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Providing Family Planning Services at Primary Care Organizations after the Exclusion of Planned Parenthood from Publicly Funded Programs in Texas: Early Qualitative Evidence.
Health Services Research. 2017 Oct 20;OBJECTIVE: To explore organizations' experiences providing family planning during the first year of an expanded primary care program in Texas. DATA SOURCES: Between November 2014 and February 2015, in-depth interviews were conducted with program administrators at 30 organizations: 7 women's health organizations, 13 established primary care contractors (e.g., community health centers, public health departments), and 10 new primary care contractors. STUDY DESIGN: Interviews addressed organizational capacities to expand family planning and integrate services with primary care. DATA EXTRACTION: Interview transcripts were analyzed using a theme-based approach. Themes were compared across the three types of organizations. PRINCIPAL FINDINGS: Established and new primary care contractors identified several challenges expanding family planning services, which were uncommon among women's health organizations. Clinicians often lacked training to provide intrauterine devices and contraceptive implants. Organizations often recruited existing clients into family planning services, rather than expanding their patient base, and new contractors found family planning difficult to integrate because of clients' other health needs. Primary care contractors frequently described contraceptive provision protocols that were not evidence-based. CONCLUSIONS: Many primary care organizations in Texas initially lacked the capacity to provide evidence-based family planning services that women's health organizations already provided. (c) Health Research and Educational Trust.
Geneva, Switzerland, World Health Organization [WHO], 2017. 73 p.This tool for Monitoring human rights in contraceptive services and programmes contributes to the World Health Organization’s (WHO’s) ongoing work on rights-based contraceptive programmes. This work builds directly on WHO’s 2014 Ensuring human rights within contraceptive programmes: a human rights analysis of existing quantitative indicators and the 2015 publication Ensuring human rights within contraceptive service delivery implementation guide by the United Nations Population Fund (UNFPA) and WHO. This tool is intended for use by countries to assist them in strengthening their human rights efforts in contraceptive programming. The tool uses existing commonly-used indicators to highlight areas where human rights have been promoted, neglected or violated in contraceptive programming; gaps in programming and in data collection; and opportunities for action within the health sector and beyond, including opportunities for partnership initiatives.
New York, Evaluation Office, United Nations Population Fund [UNFPA], 2016. 24 p.This evaluation focuses on how UNFPA performed in the area of family planning during the period covered by the UNFPA Strategic Plan 2008-2013. It provides valuable insights and learning which can be used to inform the current UNFPA family planning strategy as well as other relevant programmes, including UNFPA Supplies (2013-2020). All the countries where UNFPA works in family planning were included, but the evaluation focuses on the 69 priority countries identified in the 2012 London Summit on Family Planning as having low rates of contraceptive use and high unmet needs. The evaluation took place in 2014-2016 and was conducted by Euro Health Group in collaboration with the Royal Tropical Institute Netherlands. It involved a multidisciplinary team of senior evaluators and family planning and sexual and reproductive health and rights specialists, which was supervised and guided by the Evaluation Office in consultation with the Evaluation Reference Group. The outputs include a thematic evaluation report, an evaluation brief and country case study notes for Bolivia, Burkina Faso, Cambodia, Ethiopia and Zimbabwe.
New York, Evaluation Office, United Nations Population Fund [UNFPA], 2016 Apr. 214 p.The purpose of the evaluation was to assess the performance of UNFPA in the field of family planning during the period covered by the Strategic Plan 2008-2013 and to provide learning to inform the implementation of the current UNFPA Family Planning Strategy Choices not chance (2012-2020). The evaluation provided an overall independent assessment of UNFPA interventions in the area of family planning and identified key lessons learned for the current and future strategies. The particular emphasis of this evaluation was on learning with a view to informing the implementation of the UNFPA family planning strategy Choices not chance 2012-2020, as well as other related interventions and programmes, such as the Global Programme to Enhance Reproductive Health Commodity Security (GPRHCS- 2013-2020). The evaluation constituted an important contribution to the mid-term review of UNFPA strategic plan 2014-2017. The evaluation features five country case study reports: Bolivia, Burkina Faso, Cambodia, Ethiopia, and Zimbabwe.
