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  1. 1
    093107

    Increasing the availability and acceptability of contraceptives through community-based outreach in Bas Zaire Programme d'Education Familiale (PRODEF). Original.

    Communaute Baptiste du Zaire Ouest; Tulane University. Family Planning Operations Research Project

    In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar. [2] p. (ZAI-01)

    The Tulane Family Planning (FP) Operations Research (OR) Project in Bas Zaire (known locally as PRODEF) aims to increase the availability and acceptability of modern contraceptives in an urban and a rural area. The urban program offers FP only, whereas the rural program integrates FP with 3 interventions for children under 5 years of age: anti-malarial drugs, anti-helminthic drugs, and rehydration salts. The objectives of this project, which cost US $623,504, were to: increase knowledge and use of modern contraceptives; improve attitudes toward FP; decrease "ideal" family size; and increase appropriate treatment for children under 5 years of age who have malaria, intestinal helminths, and dehydration due to malaria. The project tests 2 alternative strategies for the delivery of FP services. In treatment area A, dispensaries distribute contraceptives (and the rural children's drugs) and outreach activities are conducted. In area B, dispensaries distribute contraceptives (and the rural children's drugs), but there are no outreach activities. In the rural villages that do not have a dispensary, a matrone selected by the villagers is trained by PRODEF to serve as a distributor. Pre/post-intervention surveys were conducted in all project areas to measure changes in FP knowledge and practice and the relative effectiveness of the 2 approaches. Service statistics were used to monitor project activity, and cost/couple month of protection (CMP) was compared. The promotion of modern contraceptives was found to be culturally acceptable. Offering FP services only was acceptable in the urban area. The number of ever-married women who had ever used a modern contraceptive rose from 10 to 48% among women in area A and to 44% among women in area B. The child health interventions greatly enhanced the value of the program for the rural communities. Ever use of modern contraceptives increased from 8 to 34% in area A and from 7 to 27% in area B. The matrones were an efficient and culturally acceptable distribution channel. Simply making the contraceptives available increased contraceptive prevalence. However, the level of contraceptive prevalence was greater in area A, which also received outreach. Current use of modern methods in the urban area increased from 4 to 19% in area A and from 5 to 16% in area B. In the rural area, modern method use increased from 5 to 14% in area A, and from 2 to 10% in area B. The number of women using a traditional method decreased from 60 to 48% in area A and from 65 to 53% in area B; however, traditional methods are still used more than modern methods by a factor of 2:1 in the urban area and by over 3:1 in the rural area. The baseline survey showed that 95% of all women know at least one traditional fertility control method and about 80% had heard of at least one modern method. At follow-up, almost all urban respondents knew at least one modern and one traditional method. In the rural area, 90% knew at least one modern method. In the urban region, cost per CMP was US $7.11 in area A and $6.18 in area B; in the rural region the respective costs were US $11.22 and $7.95.
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  2. 2
    093057

    Community-based distribution (CBD) of low cost family planning and maternal and child health services in rural Nigeria (expansion).

    Nigeria. Ministry of Health; Columbia University. Center for Population and Family Health [CPFH]

    In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar. [2] p. (NGA-02)

