1. 1 7 th October, 2012 Welcome to Presentation On the Study of “Identify weakness of service delivery system in delivering family planning services at different levels” Presented by Dr. Jahir Uddin Ahmed Research Evaluation Associates For Development Ltd. (READ)

2. 2 PP 1: Objectives of the Study Determine the reasons for weakness of service delivery in family planning at different levelsDetermine the reasons for weakness of service delivery in family planning at different levels Investigate what needs to be done for improving the service delivery at different levelsInvestigate what needs to be done for improving the service delivery at different levels Identify the determinants of the FP service delivery in rural Bangladesh contextIdentify the determinants of the FP service delivery in rural Bangladesh context

3. 3 PP 2: Study Scope and Methodology The study used cross-sectional statistical design The study used cross-sectional statistical design An integrated approach combining qualitative and quantitative methods has been adopted An integrated approach combining qualitative and quantitative methods has been adopted Multistage sampling procedure with equal cluster size used to select the survey unit Multistage sampling procedure with equal cluster size used to select the survey unit Of the 7 divisions, 7 districts and 14 Upazilas selected Of the 7 divisions, 7 districts and 14 Upazilas selected

4. 4 PP 3: Study Sample Design Total respondents— 2400 current user of FP methodsTotal respondents— 2400 current user of FP methods 1560 from facility level 1560 from facility level 840 from community level 840 from community level In community level, household selected randomlyIn community level, household selected randomly

5. 5 PP 4: Qualitative Investigation Qualitative Investigations conducted using following methods:Qualitative Investigations conducted using following methods: In-depth interpersonal interviews: 94 Program Personnel In-depth interpersonal interviews: 94 Program Personnel FGDs with Community Leaders – 14 FGDs with Community Leaders – 14 Observations: 6 Community Clinics; 7 FWCs; 7 UHCs; 7 DHs, 7 MCWCs; 1 Model Clinic Observations: 6 Community Clinics; 7 FWCs; 7 UHCs; 7 DHs, 7 MCWCs; 1 Model Clinic Literature/document reviews Literature/document reviews

6. 6 PP 5: Problems (Weakness) encountered by FWAs Motivational problemsMotivational problems Side effectsSide effects Work load of FWAsWork load of FWAs Problems of Supply of FP methods Problems of Supply of FP methods

7. Skill development endeavors through training, particularly for field manpowerSkill development endeavors through training, particularly for field manpower Lack of supervision on areas of program weaknesses on the manpower that are not fulfilling their assigned tasksLack of supervision on areas of program weaknesses on the manpower that are not fulfilling their assigned tasks Supply of logistics was not regular in SylhetSupply of logistics was not regular in Sylhet PP 6: Program weaknesses identified DD/AD, MOs and UFPOs

8. 8 PP 7: Weaknesses of FP Services (FGD)  Participants mentioned: Work load of FP workersWork load of FP workers Lack of timely and need based trainingLack of timely and need based training Contraceptive supplies is not regularly ensuredContraceptive supplies is not regularly ensured Rarely given support in FWAs work through supervisionRarely given support in FWAs work through supervision

9. 9 PP 8: Weaknesses of FP Services (FGD)  Participants mentioned: Side effects, rumors and social and religious dogmasSide effects, rumors and social and religious dogmas Quality of services is often not ensuredQuality of services is often not ensured Service providers are not skilled and trainedService providers are not skilled and trained FWAs do not perform home visits as per scheduleFWAs do not perform home visits as per schedule

10. 10 PP 9: Use of FP Method On the rates obtained on conventional; contraceptives across three different sources: CPR of the current Study (82%); Estimated CPR obtained from FWA Register (83%) and the CPR of BDHS 2011(85%; Pill-52%, Injection-22%, Condom- 11%) are comparableOn the rates obtained on conventional; contraceptives across three different sources: CPR of the current Study (82%); Estimated CPR obtained from FWA Register (83%) and the CPR of BDHS 2011(85%; Pill-52%, Injection-22%, Condom- 11%) are comparable On Long Acting method, findings of the three sources differ widelyOn Long Acting method, findings of the three sources differ widely On Permanent methods the rates are somewhat comparable with survey findings falling shorter than those of FWA register and of BDHS 2011, while the latter two sources are comparableOn Permanent methods the rates are somewhat comparable with survey findings falling shorter than those of FWA register and of BDHS 2011, while the latter two sources are comparable