New York, Evaluation Office, United Nations Population Fund [UNFPA], 2016 Apr. 105 p.The purpose of the evaluation was to assess the performance of UNFPA in the field of family planning during the period covered by the Strategic Plan 2008-2013 and to provide learning to inform the implementation of the current UNFPA Family Planning Strategy Choices not chance (2012-2020). The evaluation provided an overall independent assessment of UNFPA interventions in the area of family planning and identified key lessons learned for the current and future strategies. The particular emphasis of this evaluation was on learning with a view to informing the implementation of the UNFPA family planning strategy Choices not chance 2012-2020, as well as other related interventions and programmes, such as the Global Programme to Enhance Reproductive Health Commodity Security (GPRHCS- 2013-2020). The evaluation constituted an important contribution to the mid-term review of UNFPA strategic plan 2014-2017. The evaluation features five country case study reports: Bolivia, Burkina Faso, Cambodia, Ethiopia, and Zimbabwe.
[Washington, D.C.], Population Resource Center, .  p.An estimated 26 million legal and 20 million illegal abortions were performed worldwide. The resulting overall abortion rate was 35 per 1,000 women aged 15-44. Among the sub regions of the world, Eastern Europe had the highest abortion rate (90 per 1,000) and Western Europe the lowest rate (11 per 1,000). In response to the findings of surveys, the United Nations Population Fund, the UNFPA, and USAID launched targeted family planning programs in Eastern Europe, as well as other high risk regions like Asia and Latin America. (excerpt)
In: The global family planning revolution: three decades of population policies and programs, edited by Warren C. Robinson and John A. Ross. Washington, D.C., World Bank, 2007. 155-174.In Jamaica, as in many countries, the pioneers of family planning were men and women who sought to improve the well-being of their impoverished women compatriots, and who perhaps were also conscious of the social threats of rapid population growth. When, eventually, population control became national policy, the relationship between the initial private programs and the national effort did not always evolve smoothly, as the Jamaican experience shows (see box 10.1 for a timeline of the main events in relation to family planning in Jamaica). A related question was whether the family planning program should be a vertical one, that is, with a staff directed toward a sole objective, or whether it should be integrated within the public health service. These issues were not unique to Jamaica, but in one respect Jamaica was distinctive: it was the setting for the World Bank's first loan for family planning activities. Family planning programs entailed public expenditures that were quite different from the infrastructure investments for which almost all Bank loans had been made, and the design and appraisal of a loan for family planning that did not violate the principles that governed Bank lending at the time required a series of decisions at the highest levels of the Bank. These decisions shaped World Bank population lending for several years and subjected the Bank to a good deal of external criticism. For that reason, this chapter focuses on the process of making this loan. (excerpt)
Johannesburg, South Africa, University of the Witwatersrand, Reproductive Health and HIV Research Unit, 2006 Oct. 58 p.A systematic review of the literature was conducted, for evidence on whether a policy of providing a wide range of contraceptive methods, as opposed to the provision of a limited range, improves health outcomes such as contraceptive uptake, acceptability, adherence, continuation and satisfaction; reduction of unintended pregnancy; and improved maternal health and wellbeing. Studies of all designs, reviews, reports, policy documents, commentaries, opinion papers and position papers were included in a search of MEDLINE (via Pubmed, Ovid MEDLINE and Old Ovid MEDLINE), All EBM Reviews, POPLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), LILACS and Psyc Info. A total of 6977 citations were identified. Of these, 3586 were duplicates, leaving 3391 titles/abstracts for screening. After more sensitive review by three authors (AG, JS, NM), 231 citations were included in the review. Two authors (AG, JS) independently extracted data from full reports or papers of all included studies. In a few instances, the full text could not be accessed and the study was assessed on the abstract only. Not unsurprisingly, this systematic review has failed to find large quantities of high quality evidence that increasing choice has a direct impact on the contraceptive outcomes of interest. The best evidence retrieved is summarised in Table 1. (excerpt)
