Reference Guides for Health Care Organizations Seeking Accreditation for High-quality, Gender-sensitive Reproductive Health Services

Bolivia’s Integral Health Coordination Program (PROCOSI), a network of 33 nongovernmental organizations (NGOs) providing reproductive health care, has long promoted gender sensitivity as a necessary component of high-quality health care. PROCOSI encourages member NGOs to address gender-based differences in roles, relationships, access to services, and service needs in their reproductive health programs. The Reference Guides in this publication provide guidance to help health-care organizations and NGOs implement high-quality, gender-sensitive standards to achieve certification for their member clinics and administrative centers. The procedures and standards included here are based on the process developed by PROCOSI, but the approach and standards can be modified to fit local needs and conditions. The Reference Guides focus on a formal certification process, but this guidance can also be used by NGOs that are not aiming for certification but that wish to evaluate and improve the quality and gender sensitivity of their services. The publication includes a Procedures Guide, Self-Training Guide, Assessment Guide, and Costing Guide

Reference Guides for Health Care Organizations Seeking Accreditation for High-quality, Gender-sensitive Reproductive Health Services—Appendixes

Bolivia’s Integral Health Coordination Program (PROCOSI), a network of 33 nongovernmental organizations (NGOs) providing reproductive health care, has long promoted gender sensitivity as a necessary component of high-quality health care. PROCOSI encourages member NGOs to address gender-based differences in roles, relationships, access to services, and service needs in their reproductive health programs. Included in this document are the Appendixes to “The Reference Guides for Health Care Organizations Seeking Accreditation for High-Quality, Gender-Sensitive Reproductive Health Services,” which provide guidance to help health-care organizations and NGOs implement high-quality, gender-sensitive standards to achieve certification for their member clinics and administrative centers. The procedures and standards are based on the process developed by PROCOSI, but the approach and standards can be modified to fit local needs and conditions. The reference guides focus on a formal certification process, but this guidance can also be used by NGOs that are not aiming for certification but that wish to evaluate and improve the quality and gender sensitivity of their services

Leveraging Farmer Field Days to Provide Family Planning and Other Health Services in Rural Kenya

Background: Access to family planning (FP) and other reproductive health (RH) services is difficult in much of rural Africa. Distance to health facilities, staff shortages, stock-outs, and other barriers impede the uptake and continued use of contraception. One way to improve FP access in rural areas is to deliver FP services at non-health events. FHI and Land O’Lakes collaborated to assess a model for providing health services through existing farmer-education events.  This study examined the introduction of Family Planning/Reproductive Health services through Land O’Lakes-supported dairy cooperatives. Methods: The study was conducted at seven events in Central and Rift Valley provinces between August and December 2010. Typical field days draw attendees from across the dairy sector: farmers, processors, development partners and officials from the Ministry of Livestock Development and the Kenya Dairy Board. At each study site, local Land O Lakes and dairy cooperative staff helped to incorporate a “family health camp” where attendees could consult with clinicians. The package included FP services, child immunizations, antenatal care, sexually transmitted infection screening and treatment, and HIV counseling and testing. All women, 18 to 49 years old, who received services from an on-site provider, were invited to participate in a survey about the health camp and the offered services. A total of 319 women were interviewed. Key findings: Use of health services at the seven field days was high; more than 80% of the 2,344 attendees received consultations. The services provided most frequently during the field-days were non-reproductive health exams (66%), FP counseling (18%), and HIV counseling and testing (13%). Of the women interviewed, 40% were affiliated with a dairy cooperative. One-quarter of current FP users acquired additional supplies of contraceptives at the event.  Knowledge contributions: This study contributes to the scant data regarding the provision of health services in the non-health sector. . This model provides a convenient way for rural people to access health services. Key Words: FP services, non-health sector, rural area, farmer

Willingness-to-pay for services provided by the Clinical Services Improvement Project (CSI) in Egypt

Willingness-to-pay (WTP) surveys are increasingly used in reproductive health programs to predict the impact of price changes on revenues, utilization, and client profile. The FRONTIERS program worked with the Clinical Services Improvement (CSI) project and the Cairo Demographic Center to carry out a WTP survey in six CSI clinics in Egypt. The survey found that most clients would be willing to pay higher prices for CSI services, and WTP did not vary much by client economic status. However, predictive validity was low when all reasons for client discontinuation were included. WTP surveys have the potential to be useful tools for predicting client response to price increases, but predictions for methods like DMPA (which have high discontinuation for method-related reasons) must be adjusted downward using data on method discontinuation from program statistics or from the literature

Effects and cost of implementing a gender-sensitive reproductive health program in Bolivia

