1. Quality in Family Planning / Reproductive Health services
Dr. Babar T. Shaikh
The Aga Khan University

2. Objectives of the session
At the end of the session, we shall be able to
define ‘quality’ in FP/RH services
learn elements of quality care in family planning
understand Quality Family Planning, Quality Post Abortion Care, Quality treatment of STIs/RTIs

3. Quality Quality is often defined as ‘meeting the needs of clients’.
Programs that are customer focused consistently involve clients in defining their needs and in designing the services.
Providing quality services is fundamental to sustainable services.
Providing and subsequently maintaining quality services can only be accomplished through continuous problem solving and quality improvement.

4. Reproductive Health
It is a state of complete physical, mental and social well-being and not merely absence of disease or infirmity, in all matters relating to reproductive system and to its functions and processes.
Reproductive health care is defined as the constellation of methods, techniques and services that contribute to reproductive health and well-being through preventing and solving reproductive health problems.

5. Concept of Reproductive Health
It implies that
couples have the ability to reproduce and regulate their fertility
women are able to go through pregnancy and child birth safely
outcome of the pregnancy is successful in terms of maternal and infant survival and well-being and
couples are able to have sexual relations free of the fear of pregnancy and of contracting any disease.

6. Aims & Objectives
In 1994, the International Conference on Population and Development (ICPD) set a broader agenda for incorporating elements of quality in FP/RH services.
to provide more and improved services to new groups of clients and to larger numbers of clients than ever before;
to increase client satisfaction and client use of services;
to have a positive impact on reproductive & overall health; and
to increase efficiency and savings.
The early family planning initiatives in the 1950s and 1960s were motivated
by demographic concerns; the vanguard countries developed family planning programs in an effort to control rapid population growth. As such, the ultimate objective of these programs (and the majority that have followed) was to reduce fertility. This translated to a strong emphasis on the quantitative aspects of service delivery. How many acceptors entered the program each year? What volume of contraception was distributed? What percentage of the population at risk used a contraceptive method?

7. Elements of ‘Quality of Care’ in family planning
By Judith Bruce, 1990
Choice of method
Interpersonal communication (verbal & non verbal)
Technical Competence
Information
Follow-up
Appropriate constellation of services

8. Choice of method
Offering the right to the client to choose the method means giving confidence to the individual.
He/she feels more comfortable in
using the method for which he/she has been provided with clear, accurate and specific information and which is the best for his/her needs.

9. Good interpersonal communication (verbal & non verbal)
It helps in conveying the right message and to build a rapport with the client.
The language should be simple enough, without any technical terms so to put him/her at ease.
It is a tool to get acquainted to the client’s knowledge, attitude, perceptions and feelings about the subject.

10. Technical Competence Quality needs command on the subject.
It is inevitable to acquire all the essential knowledge and to polish one’s technical competence regarding family planning services.

11. Information
Providing all the necessary information to the client helps him/her in using the selected method correctly, without any fear.
Right information will certainly clear the myths and rumors about the subject and will improve the adopting rate among the potential clients.

12. Follow-up
Correct and continuous follow up of the users is indispensable to monitor the possible complications with the use of contraceptives.
It ensures eventually an improved continuation rate among the users.

13. Appropriate constellation of services
Adding family planning services along with the routine ones under the same roof may attract more clientele.
The clients do not have to go to some other service specialized in family planning only.
Clients discuss their problems with more openness with their own physician in a friendly ambiance.

14. Indicators QUALITY OF CARE
Number of contraceptive methods available at a specific outlet
Percentage of counseling sessions with new acceptors in which provider discusses all methods
Percentage of client visits during which provider demonstrates skill at clinical procedures, including asepsis
Percentage of clients reporting “sufficient time” with provider
Percentage of clients informed of timing and sources for re-supply/revisit
Percentage of clients who perceive that hours/days are convenient and the range of services provided is adequate.

15. Quality Post Abortion Care Services
It is a public health strategy to reduce maternal mortality and morbidity.
The three levels of Post abortion care are:
Emergency treatment services for incomplete abortion and related complications to reduce morbidity & mortality.
Post abortion family planning to prevent unwanted pregnancy.
Links between emergency abortion treatment services and comprehensive reproductive health services to improve overall health.

16. Key Elements of Post Abortion Counseling
Informed choice
Two way communication
Problem solving focus
Decision making information
Consider patient's emotional & physical state
Reasons of unwanted pregnancy
Discuss woman’s return to fertility
Selection of an interim period
Discussion of long term methods
Decision about permanent methods

17. Quality Treatment of RTIs & STIs
RTIs and STIs constitute a major health problem because of the complications they cause & the facilitation to HIV transmission.
Provider should be able to deal RTIs/STIs with the syndromic approach which is internationally recommended and universally adopted to deal with such patients.
Early diagnosis, Prompt treatment or referral, Appropriate counseling, Treatment of associated complications of RTIs & STIs.
Reproductive Tract Infections (RTIs) & Sexually Transmitted Infections (STIs)

18. RTI/STI counseling resolve the current RTI/STI prevent further ones
give emotional support to change sexual behavior
help client cope with the feeling of shame, guilt and embarrassment

19. GATHER Approach to Counseling
G reet the client in a friendly and respectful manner
A sk the client about FP/RH needs
T ell the client about different methods/services
H elp the client to make her own decision about which method/service to use
E xplain to the client how to use the method/service she has chosen
R eturn visit and follow-ups of client scheduled

20. Rights of Clients
Information about all the methods / services available.
Knowledge of not only the benefits but also the risks / side effects of all the contraceptive methods / RH services to make an independent decision.
Outlets providing FP/ RH services should carry a logo / indicative sign on a prominent place. They should also provide a comfortable clean environment to the clients where they will be treated with respect, attention and courtesy.
Access to get the FP/RH services regardless of his/her sex, race, religion, color and socio-economic status. FP services should be available to people in their closest vicinity.

21. Rights of Clients contd…
Choice to practice FP or RH service should be absolutely voluntary and free. A competent provider will help the client to make a decision and will not pressurize the client to make certain choice for a certain method/service.
Privacy for FP/ RH counseling where the client would feel open and frank with the provider.
Continuity to obtain the FP/RH services without any break or discontinuation to avoid the after effects and the give-ups of the service.
Opinion about the subject, method used and the service provided. This feedback is always helpful for the provider to improve one’s service delivery.

22. Provider’s needs
Training will certainly help the provider to do a better counseling. It is needed to polish one’s skills to pass the right information, to help the client in decision making, to explain the use of a specific method, to screen the client etc.
Information about all the FP methods/RH services.Moreover, other information about the local community like social, cultural and religious beliefs is always helpful in dealing with the FP clients.
Update about the FP methods and about the new developments in the reproductive health.
Outlet adequately equipped for a trained provider is an essential requirement for the FP/RH services. There should be a logo / sign to show the availability of FP services in that particular outlet.

23. Provider’s needs contd…
Supplies continuous & adequate - needed at the provider’s outlet to ensure an all time good service for the users and other potential clients.
Backup & referral for the complicated cases should be there, where and when needed.
Feedback about the services provided in a certain outlet helps the provider to amend and ameliorate his/her services.
Acknowledgement in the shape of certification or some incentives to be encouraged to continue with the same motivation and involvement.