Notes from the Field. 2002 Jul; (14): p..Alejandra, senior program officer, and Rebecca, evaluation officer, traveled to Ecuador in June 2002 to monitor the implementation of two adolescent projects funded by the Hewlett and Turner foundations. We spent the first two days of our trip in Guayaquil, where IPPF/WHR's affiliate, APROFE, has its main offices and clinics. This organization has begun providing services tailored to the needs of youth for the first time. Their idea was to build a separate space for youth with funds from the Hewlett Foundation to allow the clients to have access to health care providers who are specially trained to meet their needs as young people. It will also provide them with greater privacy. Unfortunately, there have been some construction delays for the new youth center. APROFE is therefore providing youth services in a section of the main clinic's office which has been refurbished as a youth clinic. I was struck by how friendly and colorful the office looked. There were lots of posters and signs painted by the youth. We also saw the blueprints for the youth center, which APROFE hopes to have completed by December. (excerpt)
American Journal of Preventive Medicine. 2005; 28(5):483-490.The World Health Organization (WHO) is responsible for providing evidence-based family planning guidance for use worldwide. WHO currently has two such guidelines, Medical Eligibility Criteria for Contraceptive Use and Selected Practice Recommendations for Contraceptive Use, which are widely used globally and often incorporated into national family planning standards and guidelines. To ensure that these guidelines remain up-to-date, WHO, in collaboration with the Centers for Disease Control and Prevention and the Information and Knowledge for Optimal Health (INFO) Project at the Johns Hopkins Bloomberg School of Public Health’s Center for Communication Programs, has developed the Continuous Identification of Research Evidence (CIRE) system to identify, synthesize, and evaluate new scientific evidence as it becomes available. The CIRE system identifies new evidence that is relevant to current WHO family planning recommendations through ongoing review of the input to the POPulation information onLINE (POPLINE) database. Using the Meta-Analysis of Observational Studies in Epidemiology guidelines and standardized abstract forms, systematic reviews are conducted, peer-reviewed, and sent to WHO for further action. Since the system began in October 2002, 90 relevant new articles have been identified, leading to 43 systematic reviews, which were used during the 2003–2004 revisions of WHO’s family planning guidelines. The partnership developed to create and manage the CIRE system has pooled existing resources; scaled up the methodology for evaluating and synthesizing evidence, including a peer-review process; and provided WHO with finger-on-the-pulse capability to ensure that its family planning guidelines remain up-to-date and based on the best available evidence. (author's)
Report on field test of the WHO Decision-Making Tool (DMT) for family planning clients and providers in Mexico. Draft. [Informe sobre pruebas de campo de la Herramienta de toma de decisiones (DMT, Decision-Making Tool) de la OMS para los clientes y prestadores de planificación familiar en México. Versión preliminar]
[Unpublished] 2003 Apr 13. 8 p.To test the usefulness of the flipchart on the quality of counseling, this study compared videotaped counseling sessions conducted by the same providers before and after they were trained to use the DMT and had practice using it. Data were collected at two points in time: a baseline round before the intervention began and a post-intervention round one month after providers were trained to use the DMT. Qualitative data were collected through interviews with providers and clients to complement the data from videotaped sessions. Participating in the study were 17 providers working at nine Secretary of Health facilities of the Government of Mexico, D.F. They included 9 doctors, 4 nurses, 3 social workers, and 1 psychologist. Eight of the participating facilities were hospitals, and one was a health center. At each facility, one doctor who routinely provided family planning services participated in the study. In some facilities, a nurse, social worker, or psychologist, each of whom routinely provided FP services, also participated in the study. Each provider was videotaped with about 8 clients, that is, 4 clients per round of data collection. Each set of 4 clients included one new client with a contraceptive method in mind, one new client without a method in mind, one returning client with a problem, and one returning client without a problem. Only 13 of the 17 providers had complete data from both the baseline and post-intervention rounds. (excerpt)
Report on the field test of the WHO Decision-Making Tool (DMT) for family planning clients and providers in Indonesia. Draft.
