Title: [Quality of care in family health]

POPLINE Document Number: 081312

Author(s):

Boukhris MM

Source citation:

TUNISIE MEDICALE, 1992 May;70(5):313-8.

Abstract:

Tunisia's National Office of Family and Population (ONFP), created in 1973, has 5 distinct components at the central level: the Departments of Medical Services, Communications, Studies and Planning, Training, and Family Health. The ONFP has facilities in all regions of Tunisia. In 1991, Tunisia's population was 8,220,000, the crude birth rate was 24.7/1000, and the crude death rate was 6.5/1000. The resulting rate of natural increase was 1.82% and the total fertility rate was 3.45. In 1989, there were 1834 inhabitants per physician, 6548 per midwife, and 354 per paramedic. The contraceptive prevalence rate in 1988 was 50%. These data demonstrate that Tunisia is in a relatively advanced state of its demographic transition, and that its coverage of health services is among the most advanced in the Third World. The methodology of the ONFP requires diagnosis of the preexisting situation including identification of needs, translation of needs into a program, and evaluation of the impact of the action. All "products" of the Office, whether medical procedures, contraceptive methods, or media support, are pretested. Tunisia's criteria for assessing its family planning program demand that the contraceptive choice be free, multiple, and informed, and that services be offered in conditions of confidentiality, scientific rigor, and with human dignity. The ONFP currently offers copper T or Multiload IUDs, 4 different oral contraceptive formulations, Norplant, Neosampoon vaginal spermicide, condoms, and male and female sterilization. Injectables are under study. ONFP clinic personnel are trained in counselling techniques in order to improve interpersonal relations with clients. The definition of quality of care in family planning is different for service providers and clients. Providers stress method efficacy and coverage rates without special emphasis on side effects or discomfort, which are not defined as illness. For users, high quality family planning allows control to be exercised over the body, health to be preserved, and sexual satisfaction to be increased, without concern about implications for public health. A 1988 survey indicated that among clients of public and private sector family planning facilities, respectively, 82.3 and 94.4% found no problems to report, 3.1 and 2.1% complained of long waits, 11.8 and 2.1% of poor treatment, .3 and 7% of cost or accessibility, .6 and 0 that the desired method was not received, and .9 and .7 % of deficient hygiene. The same study showed that very low proportions of women had discontinued use of any method because of poor follow-up.

Keywords:

Tunisia
Quality of Health Care
Family Planning Programs
Family Planning Program Evaluation
Contraceptive Usage
Program Activities
Health Services
Government Programs
Contraceptive Availability
Africa, Northern
Africa
Developing Countries
Health Services Evaluation
Program Evaluation
Programs
Organization and Administration
Family Planning
Contraception
Delivery of Health Care
Health