

Something we’ve been thinking about, and it’s a work in progress, is better identification of our users so we can track their continuation journeys over time. Our communities often don’t have health records or any kind of formal health system registration, so tracking the same person’s engagement with the same health worker over multiple years is hard without an ID document. We’re considering more advanced solutions, like face or fingerprint scanning, that could bridge that gap. But before we go anywhere near that, we first need to understand whether our users would be okay with it, whether they’d be willing to be part of it.

What would it look like? What training would health providers need to do this well? How do we explain all the guidelines, ethics, and consent considerations before introducing something like that? It’s a long process. We’ve been talking about it internally for a few months already, and it’ll probably be a long process before, if it’s even something our users want, it becomes operational. We’re trying to be really considerate and slow about these changes.

Amie Vaccaro: I really appreciate that slow approach, I think that’s super smart. Thank you so much for sharing that.

Amie Vaccaro: Klau, what’s something about this work that the data will never quite capture?

Klau Pakos: Great question. I feel like the data captures the health benefits, and some of the income benefits I mentioned, maternal deaths averted, maternal DALYs, and we really care about those, because they help us understand whether we’re on track and using resources well, whether we’re highly cost-effective. But I personally care about family planning because it’s so much more than that. As we’ve said, it brings the foundation for everything else. It creates ripple effects across families and generations: one of the best ways to make sure an infant under five survives is if their mother survives. It creates safer spaces for families and communities, and when there’s more gender parity, women can start their own businesses and continue their education. These are all things that aren’t easily captured.

There are some great models trying to get at this, but the level of autonomy and agency that family planning and contraception bring is just so hard to capture with data. I wish we could be more direct about it, but we always try to be very conservative with our numbers, not to overpromise or overestimate. So some of those benefits get lost in translation when we talk about the program’s effects.

Jonathan Jackson: That’s so well put, I can feel all of those intangible, hard-to-measure, but really important things coming out of this program. Klau, this has been a really wonderful conversation. I feel like I could ask you so many more questions, but I’ll be mindful of your time and close us out here. Thank you so much for joining us today. I’m really excited to share this conversation with our audience, there are so many great nuggets of wisdom you’ve shared that I know will be valuable to our listeners. Thank you so much.

Klau Pakos: Yeah.

Jonathan Jackson: Thanks a lot, this was great.

Klau Pakos: Thank you so much for the great questions, and for putting together this podcast and creating this space for reflection for the entire sector. I really appreciate it. Looking forward to connecting. Thanks, okay, bye.

Jonathan Jackson: Our pleasure.

Amie Vaccaro: What a rich conversation. Huge thank you to Klau Pakos for sharing not just the results, but the hard-won thinking behind them. And thank you, dear listener, as always, for being here. A few things I’m taking away from this one.

First, the family planning gap Lafiya identified wasn’t awareness, it was the last mile. By the time Lafiya arrived, years of radio and outreach had already done their job: women knew about family planning and wanted it. What was missing was the final stretch, help figuring out which method was right for them, and a product actually in stock when they asked. Too often, a woman would travel hours to a clinic only to be sent home empty-handed. Lafiya closes that gap with Lafiya Sisters, trusted health workers from the same communities who bring counseling and supply right to where women already are.

Second, an incredibly useful insight for anyone working on government buy-in: the barrier often isn’t evidence, it’s capacity. This government had prioritized family planning for years; what unlocked the partnership was Lafiya offering to absorb the work.

Third, know what’s actually driving your impact. Lafiya solves stockouts and last-mile delivery at once, and they’re now pulling those apart to see which really moves the needle.

And finally, a through line in everything Klau shared: go slow, and stay local. Lafiya found that “child spacing” works as a message where “family planning” doesn’t, in certain parts of Nigeria, for example. And be honest about what technology actually solves versus what just looks shiny.

That’s our show. Please like, rate, review, subscribe, and share this episode if you found it useful. It really helps us grow our impact. And write to us at podcast@dimagi.com with any ideas, comments, or feedback. This show is executive produced by myself. Parthana Balachander and Michelle Valencia are our editors. Natalia Glowacki is our producer, and cover art is by Sudanshu Kant. A final note in the spirit of transparency: we use AI to assist with guest research, copywriting, and post-production, so a small team can produce a high-quality show. All AI-assisted content is reviewed and edited by humans, and we retain full responsibility for what you hear.