[Unpublished] 2003 May 14. 11 p.This field test assessed the acceptability and usability of the Decision-making Tool for Family Planning Clients and Providers (DMT) in ten Puskesmas (public clinics) in two districts of West Java province in Indonesia. The study was conducted by the INFO Project at the Johns Hopkins Bloomberg School of Public Health Center for Communication Programs (CCP) in collaboration with the World Health Organization (WHO) and CCP's STARH Program in Indonesia. The assessment focused on the following areas: the comprehensibility, usability, and acceptability of the DMT among providers and clients; how the DMT can facilitate or hinder the family planning (FP) counseling process; how the DMT can help clients make appropriate decisions in order to solve problems regarding FP; how providers integrate the flipchart into their daily work; and changes needed to increase the impact of the DMT on the FP decision-making process and client-provider communication. WHO, the Population Information Program at CCP (now the INFO Project), and INTRAH developed a normative model of client-provider communication to provide a theoretical foundation for improving FP counseling. Drawing upon this model, the Promoting Family Planning team of the Department of Reproductive Health and Research at the WHO and CCP created the DMT in a flipchart format. The tool seeks to improve the quality of counseling by: promoting informed choice and participation by clients during family planning service delivery; facilitating providers' application of evidence-based best practices in client-provider interaction; and providing the technical information clients need in order to make optimal choices and to use contraceptive methods. (excerpt)
Development of a scale to assess maternal and child health and family planning knowledge level among rural women.
Health and Population: Perspectives and Issues. 2000; 23(1):37-52.This paper presents a tool specifically developed for assessing the knowledge of rural women in Rohtak district of Haryana regarding maternal and child health. This tool can also be used for (i) identification of high risk women groups in the community by the programme managers as well as by the researchers; (ii) quantitative analysis of the relationship between various decisions making variables and the knowledge level of women regarding MCH and FP and (iii) impact evaluation of the IEC programme on the knowledge of women regarding maternal and child health. (author's)
Male involvement in a reproductive health programme: where we stand today. A critical review of the initiatives taken in India.
In: Programming for male involvement in reproductive health. Report of the meeting of WHO Regional Advisers in Reproductive Health, WHO / PAHO, Washington DC, USA, 5-7 September 2001. Geneva, Switzerland, World Health Organization [WHO], 2002. 58-62. (WHO/FCH/RHR/02.3)Since ICPD Cairo (1994), male involvement in reproductive health has become a fashionable topic and is mentioned in most forums addressing the issues of reproductive health, gender equity and empowerment of women. Very little however, is known about how to enhance male involvement. Given the patriarchal social structure of South Asian countries, bringing about changes which strive to enhance male involvement and the gender equity this implies, is not easy. Against this backdrop, it is interesting to take a look at how the Ministry of Health and Family Planning, Government of India (MOH&FP), which is committed to implementing ICPD Programme of Action, is addressing these issues. What efforts have been made either by government or by NGOs to involve men in reproductive health and safe motherhood and what results have been achieved? Are innovative and replicable model(s) to enhance male involvement available? (author's)
In: An agenda for people: the UNFPA through three decades, edited by Nafis Sadik. New York, New York, New York University Press, 2002. 24-46.The solemn commitment that was made in Cairo in 1994 to make reproductive health care universally available was a culmination of efforts made by the United Nations Population Fund (UNFPA) and all those concerned about a people-centred and human rights approach to population issues. The commitment posed important challenges to national governments and the international community, to policy makers, programme planners and service providers, and to the civil society at large. The role of UNFPA in building up the consensus for the reproductive health approach before Cairo had to continue after Cairo if the goals of the International Conference on Population and Development (ICPD) were to be achieved. UNFPA continues to be needed to strengthen the commitment, maintain the momentum, mobilize the required resources, and help national governments and the international community move from word to action, and from rhetoric to reality. Reproductive health, including family planning and sexual health, is now one of three major programme areas for UNFPA. During 1997, reproductive health accounted for over 60 per cent of total programme allocations by the Fund. (excerpt)
New York, New York, United Nations, 2003. iv, 37 p. (ESA/P/WP.182)Governments’ views and policies with regard to the use of contraceptives have changed considerably during the second half of the 20th century. At the same time, many developing countries have experienced a transition from high to low fertility with a speed and magnitude that far exceeds the earlier fertility transition in European countries. Government policies on access to contraceptives have played an important role in the shift in reproductive behaviour. Low fertility now prevails in some developing countries, as well as in most developed countries. The use of contraception is currently widespread throughout the world. The highest prevalence rates at present are found in more developed countries and in China. This chapter begins with a global overview of the current situation with regard to Governments’ views and policies on contraception. It then briefly summarizes the five phases in the evolution of population policies, from the founding of the United