11. About a third of the users from both high & medium performing clusters changed (shifted) use of FP methods in the pastAbout a third of the users from both high & medium performing clusters changed (shifted) use of FP methods in the past In low performing clusters—53%In low performing clusters—53% The most predominant reasons for shifting use of FP methods—desire for another child, sufferings due to side effectsThe most predominant reasons for shifting use of FP methods—desire for another child, sufferings due to side effects PP 10: Continuity of Use of FP Method

12. 56% respondents mentioned about the FWAs as source of information on FP methods56% respondents mentioned about the FWAs as source of information on FP methods 75% users mentioned the public sector clinics/ hospitals and 68% users mentioned the UHC, MCWC, District Hospital and FWC as the source of obtaining services on FP modern methods75% users mentioned the public sector clinics/ hospitals and 68% users mentioned the UHC, MCWC, District Hospital and FWC as the source of obtaining services on FP modern methods In the overall 18% users complained that they faced problems in collecting FP methodsIn the overall 18% users complained that they faced problems in collecting FP methods PP 11: Sources on FP method

13. 13 PP 12: Lessons Learn from the Study PP 12: Lessons Learn from the Study Wide differences on FP program achievements between high, medium and low performing areasWide differences on FP program achievements between high, medium and low performing areas Differential performance identified due to: Vacancies; Coverage (size) of eligible couples and status of availability of FP suppliesDifferential performance identified due to: Vacancies; Coverage (size) of eligible couples and status of availability of FP supplies Absenteeism of service providers, irregular home visits performed by FWAs and unacceptable behaviors by some of service providers are causes of affecting performances on service delivery in FPAbsenteeism of service providers, irregular home visits performed by FWAs and unacceptable behaviors by some of service providers are causes of affecting performances on service delivery in FP Motivational levels of the target population are still not improved or strongMotivational levels of the target population are still not improved or strong Facilities observations reveal that none of facilities are fully equipped with all standard components ideally provided for a facility (FWC or CC)Facilities observations reveal that none of facilities are fully equipped with all standard components ideally provided for a facility (FWC or CC)

14. 14 PP 13: Recommendations  Improve service delivery, its coverage and quality, uniformity or standardization of the training irrespective of areas need to be ensured  FP Directorate may conduct both program related surveys and also official investigations through supervision and monitoring  Supervision of the program areas need to be designed focusing on problems

15. 15 Program interventions may design BCC and Counseling strategiesProgram interventions may design BCC and Counseling strategies All the service delivery facilities should be fully equipped with all the standard componentsAll the service delivery facilities should be fully equipped with all the standard components Data collection or estimation on long acting method need to be reported after careful verificationData collection or estimation on long acting method need to be reported after careful verification Program efforts in the low performing areas may be further redesigned and intensified. PP 14: Recommendations

16. 16 A national plan of training of FP service delivery manpower may be designed and also implementedA national plan of training of FP service delivery manpower may be designed and also implemented An expert committee may be engaged to recommend program interventions to remove problemsAn expert committee may be engaged to recommend program interventions to remove problems Concerned authorities may design feasible incentives and disincentives for the program personnelConcerned authorities may design feasible incentives and disincentives for the program personnel PP 15: Implementation Plan

17. 17 To Promote both individual, familial and social benefitsnvolve service providers, satisfied users and community leadersTo Promote both individual, familial and social benefits involve service providers, satisfied users and community leaders Authority (program mangers) at District and Upazila levels through routine supervision may identify the shortfalls on facilities in the service centersAuthority (program mangers) at District and Upazila levels through routine supervision may identify the shortfalls on facilities in the service centers Authority can take steps to improve the situation according to shortfallsAuthority can take steps to improve the situation according to shortfalls Program efforts in the low performing areas may be further redesigned and intensifiedProgram efforts in the low performing areas may be further redesigned and intensified PP 16: Implementation Plan

18. 18 Thank You