Make better use of provider time in public health clinics

Funding for reproductive health services is stagnant or declining globally, yet population projections, particularly in Africa, indicate that demand for services will increase in the near term. Between 2002 and 2025, for example, the population of women of childbearing age (15–49) is expected to increase by 2 percent annually in sub-Saharan Africa. With this growth will come increased demand for contraception, and other reproductive health services such as antenatal care, safe birthing services, and postpartum care for mothers and children. Concern about increasing demand for services has led program managers to examine the productivity and costs of existing programs. While all programs can advocate for additional funds from their governments and establish or increase prices for services to clients, often they can also use their existing resources more efficiently. Increasing provider productivity—the time they spend with clients—can permit clinics and nonclinical programs to meet increased service demands and enhance quality, without requiring significant additional funding. This brief focuses on provider time use and how programs can make better use of existing labor resources in clinic programs. The data come from ten time-use studies conducted in nine countries in Asia and the Near East, Latin America and the Caribbean, and sub-Saharan Africa

An assessment of the Zimbabwe National Family Planning Council\u27s community based distribution programme

Since its inception, the Zimbabwe National Family Planning Council’s (ZNFPC) community-based distribution (CBD) program has made significant and well-documented contributions to the demand for and use of family planning in Zimbabwe. Data from several studies have shown, however, a steady decline in this contribution and that the CBD agents spend more time resupplying existing clients than recruiting new acceptors. Moreover, the CBD program urgently needs to be able to address the AIDS crisis in the country. ZNFPC has undertaken this review to guide it in making appropriate decisions about the future direction of the program, allowing CBDs to have a broader range of responsibilities and modifying the structure to become more efficient. Some activities felt to be acceptable and feasible include: providing more detailed information on STIs/HIV/AIDS; identifying and referring individuals with STI symptoms for diagnosis and treatment at clinics; providing supportive counseling to people living with HIV/AIDS; educating communities about HIV voluntary counseling and testing (VCT) services and motivating their use; providing ongoing supportive counseling after HIV VCT testing; assisting parents to better communicate with their children on sexual and reproductive health issues; and advising adolescents like surrogate aunts and uncles

The cost of health services at the facilities level of the Nakuru Municipal Council, Nakuru, Kenya

The Nakuru Municipal Council (NMC), in Kenya, is concerned with the financial sustainability of its services and is considering increasing prices. The Council is currently charging for services but these fees are not based on the cost of providing services. Before changing its prices, the NMC wanted information on its costs because another strategy to improve financial sustainability is to decrease the costs of producing various services. Information on current costs of services can also help the NMC to determine ways to reduce these costs. The NMC, in collaboration with the Africa OR/TA II project and Family Health International, conducted a study to measure the recurrent financial costs of providing visits for different types of services, including family planning, sexually transmitted infections, antenatal care, child health, tuberculosis, and outpatient treatment. According to this report, the cost analysis focused on recurrent costs (drugs, supplies, labor, overhead). Capital costs were not included as it would be difficult to cover even recurrent costs

What Happens to Contraceptive Use After Injectables Are Introduced? An Analysis of 13 Countries

Although the introduction of a new method is generally hailed as a boon to contraceptive prevalence, uptake of new methods can reduce the use of existing methods. It is important to examine..

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

Autocratic Breakdown and Regime Transitions: A New Data Set

When the leader of an autocratic regime loses power, one of three things happens. The incumbent leadership group is replaced by democratically elected leaders. Someone from the incumbent leadership group replaces him, and the regime persists. Or the incumbent leadership group loses control to a different group that replaces it with a new autocracy. Much scholarship exists on the first kind of transition, but little on transitions from one autocracy to another, though they make up about half of all regime changes. We introduce a new data set that facilitates the investigation of all three kinds of transition. It provides transition information for the 280 autocratic regimes in existence from 1946 to 2010. The data identify how regimes exit power, how much violence occurs during transitions, and whether the regimes that precede and succeed them are autocratic. We explain the data set and show how it differs from currently available data. The new data identify autocratic regime breakdowns regardless of whether the country democratizes, which makes possible the investigation of why the ouster of dictators sometimes leads to democracy but often does not, and many other questions. We present a number of examples to highlight how the new data can be used to explore questions about why dictators start wars and why autocratic breakdown sometimes results in the establishment of a new autocratic regime rather than democratization. We discuss the implications of these findings for the Arab Spring

Improving quality of care for family planning services in Uganda

The Regional Centre for Quality of Health Care at Makerere University, Uganda in collaboration with the Delivery of Improved Services for Health II Project, the Ministry of Health (MOH), and the Population Council’s FRONTIERS Program, conducted an operations research project to help the MOH improve the quality of family planning services with the aim of helping couples better attain their reproductive goals. The study developed a package of interventions (the Yellow Star Programme—YSP) that sought to increase the readiness of clinics to offer basic family planning services, to improve provider motivation, and to empower clients to request quality services. The interventions did somewhat increase the functioning of basic family planning services and created an immediate effect on quality of care in the clinics, with an increasing number of clinics attaining most of the basic quality standards set by the YSP. However, there was only a moderately significant difference between the experimental and comparison groups during the post-intervention survey, suggesting a limited effect of the study. In conclusion, the study provided empirical evidence that quality of care can be improved by a combination of interventions targeting system, provider, and client levels. In addition, introducing non-monetary incentives can improve provider motivation

The costs of integrating reproductive health services: An example using syndromic management of STIs in family planning clinics in Zimbabwe

Estimates from the United Nations Population Fund indicate that the costs of family planning (FP) and other reproductive health (RH) services are increasing and that it will be difficult for donors and countries to meet these costs. Many institutions delivering RH services operate significantly below their physical capacity to see clients, and much of the equipment required for expanding RH services may already be available for use. The marginal costs of adding infrastructure could be low. Many institutions have staff that are not fully occupied, and thus the staff necessary to expand RH services may also be in place. In this paper, we examine the cost implications for labor of expanding the provision of syndromic management services in FP clinics in Zimbabwe. Syndromic management of sexually transmitted infections allows health care workers to make a diagnosis without sophisticated laboratory tests because it is based on clinical syndromes and, in some cases, assessments of an individual patient’s risk for STI infection

Demand for and cost-effectiveness of integrating RTI/HIV services with clinic-based family planning services in Zimbabwe

The current spread of HIV/AIDS poses a major threat to individual lives and national economies in many sub-Saharan African countries. The region also has some of the highest levels of other reproductive tract infections (RTIs) in the world. Some of these RTIs increase the risk of sexual transmission of HIV infection. Thus, the control of RTIs is seen not only as an important reproductive health care strategy to alleviate symptoms of infection and long-term gynecological, obstetric, and neonatal complications, but also as a key strategy in reducing the spread of HIV/AIDS. As a result, all national health care programs in the region are actively seeking cost-effective ways of implementing an RTI management program that would reduce the spread of RTIs and ultimately HIV. Although there are many reasons to support an integrated approach to service delivery, many unanswered questions remain concerning its implementation, effectiveness, and cost-effectiveness. In 1998, the Africa OR/TA II Project and the Zimbabwe National Family Planning Council (ZNFPC) undertook a study to assist the ZNFPC in developing the most appropriate and cost-effective approach to managing RTIs in its clinics. Findings from the study are presented in this report