Nations to the beginning of the 21st century. It examines the various policy recommendations concerning contraception adopted at the three United Nations international population conferences, and it discusses the role of regional population conferences in shaping the policies of developed and developing countries. As part of its work programme, the Population Division of the United Nations Secretariat is responsible for the global monitoring of the implementation of the Programme of Action of the 1994 International Conference on Population and Development (ICPD). To this end, the Population Division maintains a Population Policy Data Bank, which includes information from many sources. Among these sources are official Government responses to the United Nations Population Inquiries; Government and inter-governmental publications, documents and other sources; and non-governmental publications and related materials. (excerpt)
[Unpublished] 1993. , 23,  p.In 1993 in Tanzania, the Association for Voluntary Surgical Contraception (AVSC) helped the Tanzania organization UMATI and the Ministry of Health (MOH) evaluate the 5-year Permanent and Long-Term (P<) Contraception Program. The program planned to use the findings to develop action workplans to address the issues and to expand services. The assessment team visited sits in Dar es Salaam, Iringa and Mbeya, and Arusha and Moshi. In 4 years, the program had expanded from 2 sites to 35 sites nationwide. It trained 250 family planning providers in tubal ligation. P< providers performed more than 9000 tubal ligations (90,000 couple years of protection). The program has surpassed all its service objectives, which contributed to a lack of resources. It established a national network of interested health providers and administrators. Demand for services outpaces the supply countrywide. Since clients and providers have accepted tubal ligation, the government has incorporated sexual sterilization into its national family planning program. It is now preparing to introduce the contraceptive implant Norplant. USAID/AVSC and UMATI/IPPF, (International Planned Parenthood Federation) support 3 full-time staff positions and plan on adding staff in area offices. Other than the 3 AVSC-funded positions in UMATI, UMATI, and MOH have provided all staff time. Other donors to the P< Contraception Program include the development agencies of the UK and Germany and perhaps the World Bank. The MOH has requested future goods from UNFPA for the Interim Norplant Expansion Program. The 2 major outcomes of the assessment were realization of the need to support full-time physician-nurse teams in each UMATI area office and MOH agreement to integrate training for P< methods into the national training strategy. UMATI and USAID planned to add 2 more area offices. Service obstacles were insufficient trained staff, expendable supplies, and equipment to expand to the 35 sites (25 were planned). The key management problem was failure to completely integrate the P< program into the UMATI mainstream.
In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar.  p. (EGY-01)Egypt's family planning (FP) program, active since 1966, has been facilitated by the country's population density, flat terrain, and extensive health infrastructure. Nevertheless, by the early 1970s, a substantial proportion of couples were still not using contraception because of minimal clinic outreach; high dropout rates for oral contraceptive (OC) users; lack of knowledge about side effects among clinic staff and clients; disruptions in clinical supplies; and unavailability of other methods, such as the IUD, especially in rural areas. In 1971, USAID supported the American University in Cairo's (AUC) FP research activities in rural Egypt, in which household fertility survey data, a follow-up of women attending FP clinics, the cultural context of FP, communication and education, and the implementation of services were studied. In 1974, AUC initiated a demonstration project (which cost US $224,000) of a low-cost way to provide FP services to all married women in a treatment population through a household contraceptive distribution system. The interventions were implemented in the Shanawan (rural) and Sayeda Zeinab (city of Cairo) communities of Menoufia Governorate. During an initial canvas in November 1974, married women 15-49 years of age, who were living with their husbands and were not pregnant or less than 3 months postpartum and breast feeding, were offered 4 cycles of OCs or a supply of condoms. During a second canvas in February 1975, acceptors were provided with an additional 4 cycles of OCs and referred to a local depot for resupply. Each distribution area was mapped, and each housing unit numbered. Data collected through canvassing consisted primarily of eligibility screening items and provided numbers of acceptors, refusals, ineligibles, not at homes, etc. To increase coverage, 2 attempts were made to reach women not at home. Of the 2,493 women canvassed in Sayeda Zeinab, 1713 (69%) were eligible to receive contraceptives. Of these, 58% accepted 4 to 6 cycles of OCs. At the time of initial household distribution, 45% of eligible women were already using OCs. As a result of the canvass, an additional 5% of the women became acceptors. The AUC did not expand the household distribution of contraceptives to other urban areas of Cairo, because women there evidently already had adequate access to FP information and supplies. In the 6,915 households canvassed in Shanawan, 1156 of the 1820 women (64%) were eligible to receive contraceptives. Of these, 45% accepted 4 to 6 cycles of OCs. 21% of eligible women were already using OCs at the time of initial household distribution. Although condoms were offered, few were accepted, apparently because it was not culturally acceptable for women to either distribute or accept condoms. One year after the initial household distribution, contraceptive use among married women of reproductive age had increased 69% from 18.4 to 31% among all age and parity groups and at all educational and occupational levels, and the incidence of pregnancy declined from 19.3 to 14.9%.
