Suchergebnisse

This study reviews the major research and interventions concerning readiness and quality of care in family planning programs. It has three aims: to identify and describe the principal methodological research including conceptual frameworks, perspectives, and tools for measuring and improving quality; to describe the results from various intervention studies; and to assess what is known about the effect of such interventions. The review suggests that interventions that improve client‐provider interactions show the greatest promise. Good quality of care results in such positive outcomes as clients' satisfaction, increased knowledge, and more effective and longer use of contraceptives. Rigorously documented evidence of the effects of interventions is sorely needed. The review indicates areas requiring additional research.

A flurry of policy initiatives in the fields of both population and development and reproductive health, many addressing the provision of family planning services, are currently underway: FP2020, the ICPD Beyond 2014, and the post‐2015 development agenda, among others. This is an opportune time, therefore, to reflect upon and take into consideration what five decades of family planning programs can teach us about ensuring that policies and programs integrate their underlying intents, concrete goals, and performance indicators. The family planning field has encountered instances in its history when inconsistencies between goals, intents, and indicators arose and adversely affected the delivery of services. This commentary presents our observations concerning potential misalignments that may arise within the many promising initiatives underway. We examine the relationship between the intent, goal, and indicators of FP2020 as a case study highlighting the need for ensuring a tight alignment. We offer suggestions for ensuring that this and other initiatives use carefully calibrated indicators to guide the achievement of explicit program goals without undermining their underlying intent—namely, promoting well‐being and reproductive rights.

Le Gouvernement du Sénégal, à travers l'adoption du Plan National d'Action pour la Planification Familiale, s'est résolument engagé dans une politique de repositionnement de la planification familiale (PF) qui s'est fixé comme objectif d'augmenter le taux de prévalence contraceptive. L'introduction de l'anneau vaginal à progestérone (AVP) dans la gamme des méthodes contraceptives devra apporter une perspective intéressante pour la promotion de la planification familiale post-partum (PFPP). Pour faciliter cette introduction, il demeure important de bien comprendre le contexte dans lequel évolue le programme national de PF en général et celui de la PFPP en particulier. Grâce à un financement de l'USAID, le Population Council a procédé à une revue documentaire de l'expérience du Sénégal en matière de promotion de la PFPP. Les leçons tirées de cette revue permettront de mieux orienter l'introduction de l'AVP dans la gamme des méthodes contraceptives disponibles au niveau du programme national. --- The Government of Senegal, through the adoption of the National Plan of Action for Family Planning, has strongly repositioned family planning (FP), and set itself the goal of increasing contraceptive prevalence. The introduction of the vaginal progesterone ring (VPR) in the array of contraceptives should provide an interesting perspective for the promotion of postpartum family planning (PPFP). To facilitate this introduction, it is important to understand the context in which the national FP program in general and PPFP in particular evolve. With funding from USAID, the Population Council conducted a literature review of Senegal's experience in promoting PPFP. The lessons learned from this review will better guide the introduction of VPR into the range of contraceptive methods available at the national program level.

The Government of India has adopted a Reproductive and Child Health (RCH) approach as the basis of its new family welfare policy. One component of RCH is management of reproductive tract infections (RTIs). The Population Council's Asia and the Near East Operations Research and Technical Assistance (ANE OR/TA) Project, in collaboration with the State of Uttar Pradesh, Ministry of Health and Family Welfare, is conducting a study on the feasibility and cost of providing RTI case management at the primary-care level. The estimated annual cost of RTI case management at the district level would be about US$64,000. From the analysis, it is clear that the average annual drug budget of a Primary Health Care Centre in India is inadequate even if used only for subsidized RTI case management. Policymakers and program managers are examining the initial and continuing costs of RTI case management within the overall RCH package in India, with a focus on quality and sustainability. As noted in this paper, alternatives for controlling costs include better efforts at primary prevention, partner participation to reduce reinfection, user fees, and more private-sector involvement in reproductive health care.

The intent of the ethical guidelines and regulations, developed over time, that govern research on human subjects is to ensure that research participants are well‐informed volunteers, protected from harm, ensured potential benefit, and enrolled in an egalitarian fashion. This study discusses ethical issues that researchers and program planners grapple with in the area of sexual and reproductive health. We illustrate the dilemmas that arise in the application of the ethical principles, how they have been addressed, lessons learned, and remaining challenges. The illustrations come both from research and from service‐delivery situations.

