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Adolescent girls in disaster and conflict. Interventions for improving access to sexual and reproductive health services.
New York, New York, UNFPA, 2016. 92 p.Safe spaces, mobile medical teams and youth engagement are effective ways to reach displaced, uprooted, crisis-affected girls at a critical time in their young lives. Adolescent Girls in Disaster & Conflict: Interventions for Improving Access to Sexual and Reproductive Health Services is a collection of UNFPA-supported humanitarian interventions for reaching adolescents when crisis heightens vulnerability to gender-based violence, unwanted pregnancy, HIV infection, early and forced marriage and other risks.
The impact of strengthening clinic services and community education programs on family planning acceptance in rural Madagascar.
In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar.  p. (MAD-01)The government of Madagascar and donors are planning substantial increases in family planning (FP) services; at present the Ministry of Health (MOH), with UN Population Fund support and local Planned Parenthood collaboration, offers FP services in only 5-10% of the country's 2000 clinics. Initial efforts by JIRAMA (the Water and Power Company) to use a mobile clinic to offer FP services in the rural areas of the central province demonstrated some demand for FP services and achieved an estimated prevalence rate of 5-6% in the first 2 years, compared to an estimated 1-2% nationally (in 1989). The mobile approach has several weaknesses, however, and its implementation has entailed problems. For example, JIRAMA added no new staff to already busy government MCH clinics when it began to offer FP services, and contraceptives and equipment were in short supply during the first 2 years. Training for collaborating MOH staff was minimal, and educational efforts were sporadic. Also, costs were relatively high. This study, which cost US $35,259, investigated the impact of a new approach by comparing 2 different levels of program intensity with a control group. In 3 rural clinics, a more intense and higher quality program, consisting of new, locally-based, nurse-midwife staff, as well as increased training, supplies, and equipment and increased clinic and community educational efforts, was compared to the mobile-based program. Data were collected over 2 years, after which a sample survey will measure results. The study will determine the relative cost and effectiveness of recruiting new FP clients and maintaining them on a contraceptive method for a period of at least 3 months in an intensive clinic program compared to a less-intensive program of 24 mobile clinic sites in the same general area. The high-intensity program enrolled 17.4 new acceptors per month, compared to 12.8 in the medium-intensity program and 3.2 in the mobile program, about the same as all the mobile clinics prior to the intervention. Service delivery costs/new acceptor were $4.33 in the medium-intensity, $5.14 in the high-intensity, and $15.75 in the mobile program. Continuation rates improved in both the high- and medium-intensity program clinics, but deteriorated in the mobile program, perhaps partly due to the disturbed social and political climate in the latter half of 1991, which interfered with all program activities. While uncontrolled factors in the study deserve additional consideration and analysis, researchers recommended that the mobile clinics be converted to the medium- or high-intensity program and drew possible lessons for the forthcoming expansion of the national FP program. The final data analysis and report remain to be completed. A dissemination seminar will be held as soon as possible.
JOURNALEN SYKEPLEIEN. 1993 Jun 8; 81(10):19.The author worked for almost two years in a remote little clinic in Chesta, West Kenya. It was common for a child to be brought to the clinic with high temperature and other symptoms and be treated for cerebral malaria, lung inflammation, or meningitis. These episodes occurred day and night, sometimes the children were saved and sometimes they died. The author arrived in Kenya on her fourth missionary assignment looking for work and acceptance as a registered nurse. Six weeks had to be spent at a polyclinic and 12 weeks at various children's wards with Kenyan hospitals. There was a lack of medicines and supplies and an enormous turnover of patients. The organization that she was associated with had problems in finding replacements in health work in West Kenya, where, in connection with the usual evangelical work, clinics had been in operation for 12 years. She was requested by NORAD to participate in the health care component of an integrated development program at the Chesta mission station in West Pokot. The work involved being on duty in the clinic as well as out in the field, driving around and even flying on the mission's helicopter to reach villages in the Cherangani Hills. There were mobile clinics at 6 sites in the mountains with 1 visit per month. At 2 of these sites there was an integrated development program comprising health, agriculture, school development, and evangelization. The World Health Organization's vaccination program was conducted at every site. The available services included a maternal-child health care clinic, family planning, teaching of local midwives, and treatment of the sick. The Christian principle of placing equal value on all people was the foundation of the work. This was especially important for women: to be considered not just as chattel of men but as work partners with their own identities and worth.