In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar.  p. (ZAI-10)This project grew out of the need to monitor the quality of care in the various community-based contraception distribution (CBD) projects which were subprojects of the Tulane Family Planning Operations Research Project. The objectives of this activity were to: 1) assure that women who use the services of CBD workers were properly screened for use of oral contraceptives (if that was the method they chose), that they received correct information about the methods and their use, and that they were referred to other levels in the health system when appropriate; 2) to strengthen the position of existing CBD programs if they were to come under attack in the future over the issue of quality of service; and 3) to develop a methodology that could be used in other CBD programs, including those outside of Zaire. The project consisted of a series of activities designed to improve the quality of care in CBD programs, including conducting workshops among project personnel and standardizing medical norms and program procedures. A system for evaluating distributor performance, based on a knowledge test, observation of interactions with clients, and a client survey, was developed and tested in the field. A guide for implementing contraceptive CBD programs and a manual for training CBD distributors were produced to standardize many of the procedures used in the CBD programs and to provide certain norms for service delivery. A methodology was subsequently developed for evaluating distributor performance which included: a knowledge test for distributors to assure that they were able to answer basic questions about the contraceptives and other medications they sold (correct use, side effects, contraindications); an observation guide consisting of a list of points which a distributor should cover during visits to a potential (new) client as well as to a continuing user; and a subjective measurement of rapport between distributor and client. A short questionnaire was prepared for clients to determine whether they knew the correct use of the method chosen and whether they were satisfied with the services of the distributor. This 3-pronged approach to the evaluation of distributor performance was tested at 2 sites: Kisangani and Matadi. The knowledge test was also administered in Mbuyi Mayi and Miabi. While the knowledge test proved to be a quick way to determine whether distributors were informed on key points, the full evaluation approach proved too labor-intensive to be practical as a tool for continuously monitoring distributor performance. Based on experience with the full model, a supervisory form was developed which included some of the same elements but was more practical for routine use in the field.
Family Life Association of Swaziland [FLAS] community-based distribution (CBD) pilot project evaluation.
In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar.  p. (SWA-01)The Family Life Association of Swaziland (FLAS), an associate member of the International Planned Parenthood Federation, provides family planning (FP) services through a network of 3 clinics and through industry- and community-based distributors (CBDs). FLAS is the second largest provider of FP services in Swaziland, supplying approximately 30% of all services available. In 1986, FLAS initiated a 2-year CBD pilot project to demonstrate the effectiveness of an alternative service delivery approach to increase contraceptive availability and use in rural areas. If effective, the model was to be recommended for replication on a larger scale in similar rural settings. FLAS conducted an internal assessment of its activities in 1987. The evaluation found that the project's immediate objectives had been met and the project had community support. However, the future of the pilot project was not adequately addressed in the internal evaluation. Ministry of Health officials determined there was a need for additional information in order to decide the pilot program's future. The Population Council conducted the first external evaluation of the FLAS' CBD project. The pilot CBD project successfully demonstrated that CBD of FP services can increase contraceptive availability and accessibility in underserved rural areas. Success in terms of service use was influenced by the level and quality of supervision, the appropriate selection of agents and areas, and adequate training. An area of need in the expanded program is to broaden the choice of methods given to clients in order to increase service coverage. Several research topics related to improved delivery and sustainability of CBD services were identified.
