XIII Annual IAPSM Conference UP and UK CHAPTER 2010October 30, 2010HIHT, Dehradun

ASSESSMENT OF ‘QUALITY’ OF FAMILY PLANNING SERVICES

A Model Initiative to Ensure Quality

Family Planning Services in Uttarakhand

Elements of Quality of Care

Choice of method

Appropriateconstellation of

services

Information

Interpersonal communication

(verbal & non verbal)

Technical Competence of the service

providers

QoC Project: Rapid Assessment

NEED• MIS captured

information only about the current usage• Provider’s Bias

SAMPLE FRAME• Health facilities (govt./

HIHT’s) under the project area• Acceptors of Terminal Methods

METHODOLOGY• Facility observation• Client – Provider Process Observation• Exit Interviews• Interview of Tubectomy Acceptors• Interview of Vasectomy/ NSV acceptors• Feedback from service providers

FINDINGS

Facility Observation: Health Camps

Facilities overall clean and spacious

No power back-up in any of the facility

Differed with regard to waiting/ reception area

No separate counselor room

Necessary equipments and medical supplies available

Record keeping satisfactory

Facility Observation: Urban health Training Centre (UHTC)

Two gynecologists posted

Medical abortion services available

OCPs and condoms available

IUCD services provided free of cost

Injectables, female condoms and emergency contraceptives available at subsidized cost

Facility Observation: HIHT Hospital

Multi-specialty hospital and medical and nursing college

Medical abortion services available

Induction of trained counselor has helped

Increased referral of FP clients through project efforts

Does not have dedicated staff and department for FP

Client-Provider Process Observation: Health Camps

Friendly and enabling behavior

IEC material provided

Basket of choice only lacked female condoms and injectables

Provider’s bias towards male sterilization

Information provided about all methods

Pre-suggestion examination done in most of cases

Privacy Ensured

Efforts to Alleviate Myths

Exit Interviews: Client’s Perspective

2/3rd reported that adoption was their own decision

Few reported difficult access due to distance from home

None of the client reported pre-suggestion examination

Overall satisfied with the cleanliness, hygiene, waiting time, timings of the camp & privacy

Almost all reported that information was provided about all the methods, but not about the side-effects

Few reported follow-up

Feedback from acceptors of Tubectomy

Found facilities clean and comfortable

Varied waiting time

1/4th reported that MTP preceded sterilization

Most of respondents satisfied with the behavior of the staff

Majority received follow-up services

Half of the respondents were accompanied by ASHA

Consulted Spouse before accepting

Feedback from acceptors of Vasectomy

Self-motivated

Follow-up services received

Found facilities clean and comfortable

Consulted spouse before accepting

Pre-acceptance counseling received

Most of respondents satisfied with the behavior of the staff

Varied waiting time

Feedback from Service Providers

Financial benefits for clients equivalent to govt. benefits

Non-compliance among pill users leading to unwanted pregnancies

Very low acceptance of CuTASHA has her own inhibitionsProject counselor is playing a vital roleNeed to enhance the knowledge with updates

Feedback from Service Providers

Need to restrict indiscriminate use of E-pillEfforts required to popularize IUCDsLong waiting time for sterilization servicesLow acceptance of male sterilizationMotivating for IUCD still a big challengeInjectables getting popularized

RECOMMENDATIONS

UHTC needs to be developed as model facility for integrated RCH and FP services

Advocacy efforts required for accreditation of UHTC

Counseling skills to be strengthened Need to develop a system for collecting client’s

feedback on regular basisFollow-up needs to be strengthenedTAG to play a more focused roleBasket of choice to be widened

THANK YOU