IPPF COUNTRY PROFILES. 1992 Jan; 19-24.A country profile of demographic/statistical data, social and health aspects, and government policies and program in Pakistan particularly as they relate to family planning is presented by the International Planned Parenthood Federation (IPPF). Finding current population growth too high and impeding of development, the government enacted a population policy in 1991 aimed at reducing population growth to 2.5% in 10 years. An integrated approach will stress population education in secondary schools, the use of mobile services to promote birth spacing and provide maternal-child health care, and the provision of services through government facilities and family welfare centers. The Family Planning Association (FPA) of Pakistan was created in 1953, and became a member of the IPPF in 1954. It promotes family planning through education, clinics, and the use of male community institutions, and is the main provider of services. The organization also campaigns for both more government involvement in family planning and improvements in the status of women. 16% of married women practice contraception. Female sterilization is the most popular method, followed by condoms. with husband's consent, sterilization is permitted for married women with at least 2-3 children. Abortion is legal only to save a woman's life. Family planning constraints, education, demographic trends, health issues, status of women, contraceptive availability and accessibility, and the operations and funding of the family planning association are fully discussed.
BULLETIN OF THE PAN AMERICAN HEALTH ORGANIZATION. 1984; 18(2):188-92.Outbreaks of yellow fever in recent years in the Americas have prompted concern about the possible urbanization of jungle fever. Vaccination, using the 17D strain of yellow fever virus, provides an effective, practical method of large scale protection against the disease. Because yellow fever can reappear in certain areas after a 2-year dormancy period, some countries maintain routine vaccination programs in areas where jungle yellow fever is endemic. The size of the endemic area (approximately half of South America), transportation and communication difficulties, and the inability to ensure a reliable cold chain are problems facing these programs. In addition, the problem of reaching dispersed and isolated populations has been addressed by the use of mobile teams, radio monitoring, and educational methods. During yellow fever outbreaks, many countries institute massive vaccination campaigns, targeted at temporary workers and migrants. Because epidemics in South America may involve extensive areas, these campaigns may not effectively address the problem. The ped-o-jet injector method, used in Brazil and Colombia, should be used in outbreak situations, as it is effective for large-scale vaccination. Vaccine by needle, suggested for maintenance programs, should be administered to those above 1 year of age. An efficient monitoring method to avoid revaccination, and to assess immunity, should be developed. The 17D strain produces seroconversion in 95% of recipients, and most is prepared in Brazil and Colombia. But, problems with storage methods, instability in seed lots, and difficulties in large-scale production were identified in 1981 by the Pan American Health Organization and WHO. The group recommended modernization of current production techniques and further research to develop a vaccine that could be produced in cell cultures. Brazil and Colombia have acted on these recommendations, modernizing vaccine production and researching thermostabilizing media for yellow fever vaccine.