In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar.  p. (KEN-13)For the past 20 years, Chogoria Hospital has run a steadily expanding clinic and community-based health service program in Meru District. This hospital, with its 32 satellite clinics and its catchment area, has been renowned for its high contraceptive prevalence and low fertility rate compared to the Kenyan national average and that of many sub-Saharan countries. Several factors have contributed to this success, including community-based distribution by family health educators (FHEs) and community health workers (CHWs). Through these community-based distributors, family planning (FP), child welfare, and antenatal clients who fail to turn up for appointments within a month after the default date are followed-up and encouraged to visit a clinic. Financial support for this default tracking system has been ensured through donor funds. Lately, however, the longterm sustainability and usefulness of the tracking system have been questioned. In response to this concern, the management at Chogoria Hospital asked The Population Council to evaluate the default tracking system. This study, which cost US $15,080, determined the extent to which the default tracking system is effective in identifying, tracking, and bringing defaulters back to the program. In addition, the cost of tracking down and bringing back a client was determined. A third component involved assessing the attitude of clients towards this activity and their consequent behavior when they visit Chogoria or other clinics. Data were collected from interviews with 654 defaulting clients using a general questionnaire and 3 other ones specific to FP, child welfare, and antenatal issues. 4 teams composed of local school teachers, with heads of schools acting as supervisors, identified and interviewed the defaulters over a period of 13 days. The teams, who had substantial previous experience in interviewing and data collection, received a week-long training session which included 2 days of fieldwork. A different questionnaire was used to collect information from CHWs. These data were supplemented by information received from field team observations. True defaulters were few, and the impact of CHWs and FHEs in bringing back these clients was low (11-17%). The benefits derived from bringing back a defaulter were negligible compared to the high cost of deploying the CHWs and FHEs. As a result, it was recommended that the default tracking system be discontinued. In addition, it was suggested that the CHWs and FHEs be supervised more effectively and that they concentrate their efforts on other community health activities such as primary health care counseling.
In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar.  p. (IVO-05)The number of family planning (FP) service delivery points (SDPs) in Cote d'Ivoire is increasing rapidly with the assistance of several USAID projects: SEATS for overall management assistance, INTRAH for clinical training, Johns Hopkins University/PCS for information, education, and communication (IEC), and the Africa operations research/technical assistance (OR/TA) project for the management information system (MIS). For example, during 1991, the Association Ivoirienne pour le Bien-Etre Familial (AIBEF) increased its SDPs from 3 to 19. By the end of 1992, 33 AIBEF-assisted public sector maternal and child health centers will become FP SDPs. This is the first step in a longterm program to increase the government's FP service delivery capacity and is a model for future activities. This study, which cost US $29,392, will monitor the management information system (MIS) to define its impact and role in the expansion. The MIS project will provide data on contraceptive use, reproductive intentions, and community flow but it will not describe several service delivery functions or information relative to the client, such as provider relations and IEC activities. The MIS data, therefore, must be complemented by data on 1) the quality of provider-client interactions, 2) the SDPs functional capacity for providing FP services (both physical and human resources), and 3) the user's experiences with FP services. This study will adapt a situational analysis methodology developed by The Population Council. Information will be collected from all operational SDPs (approximately 20). Of the 13 SDPs observed, 4 serviced 1200 to 1800 new and continuing users in 3 months. 3 other clinics serviced between 22 and 37. 24,221 clients accepted modern methods during that time, with 19% (mainly men) choosing condoms and 81% selecting prescription methods (85% oral contraceptives (OCs), 11% injectables, and 3% IUD). All clinics had a system for ordering contraceptives, yet all experienced stock-outs. Only 8% of clinics had an appropriate storage system. 55% of clinics held discussions about FP and reproductive health with service providers and clients. The study also revealed that 25% of all clients interviewed had had an abortion. In terms of personnel, there was a lack of FP educators disseminating IEC, and most clinics needed updated IEC materials. The record-keeping land logistics departments needed improvement as stock-outs were common. International management meetings and external supervisory visits were infrequent. For the most part, clients were satisfied with the FP services, although some mentioned a long wait and a lack of privacy. Numerous recommendations were made in order to provide FP services in clinics including: development of FP activities, improvement of quality of services, and development of counseling and interpersonal communication skills.
