Evaluation of family planning and reproductive health programmes

The paper documents the issues of the Philippine Reproductive Health Bill and to present a case study of the fertility experience of farmers in northern rural part of the Philippines. The first population policy , HB 4244 ,better known as the Reproductive Health Bill (RH Bill) has many debatable issues that borders on the moral and ethical values such as, When does life begins and its implication on the use of contraceptives. Who will teach child sex education? and How can the Philippine government afford to spend for alternative family planning methods when at its present economic state, it can barely meet the basic needs and social services of its people. A case study done in 2011 on unmet family planning needs among farming couples in the northern rural part of the Philippines supports the RH Bill. The RH Bill is a step toward minimizing poverty.

Introduction. Maternal health care suffers from sub-optimal performance, client extortion and low quality of care in Bangladesh. Supply side barriers with a synergistic effect on demand side constraints make services inaccessible for poor women living in rural, remote areas.
Theoretical focus. Inspired by Pay-for-performance (P4P) that ties performance with financial incentives, the government implemented two P4P models- Strategy-I incentivized both providers and clients, and Strategy-II only the providers.
Methods. With a quasi-experimental design, interviews with 2,124 exit clients and 473 providers were conducted; monthly service statistics, quarterly quality assurance visit measurements, and auditor’s validation reports were collected for evaluation.
Findings. Institutional deliveries and quality of care score were increased significantly. Overall client satisfaction was highest in strategy-I for providing free medicines and not requiring extra payment. Cost per service unit was US$8. Although overall client satisfaction increased, staff behavior was not improved. Targets could not be set for complications services. Facilities not having minimal staff tend to fail.
Conclusions. The study tested a team based incentive mechanism. Design adjustments are to be made to make providers accountable for their behaviors.

Sterilization is the most popular method of contraception in India. As the demand for sterilization services remains very high with a large unmet need, the country has continued with the camp mode (mobile clinic) to reach the people in under-served and under-reached areas (MoHFW, 2008). The paper compares the types of service delivery for female sterilization in India by their socio-economic characteristics and by the awareness of alternative contraceptive methods. At the same time, the study also tries to see differentials in static and mobile service delivery facilities. The present study uses the third round of DLHS (2007-08). In the DLHS-III, 1,156,932 ever married women in the age group 15-49 have been interviewed. To analyse the data, bi-variate analysis have been performed to compare static and mobile service facilities. At the same time, logistic regression analysis has been performed to look into the factors responsible for different service deliveries. The result shows that mobile facility is more effective in rural areas. The result also depicts that Muslims compared to Hindus; urban resident compared to rural resident; and women having higher education compared to no education are statistically significant and less likely to use female sterilization.

A cross-sectional study was done using the women’s data set from the 2008 Nigeria Demographic and Health Survey to determine factors associated with the utilization of postpartum care services among Nigerian women during their last childbirth in the five years preceding the survey. With postpartum care utilization at 44.9% and timely provision of care within 24 hours of childbirth at 33.3%, postpartum services remain a poor and neglected area of maternal health services in Nigeria. Age, marital status, parity, place of residence, region, level of education, wealth, religion and all three forms of media exposure were shown to be associated with utilization of postpartum care services. However after controlling for confounding factors all but daily radio listening and daily television watching were significant predictors. While not all categories of these individual characteristics turned out to be significant predictors, some of those that were significant had a positive influence on utilization of postpartum care services, while others had a negative influence. It is necessary to conduct further studies using these predictors to find out why and how they influence the health care seeking behaviors of women. The findings from this study should form the basis for interventions to increase the rate of utilization of postpartum care

Family planning program in Indonesia has proven effective in reducing the birth rate since 1970, from 5,6 children per woman in 1970 to 2,6 children per woman in 2007 and as well as successfully increased contraceptive prevalence from 15 percent in 1970 to 61,4 percent in 2007. But since 2004, when the decentralization policy has been applied, the family planning program seemed to recede. Indonesia Demographic and Health Survey (IDHS) 2007 showed that for the first time (in six IDHS), TFR Indonesia remained at 2,6 children per woman in 4 years (2003-2007) and the contraceptive prevalence was stagnant at around 60 percent. This could potentially lead to a baby boom in the coming decades, when the cohort of babies who were born in this period time will reproduce in the coming decades. The baby boom’s phenomenon is expected to be minimized by increasing the contraceptive prevalence. Promoting the family planning is one of program that has been conducted by government to increase contraceptive prevalence. Grouping of family planning participants using survival tree is done to get the groups that became the main target of the promotion. Several groups of family planning participant are obtained where they are vulnerable to stop using contraceptive.