    A community-based distribution (CBD) project has been in operation since 1980 in Oyo State, Nigeria. As a result of word-of-mouth communication among health professionals, television coverage of graduation ceremonies, and positive political feedback from the pilot area, the state government requested assistance in expanding the program. In collaboration with the State Health Council, the Pathfinder Fund, University College Hospital, and the Center for Population and Family Health of Columbia University, the program was expanded in 1982 at a cost of US $237,517. In each of the 4 health zones of the expansion area, a Primary Health Center (PHC) became the training and supervisory center. The expanded program was modified in light of experience in the pilot area. Monthly stipends to CBD workers were eliminated and, because of government policy, no fees were to be charged for services. (This policy was later reversed.) Also, a full-time CBD supervisor was assigned to each zone, rather than relying on individual maternity staff members for supervision. Each zone was limited to 100 CBD workers. Data collection included baseline and post-intervention knowledge, attitudes, and practice surveys and a village documentation survey to estimate the service population. The project also carried out in-depth CBD worker interviews, structured observations of training, mini-surveys, analyses of supervision records and service statistics, and a case study of the impact of the CBD program in which villagers were interviewed about the educational and clinical roles of the CBD workers. Although initial family planning (FP) acceptance was low, ever use of a modern method has increased from 2 to 25% in the pilot area. About half of the married women of reproductive ages in the project area are not sexually active at any one time because of postpartum abstinence. Most of the acceptance of modern contraceptives replaces use of traditional abstinence. Male promoters have proved to be an asset to male acceptance of FP services. Individual monetary incentives are not required to motivate CBD workers; however, once incentives are given, difficulties are created if they are stopped, as they were in the pilot area. The CBD approach has changed the concept of health care from that of providing services to clients who come to a fixed site to reaching out to provide services to all people living within a particular catchment area. The expanded project was subsequently extended into additional areas of Oyo State by the State Health Council. In addition, a conference to discuss the project, held in January 1985, was attended by health program managers and policymakers from all parts of Nigeria. The conference stimulated planning by State and Federal Ministries of Health to undertake CBD as a major strategy for primary health care in rural areas.
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  3. 3
    060142

    Implementing a counseling training program to enhance quality of care in family planning programs in Ecuador.

    Kopp Z; Cox K; Marangoni P

    [Unpublished] 1989. Presented at the 117th Annual Meeting of the American Public Health Association [APHA], Chicago, Illinois, October 22-26, 1989. 9, [2] p.

    To address the need to improve and expand the level of counseling offered trough family planning programs in Latin America, the Asociacion Pro-Bienestar de la Familia Ecuatoriana (APROFE), an affiliate of the International Planned Parenthood Federation, provided counseling and interpersonal communication training to its 149 staff members in 1988- 89. Before the workshops were held, 724 clients at 6 APROFE clinics were surveyed to provide a baseline assessment of the quality of care from the client's point of view. The 2-day workshops focused on counseling skills, values clarification activities in the area of human sexuality, and the importance of informed choice to the quality of client care. A KAP test was administered to staff before and after the training. The client surveys indicated overall satisfaction with APROFE in the areas addressed--cost, hours, privacy, informed consent, and attitudes of personnel--but pinpointed areas for change, including a preference for specific appointment times, more information on sexually transmitted diseases and acquired immunodeficiency syndrome, and a failure of some staff to provide information on the entire range of contraceptive choices. The clinic's director of counseling has become involved in the selection and training of new staff members. Workshop participants have expressed a need for additional training about ways to counsel clients on matters related to human sexuality and to overcome the sociocultural barriers to such discussions.
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  4. 4
    058443

    WHO-Shanghai Collaborating Center in Health Education: strategic scheme for development.

    Li VC

    HYGIE. 1989 Mar; 8(1):26-9.

    Activities of the WHO-Shanghai Collaborating Center in Health Education are described. The Center is a joint venture between WHO and the Shanghai Health Education Institute, and as such it is intended to have international significance. Its aims are to strengthen the impact of health education in primary care and to utilize effective health education technologies. Since 1956 the Center has provided guidance to districts and counties in the form of promotional materials for basic medical units, trained health personnel and conducted health promotion activities. There are 70 staff in 5 divisions: publications, art, publicity, administration and audiovisuals. Methodologies are both tested and used as a vehicle for human resource development, by training health staff on the job. Some current projects include anti-smoking educational programs for workplaces incorporating baseline and follow-up assessments, and production of media programs such as documentaries, TV series, short spots, and video cassettes, approximately 1 every 3 weeks. Several productions won national awards in 1986. An international exchange program with the University of California at Los Angeles was held to explore how the Chinese apply health education in the community. Consultation services are provided through WHO. Progress in health education in China is limited by the lack of translated literature on health education.
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