In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar.  p. (BKF-05)The family planning (FP) program in Burkina Faso has grown steadily since its introduction in 1985, but information and service provision still occur primarily at the clinic level. One way of decentralizing the provision of FP information is to train traditional birth attendants (TBAs) in FP and encourage them to promote FP during their maternal and child health (MCH) care activities. Therefore, a TBA training project was implemented by the Ministere de la Sante de l'Action Sociale et de la Famille (MSASF), with support from the American College of Nurse-Midwives (ACN-M). This operations research study, which cost US $28,608 and was conducted by the MSASF's Family Health Division (DSF) with support from the Population Council's Africa operations research/technical assistance (OR/TA) project, assessed the training project's effect on the training and supervisory capabilities of clinical staff with responsibilities for the TBAs, on the ability of TBAs to promote FP, and on the FP knowledge, attitude, and practice (KAP) of women of reproductive age (WRA) in the target villages. The goal was to assist MSASF in improving the capacity of TBAs to provide high quality FP/MCH care at the community level. The 20-month evaluation used a quasiexperimental design to test the effects of the intervention. The clinical staff was assessed for its ability to train and supervise the TBAs, and 45 TBAs were followed before and after training to assess their ability to promote FP within their communities. A random sample of 20 WRA with children under the age of 5 years was interviewed in the village of each TBA to evaluate the effect on the communities' FP/KAP. The results will be presented in a written report and at a seminar for those responsible for the national FP program. Project activities began in March 1991. The baseline study for the evaluation showed that most of the supervisors have been FP providers and were generally knowledgeable about modern contraceptive methods. At the village level, the baseline study indicated that, while modern FP methods were largely unknown, WRA were interested in birth spacing and generally disapprove of an immediate resumption of sexual relations after delivery (64% would wait at least a year). When asked about their first source of information on birth spacing, 37% of the women mentioned the health clinics and only 2% TBAs. However, 17% of the women had discussed birth spacing with a TBA. Following the training, 2 supervision strategies evolved. In one province, an "integrated" approach combined supervision of the TBAs' MCH/FP activities with periodic immunization campaigns to avoid some of the problems relating to lack of supervisory resources. The second province relied on a traditional, project-specific supervisory approach. Preliminary results indicate that TBAs could play a vital role in sensitizing the population to FP activities.
Report of the evaluation of UNFPA assistance to the National Family Planning and Sex Education Programme of Costa Rica.
[Unpublished] 1980 Mar. 89 p.This report of the evaluation of UN Fund for Population Activities (UNFPA) assistance to Costa Rica's National Family Planning and Sex Education Program covers the following: 1) project dimension and purpose of the evaluation, scope and methodology of the evaluation, composition of the mission, and constraints; 2) background information; 3) 1974-77 family planning/sex education program (overview, immediate objectives, strategy, activities and targets, and institutional framework); 4) planned and actual inputs and rephasing in 1978-79; 5) family planning activities (physical facilities and types of services provided, recruitment of new users, continuation of users within the program, distribution of contraceptive supplies, sterilizations, and indicators of program impact); 6) training and supervision; 7) education, information, and communication (formal and nonformal education, educational activities in the clinics, and the impact of the nonformal educational program); 8) maternal and child health (maternal health indicators, cytological examinations, and infant mortality); 9) program evaluation and research; 10) population policy; 11) program administration; 12) some general conclusions regarding the performance of the program; and 13) the program beyond 1979. UNFPA evaluations are independent, in depth analyses, prepared and conducted by the Office of Evaluation, usually with the assistance of outside consultants. The process of analysis used in the evaluation follows a logical progression, i.e., that which underlines the original program design. Evaluation assessment includes an analysis of inputs and outputs, an investigation of the interrelationship among activities, an indication of the effectiveness of activities in achieving the objectives, and an assessment of duplication of activities or lack of coverage and the effect of this on realization of the objectives. The program was able to expand the coverage of family planning activities but has been unsuccessful in having a population policy established. The number of hospitals, health centers, and rural health posts providing family planning services was tripled in the 1974-77 period. The program could not achieve its targets in number of new users, and it recruited in 1977, only 11% of the total population of the country, against the 20% planned. It has been estimated that between 1973-77 around 231,200 births or 44.4% of those possible had been averted. Training and supervision has been a weak area of the program. A large number of professors have been trained in sex education, but no evaluation has been undertaken of the likely impact of this trained staff at the school level. The information, education, and communication (IEC) program has been successful in taking information and education to the population on family planning/sex education concerns but less successful in motivating the political groups to formulate a population policy.
Report of the evaluation of Family Planning International Assistance. Directed and coordinated by M.E. Gorosh, D.W. Helbig and S.C. Scrimshaw.
N.Y., IISHR, Feb. 1975. 2 pAdd to my documents.