The Integral Health Coordination Program (Programa de Coordinación en Salud Integral or PROCOSI), a network of 24 Bolivian NGOs, and the Population Council’s Frontiers in Reproductive Health (FRONTIERS) program evaluated the effects of interventions on clinic clients and their partners, and estimated the costs of incorporating a gender perspective into service delivery. Results show that sexual and reproductive health service organizations can implement action plans to change organizational policies and service delivery practices and to improve their infrastructure and equipment to make them more convenient for clients. The results further show that the intervention made modest but important changes in partner dynamics. No evidence was found that the incorporation of a gender perspective had an effect on the demand for sexual and reproductive health services. In the context of the current study, if change in unmet need is posited as the measure of success, then the question for program managers is whether this expenditure is justified to achieve the resulting changes in unmet need

Costs of reproductive health services provided by four Christian Health Association of Ghana (CHAG) hospitals

The Christian Health Association of Ghana (CHAG) is a large faith-based NGO which currently serves an estimated 35 percent of the Ghanaian population, mainly in remote rural areas. This study built capacity within the CHAG secretariat to calculate the economic cost and cost recovery levels of selected reproductive health services in four CHAG-affiliated hospitals. Techniques learned in the study are applicable to most costing problems, not just to reproductive health. Information obtained in the study forms the basis for negotiating reimbursement under the Ghana National Health Insurance Scheme, and for setting cost recovery and containment policies. CHAG senior managers plan to train other association hospitals in the technique

Financial capacity building for NGO sustainability

While demand for family planning and reproductive health services is increasing worldwide, a number of recent trends threaten the financial sustainability of donor-supported NGOs that provide these services. First, the U.S. Agency for International Development has seen its funding for population assistance decline since 1995. A second reason is the growth of government-funded programs that provide these services for low-income clients, which reduced the need for NGOs to focus programs entirely on the poor. Health-sector reform has created opportunities for NGOs via public–private partnerships in some countries, but sustained public-sector support is unlikely given limited economic growth in domestic economies and competition from other health priorities. Faced with these challenges, many NGOs ceased operations, while others struggled to produce health services for which clients or donors are willing to pay. Long-term sustainability of NGOs may require that they become largely financially self-reliant, but few NGOs have the skills to reduce costs and increase income. This brief describes the FRONTIERS program’s Financial Sustainability Capacity Building Initiative (FSCBI). FSCBI’s objective is to build NGO capacity to conduct economics-related operations research to improve financial sustainability

How much will it cost to scale up a reproductive health pilot project?

Most service-delivery interventions begin as pilot projects. When a pilot study of an intervention is successful, managers begin to think about scaling up the project to new areas. Cost is a critical factor influencing the extent and pace of scale-up. This brief explains how to adapt and modify cost information obtained from a pilot project to estimate scale-up costs. The brief shows why the costs of a pilot project alone are not sufficient to predict costs of scale-up and gives examples of how costs are influenced by factors like economies and diseconomies of scale, resource substitution, and intervention modification. The aim of this brief is to help managers think critically about the factors that must be considered in estimating the costs of scaling up an effective intervention. The first decision is whether to scale up the pilot project at all. There should be evidence that the pilot project proved successful, and its success should be achieved at reasonable cost

Testing balanced counseling to improve provider-client interaction in Guatemala\u27s MOH clinics

The job aids–assisted Balanced Counseling Strategy adopted by Guatemala’s Ministry of Health required specific instructions for use by nonprofessional providers and an intervention that assured provider compliance with the behavioral requirements of the new paradigm. Results show that the trained providers outperformed the controls in quality of care at each level of session length, but used nine extra minutes per session on average. Nonprofessional providers can take advantage of the job aids–assisted Balanced Counseling Algorithm and substantially improve their quality of care. Extra time invested in counseling new family planning clients will be easily absorbed insofar as they continue to represent a small portion of the total demand for services at the clinics

Effects of IGSS\u27 job aids-assisted Balanced Counseling Algorithms on quality of care and client outcomes

This study identified a need to improve the quality of care at the main maternity hospital of the Social Security Institute (IGSS) in Guatemala. Problems included very short counseling sessions, counseling not focused on clients’ needs, redundancy in the role of physicians and social workers as providers, skewed method mix, and low client return rate for method resupply. The intervention, using Balanced Counseling Algorithms, changed the counseling behavior of physicians and social workers and enhanced the quality of family planning care. The report includes recommendations for continuing these improvements: monitoring provider implementation of the job aids–assisted Balanced Counseling Algorithms, monitoring provider output, adjusting institutional policy and goals to the reality of client preferences, testing reformulated post-choice strategy, and paying particular attention to clients who choose oral contraceptives or condoms