INFECTION CONTROL. 1984 Nov; 5(11):538-41.In 1978 the Ministry of Health and Social Welfare (MHSW) of Liberia launched the Expanded Program on Immunization (EPI) with the 5-year objective of establishing an 80% reduction in child mortality and morbidity from measles, polio, diphtheria, neonatal tetanus, pertussis, and tuberculosis. The program at first adopted a strategy of using 15 mobile units in 11 operational zones to deliver vaccinations throughout the country. However, by 1980, despite support from the Baptist World Alliance, the UN International Children's Emergency Fund (UNICEF), and the World Health Organization (WHO), it became evident that the mobile strategy was neither economically feasible nor practical. Therefore, with support from the US Agency for International Development (USAID), the EPI shifted to a strategy of integrating immunization activities into the existing network of state health facilities. After 5 years, in 1982, the Program was evaluated by a team from the MHSW, WHO, USAID, and the Centers for Disease Control. The evaluating team felt that the EPI's strategy was good, but its goals were not being achieved due to deficiencies in funding, clinic supervision, and rural community outreach, as well as shortages of kerosene and spare parts needs to keep the essential refrigerators in operating condition. Measles remains endemic; in the capital, Monrovia, only 9% of the children have been vaccinated against it. Immunization coverage is particularly low in the capital the countries. Other reasons for low vaccination coverage in Liberia are lack of community awareness of existing facilities and the importance of vaccination and lack of coordination at the community level to use the existing facilities efficiently. International assistance is still needed, especially to develop heat-stable vaccines, so that maintenance of refrigerators will not be necessary.
IPPF News 2(6):3. November-December 1977.The McCormick Hospital Family Planning Programme operates in northern Thailand with funding help from the International Planned Parenthood Federation. The program operates on a clinic and a mobile unit basis. A substantial majority of recent and current acceptors choose Depo-Provera, an injectable contraceptive. Between 25-37.5% of eligible women in the area are participating in the program. As a result, fertility has dropped by 1/2 in the 1959-1974 period. There is high demand in this area because of the relatively high level of socioeconomic development. The program provides high-quality service and careful, regular follow-up. Thorough record-keeping facilitates research and evaluation projects. This program differs from other international family planning programs because: 1) it depends on injectables rather than pills, 2) it relies on paramedical workers, 3) there is little community involvement, and 4) husbands do not play a significant role.
Family Planning Perspectives. September-October 1976; 8(5):231-240.At the end of fiscal year 1974, about 2.5 million low- and marginal-income nonmetropolitan women, or about 3/4 of all such women in the United States, had no access to family planning services from either private physicians or organized clinic programs. By this time, 3/4 of the counties in the U.S. had a family planning service center, but this included 91% of all metropolitan and only 72% of all nonmetropolitan counties. Although there are wide disparities in service levels among states, need was concentrated in nonmetropolitan counties of the South and the East North Central region. The statistics are tabulated, graphed, and mapped. Private physicians seemed to be supplying a small percentage of the nonmetropolitan family planning needs. Physician shortages mean that this trend will continue in the future. Health department programs and hospitals will have to meet the need. Coordinated action on the part of national, state, and local agencies will be necessary. Priority should be given to supplying the larger nonmetropolitan counties, perhaps with mobile units or paraprofessional personnel.
London, England, International Planned Parenthood Federation, (1968). (Working Paper No. 1) 34 pThe report covers all the main points pertaining to an IPPF questionnaire about mobile family planning units in 1967. An account is given of activities of the units in: 1) Korea, 2) Fiji, 3) pakistan covering 2 units in East and West Pakistan, 4) Rhodesia covering educaitonal and a clinic unit, 5) Sarawak, and 6) Hong Kong, 9 branch affiliates of the Planned Parenthood of America used mobile units in 1967, and details are given of those in: 1) Rochester and Munroe County, New York State; 2) Kansas City, Missouri; 3) Delaware League for Planned Parenthood, Inc., Wilmington, Delaware; 4) Planned Parenthood of St. Paul, Minnesota; and 5) Planned Parenthood of Cleveland, Inc., Maternal Health Association, Ohio. Korea also has some urban units used to serve the new suburbs. 1 of the most helpful factors in operating a mobile unit is cooperation with local family planning workers. Usually in that case there is a government family planning program, but without national suport the unit benefits from availability of premises and amenities such as water and electricity. Some of the factors operating againist the units are: 1) lack of local workers, 2) lack of premises and amenities, 3) geographical conditions and lack of roads, 4) climate, and 5) staff and maintenance costs. Appendix 1 is a report of the mobile unit in Lahore district, West Pakistan, and Appendix 2 contains instructions to the staff of an urban mobile clinic.
