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Switching back: an experimental intervention of family planning client remotivation and clinic staff retraining: impact upon reacceptance and continuity.
In: African research studies in population information, education and communication, compiled and edited by Tony Johnston, Aart de Zeeuw, and Waithira Gikonyo. Nairobi, Kenya, United Nations Population Fund [UNFPA], 1991. 73-82.In 1990, the Mauritius Family Planning Association presented educational sessions for former clients allowing them to meet f amily planning personnel and other women with similar experiences. It used audiovisual aids to discuss use of modern contraceptives and the advantage of scientific family planning, to dispel myths and rumors, and to explain how different methods could be used to meet their and partners' needs. At the same time, 10 service providers from the experimental clinic underwent a 6 week sensitization and retraining program emphasizing organization for efficiency, counseling skills, and skills to build client self esteem. Researchers observed both the control and experimental clinic for 9 months in 1991. 36 remotivated clients (73% return rate) and 29 mainly former clients who did not attend a session reaccepted a contraceptive method at the experimental clinic. As for the control clinic, 24 remotivated clinics (46% return rate) and 7 mainly former clients reaccepted a method. Both clinics' staff said that the extra clients returned because the 93 remotivated clients recommended or referred them directly to the clinics. The 2 interventions therefore had a spread effect. The experimental clinic did have a much better retention rate than the control clinic (46 client vs. 28 clients), however. Further it had higher continuity rates throughout the study period. At the end of the study, the continuity rate was 93.8 for the experimental clinic and 53.8 for the control clinic. The researchers concluded that the improved clinic services of the experimental clinic due to staff retraining in skills and attentiveness were responsible for the superior retention record and rates of return and continuity. Thus IEC programs that attend to former and potential clients' needs and develop skills and attentiveness of providers improve acceptor and continuity rates.
Arlington, Virginia, DUAL and Associates, Population Technical Assistance Project [POPTECH], 1991 Dec 5. vii, 41,  p. (Report No. 91-127-127; USAID Contract No. DPE-3024-Z-00-8078-00; PIO/T No. 623-0004-00-3-10002)In 1975, International Planned Parenthood Federation (IPPF) founded the Centre for African Family Studies (CAFS) in nairobi, Kenya to train family planning program personnel in service delivery management skills and technologies. A USAID funded 4 year CAFS Project Grant, scheduled to end in June 1993, consisted of training courses with incountry follow up to make sure courses were applicable to the changing situation of family planning programs in Africa. CAFS was to become totally self sufficient by June 1993. It planned to recover direct training costs from participants. CAFS experienced considerable difficulties in organization and management (a new director and loss of IPPF funding), during the project. The evaluation team found the training courses to be of high quality. Further former participants wished to continue receiving CAFS services and would recommended CAFS courses to colleagues. New financial procedures and addition of experienced financial staff had set CAFS on its way to financial self sufficiency, but these changes would not bring about self sufficiency by June 1993. Further CAFS restructured management and its organizational structure thereby moving it towards decentralization of authority and decision making. Even though CAFS was the only African regional institution providing training services for family planning personnel, it could lose its competitive edge since it had problems in providing francophone courses, inadequate incountry follow up visits, and insufficient research and evaluation skills in developing training programs. CAFS needed to address these obstacles. The team highlighted the need for CAFS to no longer depend on individual staff to maintain high quality courses so courses would not suffer from staff turnover. In conclusion, the team recommended that USAID continue to support CAFS.
NETWORK. 1991 Sep; 12(2):14-7, 27.Many unwanted births and pregnancies could be avoided by improving instructions for and comprehension of the use of oral contraceptives. Employed less than only the IUD, the oral contraceptive pill is the 2nd- most widely used reversible form of contraception, used by 8% of all married women of reproductive age. 6-20% of pill users, however, fall pregnant due to improper pill use. Improving instructions in the pill pack, ensuring that instructions are correct, and working to facilitate user understanding and motivation have been identified as priorities in maximizing the overall potential effectiveness of the pill against pregnancy. Since packets in developing countries may consist of pills in cycles of 21, 22, 28, or 35 days, providers must also be trained to instruct users in a manner consistent with the written instructions. Pictorial information should be available especially for semi-literate and illiterate audiences. The essay describes recommendation for instruction standardization and simplification put forth by Family Health International, and endorsed by the U.S. Food and Drug Administration. International Planned Parenthood Federation efforts to increase awareness of this issues are discussed.
STUDIES IN FAMILY PLANNING. 1991 Jan-Feb; 22(1):1-18.A study investigative the pros and cons of financial payments for sterilizations to clients, medical personnel, and agents who motivate and refer clients was conducted by the government of Bangladesh in conjunction with the World Bank. Results indicate that Bangladeshi men and women opt to be sterilized both voluntarily and after consideration of the nature and implications of the procedure. Clients were also said to be knowledgeable of alternate methods of controlling fertility. A high degree of client satisfaction was noted overall with, however, 25% regret among those clients with less than 3 children. Money is a contributing factor in a large majority of cases, though dominating as motivation for a small minority. Financial payments to referrers have sparked a proliferation of many unofficial, self-employed agents, especially men recruiting male sterilization. Targeting especially poor potential clients, these agents focus upon sterilization at the expense of other fertility regulating methods, and tend to minimize the cons of the process. Examples of client cases and agents are included in the text along with discussion of implications from study findings.