ms parul sharma
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XIII Annual IAPSM Conference UP and UK CHAPTER 2010October 30, 2010HIHT, Dehradun
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ASSESSMENT OF ‘QUALITY’ OF FAMILY PLANNING SERVICES
A Model Initiative to Ensure Quality
Family Planning Services in Uttarakhand
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Elements of Quality of Care
Choice of method
Appropriateconstellation of
services
Information
Interpersonal communication
(verbal & non verbal)
Technical Competence of the service
providers
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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
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FINDINGS
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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
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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
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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
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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
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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
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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
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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
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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
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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
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RECOMMENDATIONS
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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
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THANK YOU