IPPF Situation Report, April 1969. 6 p.Demographic statistics and some information on the cultural situation in Thailand are presented. The history of interest in family planning and the current personnel of the Family Planning Association (FPA) and family-planning-related government personnel are listed. Various FPA-funded projects are summarized. The government started a 3-year family health program in 1968 which will include family planning services. Initial surveys indicated positive attitudes toward and interest in family planning in the country. IUD insertions have totaled 100,000 so far and sterilizations are averaging 10,000 yearly. The plan is to cover 20 million people by 1970. Current training and educational activities are sumarized. Other agencies active in the family planning field are mentioned.
In: Philippines. Children's Medical Center Foundation. Institute of Maternal and Child Health (IMCH). Proceedings: One day seminar on mobile family planning service, Quezon City, February 28, 1974. Quezon City, Philippines, IMCH, (1974). n.pWorld Neighbors, which was started in the Philippines in 1954, helps local villagers establish cooperative self-help projects dedicated to up lift, progress, and general community betterment. It purpose is to encourage local initiative in cooperative self-help projects such as food production, health education and family planning, leadership training, and village industries. World Neighbors was the first agency to operate a mobile family planning clinic in many Philippine localities. Through the clinic there were medical consultations, IUD insertions, examinations of pill acceptors and follow-up check ups. The mobile clinic visited each area every 2 months. Mobile team activities during a 1-year period include: 562 IUD insertions, 290 pill acceptors, 102 condom acceptors, 102 Emko Foam acceptors, 222 meetings conducted, 43 film showings, 21 subfertile cases. Mobile team operations were suspended in 1971. It was found that rural mothers respond to family planning arguments centering on the debiliting effect and dangers of childbirth rather than on the dangers of overpopulation. It is important to detect side effects promptly and to deal with them; otherwise, the dissatisfied user can inhibit others from using the method. It was found that local doctors and allied medical personnel not trained in family planning were indifferent and often hostile to the efforts of the clinic. Acceptance of any family planning service must be voluntary on the part of the patient. Husbands must be included in the decision making. The major focus of the program should be the fieldworkers, who can easily communicate with the people, and not medical personnel.
Africa-Link, July. 1974; 3-4.A brief review of the family planning mobile units scheme in Kenya, inaugurated in 1969 under an agreement signed between the Government of Kenya and the Internation Planned Parenthood Federation (IPPF), is presented. 7 mobile units were set up in key areas to provide free family planning services in rural maternal and child health clinics. The program was established to: 1) provide services that were not available previously, and 2) train local paramedical staff in family planning methods. Dr. Luc Gourand is in charge of the Kenya Mobile Units scheme. Many of the visitors to IPPF mobile units are surprised that the units are not as mobile as they had thought. Most of the family planning clinics are held in conjunction with maternal and child health clinics. At these clinics the field workers find it a good opportunity to give their motivational talks, and sometimes support it by showing films and slides. During 1973, the mobile units serviced 90 clinics, and their monthly average of new acceptors was 1098. By far the highest demand was for pills (864) followed by IUDs (157). The total monthly average of all attendances at IPPF mobile clinics during 1973 was 4465. Because of limited funds, the IPPF wishes to withdraw from the program; the Kenya government understands that the IPPF's involvement cannot continue indefinitely, but it feels that it is not quite ready to undertake the program on its own.