This research used data collected from a randomly selected sample of sixty six respondents from Masha Sub County, Isingiro district of Uganda using an interviewer’s administered questionnaire. The main objective was to identify the factors influencing contraceptive use in the area. Frequencies, cross tabulations and Binary Logistic regression were carried out to find factors for contraceptive use in Masha, Isingiro district, Uganda.

Findings show that all women were aware of contraception, Injectables being mostly used while Implants least used, most people did not use contraceptives because they are expensive, fear side effects and long distance to the family planning units. Education level was significant with contraception after cross tabulation while multivariate analysis found education and religion significant.

The researcher recommends government to encourage girl child education to increase knowledge about contraceptives. Sensitization of masses including Religious leaders on benefits of small family sizes should be done which are only achievable through contraception. More government health facilities providing contraceptive services should be put up in rural areas with all categories of contraceptives and well trained personnel to ease service delivery in Masha.

The knowledge and attitudes of young Palestinian men with regards to contraceptive use has to a large extent been neglected in the literature dealing with family planning (FP) methods among Palestinians. In particular, information on the awareness of family planning methods among youth (15-29 years of age) has generally focused on the female population, with accounts of the male youth population rare. Indeed, it was only in 2010 that the Palestinian Central Bureau of Statistics (PCBS) included questions related to information on family planning methods among male youth. Moreover, the use of FP methods is quite low (52%). This paper will present an analysis of the related findings of the 2010 Multiple Indicators Cluster Survey in relation to awareness of condom use in particular. It will point to significant differences between young men and women in their knowledge and awareness of condom use in different locations and within different subgroups. Moreover, given the relatively low level of FP use among Palestinians, understanding the lower levels of awareness of condom use among specific groups is an important element to recognize in relation to increasing the use of FP methods on a national level and sexually transmitted diseases (STDs) awareness and prevention.

In Argentina, RH programs focus mainly on family planning and offer their health services (HS) almost exclusively to women, but there is a growing perception that men’s needs have to be attended to, both for their sake and for the sake of women’s well being.
We present results from a household survey which was carried out among men 25-59 years old in the cities of Rosario and Reconquista, Santa Fe province, Argentina. Given the expectation that rates of use would be low men were asked about where would they seek attention in hypothetical situations of need and about the characteristics those HS should have.
In both cities the majority would resort exclusively to HS, except when seeking contraceptives or when having a sexual dysfunction. The young, the single and the childless would resort less to health services than older men. Interviewees preferred services located in the existing ones, with the majority having no preference for the gender of the provider, suggesting that efforts have to concentrate in strengthening the system rather than in creating new RHS for the male popul. However, other results show that populations from the same country and province may defer in some of their health seeking behaviors with signs of the existence of different ideological climates, showing that research has to be context specific.

The Government of India piloted a new initiative in 17 states whereby local accredited social health activists (ASHAs) deliver contraceptive methods directly to the households within a modified supply chain designed to avoid stockouts and delays in supply. This paper details a process evaluation of the new initiative, undertaken by FHI 360 as requested by the Ministry of Health and Family Welfare, Government of India with the purpose of providing recommendations for its national scale-up. The objective of the evaluation was to identify operational issues, including service delivery mechanisms, program monitoring and record keeping at various levels. These objectives were achieved using quantitative and qualitative methods across six geographically representative states. The evaluation highlighted several operational challenges for the government of India to consider during scale-up. The packaging of the initiative’s contraceptive supply could be modified to highlight the price and to differentiate it from the free supply. Social marketing would improve community awareness and acceptance of the new charges. Reporting formats could be simplified, and develop guidelines on stock requisition and removal of free-supply stocks. The initiative is a promising strategy for addressing unmet family planning need and increasing the uptake

In recent years, the role of the state in provision of public services is being reexamined around the world with many experiment in alternative service delivery structures. India is at the forefront of some of these innovative programs which include one of world’s largest conditional cash transfer programs – payment to women and community health workers for hospital delivery as well as health insurance program for the poor where government pays the premiums for use of government as well private health facilities. These investments should improve maternal health outcomes including use of prenatal care, hospital delivery and postnatal care.
However, these programs are set up in a context where public service delivery systems remain indifferent to patient welfare, private health systems are poorly monitored and gender norms and intra-household inequalities constrain women’s ability to seek health care. Thus, careful evaluation of these programs and their impact is necessary to understand their effectiveness and ability to reach the poorest.
Using unique nationally representative longitudinal survey of over 40,000 households conducted before and after , this paper examines the impact of India’s Janani Suraksha Yojana (JSY), a conditional cash transfer program for hospital delivery, for improving access to maternal care.