Objectives: This paper highlights lessons from introductory efforts and presents new data on community, provider and key opinion leader perspectives to support expanded use of emergency contraception (EC) in Senegal. Sources of information: The paper draws on four data sources: (i) a literature review; (ii) a secondary analysis of a household survey conducted by the Urban Reproductive Health Initiative; (iii) in-depth interviews with key opinion leaders; and (iv) a quantitative survey of healthcare providers from a range of service delivery points. Analysis of data: Knowledge of EC among women is low in urban areas, with only 20% of women having heard of the method and 4% having ever used it. There were serious gaps in providers' technical knowledge about EC; only 57% knew its mode of action and 34% were aware of the need for timely use (within 120 h). Moreover, nearly half reported reluctance to provide EC to married women and even fewer were willing to provide it to youths, particularly to adolescent girls. Responses from key opinion leaders were mixed, demonstrating ambivalence about EC and how it could be offered. Conclusion: In Senegal, the current positive political climate for family planning provides a good opportunity for strengthening EC programming to address knowledge and attitudinal barriers among providers, key opinion leaders and communities.

The reproductive health approach to family planning shifts the focus of service provision from macro‐level demographic objectives to meeting clients' needs. Little field experience exists to date, however, to indicate how to implement this approach. This study describes afield project in Davao del Norte and Compostela Valley provinces in the Philippines that implemented the reproductive health approach on a quasi‐experimental basis. The intervention was designed to address clients' self‐defined reproductive needs by providing them with relevant and accurate information and services of good quality. It consisted of two components: Providers were trained in information exchange at fixed clinics, and supervisors were trained in facilitative supervision. The results presented here indicate that the client‐centered intervention was successful in enhancing service providers' knowledge and improving the content of information exchange between providers and clients. One provincial health officer has expanded the intervention throughout his province, while other provinces are interested in duplicating the model.

SummaryThis paper presents the results of a longitudinal intervention study carried out in the Davao del Norte province of the Philippines. The intervention, tested through a quasi-experimental design, consisted of training of family planning service providers in information exchange and training of their supervisors in facilitative supervision. The training intervention significantly improved providers' knowledge and quality of care received by clients. Moreover, good quality care received by clients at the time of initiating contraception use increased the likelihood of contraceptive continuation and decreased the likelihood of both having an unintended pregnancy and an unwanted birth. However, comparison of women in the experimental group with those in the control group did not show any significant effect of provider-level training intervention on these client-level outcomes. The reasons for this conundrum and the implications for quality of care are discussed.

Despite consistent efforts of the government and national stakeholders, every year in Bangladesh over 5,000 mothers and thousands of children die. Most of these deaths would be preventable with increased access to quality services including existing medicines and other health commodities. The United Nation's Commission on Life-Saving Commodities for Women and Children suggests that an important cause of these deaths is lack of access and appropriate use of 13 life-saving commodities. This document describes an effort by the Population Council to assess the country's policies, guidelines, and availability for these 13 life-saving commodities as well as engaging with key stakeholders to implement the UN Commission's recommendations in conjunction with this assessment's findings. This assessment validated the availability of the 13 commodities in three districts at district, subdistrict, and community levels, and within drug stores, in 15 government facilities and 27 private drug stores. Key stakeholders were consulted. A national workshop stimulated discussion, identified national priorities and information gaps, and identified areas requiring policy review. This stakeholder engagement helped identify opportunities for organizations' contributions to implementing the recommendations.

In 2006, a consortium of agencies, including the Population Council, came together to provide technical and financial support to the Government of Ghana in the rollout of comprehensive abortion care (CAC) services. The consortium collaborated with the government in expanding women's access to modern family planning and CAC. The consortium's program, Reducing Maternal Mortality and Morbidity (R3M), aims to reduce unwanted pregnancy and severe complications and deaths caused by unsafe abortion. The formative research in this report was undertaken to provide a profile of beneficiaries, their needs for information and services, their decision-making process in seeking care, and the quality of care they receive. Research findings are expected to guide health service institutions in the design and implementation of client-oriented services to support the R3M program in its effort to develop strategies and approaches for reducing maternal mortality and morbidity. The principal goal of the research is to generate evidence and information that can be fed into ongoing policy and program initiatives to expand access to legal and safe abortion services in public and private facilities.