Reports on Population/Family Planning No. 10, October 1971. p. 1-32Mobile units in family planning in Tunisia, the United Arab Republic, Honduras, Turkey, South Korea, and Pakistan are discussed. In November 1967, the Population Council distributed questionnaires to agencies responsible for mobile family planning activities in the 6 countries where the mobile units usually operated as part of either the national family planning program or through the ministry of health. Most of the analysis in this report is based on the replies to the questionnaires. In Tunisia, the mobile units offered family planning services in many areas where no other facilities of this nature were available. All the units offered IUDs. In addition, 3 units offered oral contraceptives, 6 offered conventional contraceptives such as condoms and foam tablets, and 1 offered sterilization. In the United Arab Republic, the mobile unit program of Ain Shams University, Cairo, secured more acceptors per month than the median number of acceptors obtained by the Tunisian program and 3 times as many acceptors per day as that program. In 1966, family planning in Honduras was incorporated into the organization of the Rural Mobile Health Program. The mobile units continued to emphasize medical care and only incidentally engaged in family planning activities. In terms of performance, number of IUD acceptors was very small largely because of the small time spent in recruiting acceptors. In South Korea, the Ministry of Health was responsible for the mobile unit program. In 1966, the average team in the Korean program secured more first acceptors of all methods and of IUDs in a month than the median of acceptors obtained by teams in the other programs under study. In Turkey, the program brought family planning to rural and urban areas. The main weakness of the program was lack of adequate follow-up care. In Pakistan, the district family planning boards, the West Pakistan Research and Evaluation Center, and the Family Planning Associations of Lahore and Dacca all use mobile units. Throughout the survey of mobile units, the International Planned Parenthood Federation found that 1 of the principal shortcomings of mobile unit programs was provision of adequate follow-up care.
International Planned Parenthood News, No. 210: 2. September 1971.An evaluation study by the International Planned Parenthood Federation (IPPF) INDICATED THAT ITS 7 MOBILE TEAMS PROVIDED OVER 1/3 OF ALL FAMILY PLANNING CLINIC services and attended 1/3 of all new patients in Kenya during 1970, their second year of operation. Consisting of a doctor, a midwife and a field educator, the teams visit government hospitals, health centers, subcenters and dispensaries in 7 provinces at regular intervals. The number of new and old patients more than doubled during 1970: there were 11,940 first visits and 31,247 revisits. The mobile teams were responsible for spreading information about the availability of clinic services and for assisting educational activities in each area. The 1970 report notes the effectiveness of paramedical workers in recruiting new acceptors and running clinic sessions. 11 midwives completed a training course on IUD insertion and in 6 areas, midwives were trained to manage clinic sessions. Instruction included the theoretical and practical aspects of family planning, interviewing techniques and completion of case histories, consultation for oral contraceptives, and examination of patients. Inservice training for hospital midwives and nurses, and lectures and demonstrations for student nurses and midwives were also provided by the mobile teams. The IPPF report recognizes the need for increased recruitment and training of health workers, including paramedical, clerical and field staff.
Studies in Family Planning. February 1967; 1(17):12-16.The 42 member organizations and 14 others who had received help from the International Planned Parenthood Federation (IPPF) were asked to supply questionnaire information for 1964 in an attempt to assess the work being done in family planning by the IPPF. The questionnaire covered 1) finance, 2) clinic structure and personnel, 3) staff training, 4) types of publicity, 5) mobile vans, 6) patient recruitment, and 7) contraceptive methods available. Financial resources available from outside sources varied directly with amount of government support. Training was mostly on the job or through exchange with other associations. Personal contact was the most effective method for recruiting new patients. IUDs emerged as the method for recruiting new patients. IUDs emerged as the method most favored by associations already using or hoping to use them. Training of personnel and research were both directed toward IUDs.
Novum. 1983 May; (23):10-1.To encourage family planning, a mobile health clinic will be sent to a village when child clinics are held in the Gambia, so that women may receive family planning advice. All methods are used; the Pill is the most popular. There are around 3000 family planning acceptors. The Gambia Family Planning Association (GFPA) supplies condomes and pessaries were needed. The Association sells contraceptives to private doctors at a discount. Supplies are also available in hospitals. The average family has 6 children. Seminars on family planning have been held. The GFPA trains extension workers in family planning. The infant mortality rate is 217/1000 live births; 40% of the children die before the age of 5. Breastfeeding has been a problem. Many children are malnourished. The GFPA is staffed by 1 doctor; a senior nursing sister, a nursing sister, clinical assistants, and rural fieldworkers. There are 5 main clinics. The GFPA's staff teach family life education to schoolchildren. Planned parenthood/women's development projects are also taking place. The GFPA is largely funded by the IPPF.