Quality in Family Planning Reproductive Health services

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Quality in Family Planning / Reproductive Health
services

• Dr. Babar T. Shaikh
• The Aga Khan University

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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

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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.

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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.
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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.

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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.

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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

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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.

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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 clients
  knowledge, attitude, perceptions and feelings
  about the subject.

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Technical Competence

• Quality needs command on the subject.
• It is inevitable to acquire all the essential
  knowledge and to polish ones technical
  competence regarding family planning services.

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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.

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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.

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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.

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IndicatorsQUALITY 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.

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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.

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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 womans return to fertility
• Selection of an interim period
• Discussion of long term methods
• Decision about permanent methods

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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.

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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

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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

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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.

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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 ones service
  delivery.

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Providers needs

• Training will certainly help the provider to do a
  better counseling. It is needed to polish ones
  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.

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Providers needs contd

• Supplies continuous adequate - needed at the
  providers 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.