The Situation Analysis Approach to Assessing Family Planning and Reproductive Health Services: A Handbook

Good family planning service delivery emphasizing both access and quality is key to the related goals of satisfying individual needs and achieving programmatic success. Situation Analysis (SA) provides a needed link between the manager and the client he or she is trying to serve. The data marshaled for SA offer a representative picture of how subsystems are working and provide a way to “see” the client’s experience. Situation Analyses assist managers in achieving the broadest management goal—that of efficient administration of a vital health care service while keeping in view the ultimate goal—providing good care for those who seek it. “The Situation Analysis Approach to Assessing Family Planning and Reproductive Health Services” handbook is a tool to help implement SA studies. Some of the sections are more valuable for policymakers and program planners, others for researchers, and still others for field interviewers. The handbook consists of four chapters: The Situation Analysis Study Methodology; Conducting the Study; Instruments and Question-by-Question Guides; and Data Analysis and Reporting

Testing a community-based distribution approach to reproductive health service delivery in Senegal (a study of community agents in Kébémer)

The Division of Reproductive Health (DSR) of the Senegal Ministry of Health and Social Action, in partnership with the Population Council’s FRONTIERS in Reproductive Health program and Management Sciences for Health (MSH), conducted a study to test and compare three ways of providing reproductive health services to rural communities in the Kébémer district of Senegal in terms of their effectiveness, cost, and cost-effectiveness. FRONTIERS and MSH collaborated with the DSR to design the interventions, MSH supported the DSR in implementing the interventions, and FRONTIERS undertook the evaluation. This study, funded by USAID, responded to the recommendations of a 1999 workshop, organized by FRONTIERS and the DSR, on the community-based distribution (CBD) approach, which defined alternative CBD models appropriate for Senegal. The DSR sees the development of community-based service delivery models as essential for the future of health care in Senegal. As noted in this report, the general objective of the study was to contribute to the development of an integrated cost-effective program to increase the accessibility and availability of reproductive health information and services in rural areas of Senegal

Using systematic screening to increase integration of reproductive health services delivery in Senegal

This study tested the systematic screening technique to increase the integration of reproductive health services in Senegal. The study took place in four urban health posts in the city of Dakar and three rural health posts in the district of Kebemer. A before and after design tested the hypothesis that the use of the systematic screening tool would result in more services received per client visit. In Dakar, services per visit increased significantly by 20 percent, while in Kebemer, services per visit also increased significantly by 35 percent. The study also examined several techniques to improve provider compliance with the screening technique. The Senegal Ministry of Health has requested assistance in scaling up the strategy to other reproductive health service delivery points at district, regional, and national levels

An assessment of the community based distribution programs in Ghana

This study was carried out to describe the major NGO community-based distribution (CBD) programs in Ghana, and to assess in some detail the functioning, quality of care, and performance of the Planned Parenthood Association of Ghana (PPAG) program. The study showed that national coverage by the NGO programs is extensive—virtually all the 110 districts in the 10 regions have at least one program. However, coverage within districts is sparse, as each program covers only a few communities. The results have been communicated to the NGOs whose programs were included in the study and PPAG has already identified a number of steps that it will take to address some of the issues raised, including: a revision of the training manual; introduction of a community diagnosis and mapping exercise for each agent; improved recordkeeping and reporting procedures; establishing stronger links with referral clinics; and enhancing the availability of educational materials for use when counseling clients. In addition, USAID will be using the results to guide future programming support of the PPAG program

Etude expérimentale sur l\u27offre de services à base communautaire de santé de la reproduction au Sénégal: Une étude de cas dans le District Sanitaire de Kébémer

La Division de la Santé de la Reproduction (DSR) du Ministère de la Santé et de l\u27Action Sociale du Sénégal, en partenariat avec le programme FRONTIERS in Reproductive Health du Population Council et le Management Sciences for Health, a mené une étude visant à déterminer l\u27acceptabilité et la faisabilité des modèles de services à base communautaire expérimentés du point de vue de leur acceptabilité, de leur faisabilité, de leur efficacité, de leur performance, et de leur coût et rentabilité. L\u27objectif général de cette étude était de contribuer à l\u27élaboration d\u27un programme intégré rentable visant à accroître l\u27accessibilité et la disponibilité des informations et des services de santé en matière de procréation dans les zones rurales du Sénégal. Le DSR considère que le développement de modèles de prestation de services à base communautaire est essentiel pour l\u27avenir des soins de santé au Sénégal. Le rapport conclut qu’aucun des modèles n’a réellement réussi à augmenter de façon significative les connaissances, des attitudes, et de l\u27utilisation de la planification familiale par rapport au site de comparaison. Pour optimiser les performances des agents de santé communautaires, augmenter les revenus, et assurer la pérennité des programmes communautaires, il sera nécessaire de mener une étude de recherche opérationnelle sur le meilleur mode d\u27association ou d\u27intégration des produits de planification familiale et de santé dans ces programmes dans le contexte social sénégalais. --- The Division of Reproductive Health (DSR) of the Senegal Ministry of Health and Social Action, in partnership with the Population Council’s FRONTIERS in Reproductive Health program and Management Sciences for Health, conducted a study to determine the acceptability and feasibility of two alternative community-based service delivery models in terms of their efficiency, performance, and cost-effectiveness. The general objective of this study was to contribute to the development of an integrated cost-effective program to increase the accessibility and availability of reproductive health information and services in rural areas of Senegal. The DSR sees the development of community-based service delivery models as essential for the future of health care in Senegal. The report concludes that neither model proved particularly successful in terms of increasing knowledge, attitudes, and use of family planning compared with the comparison site. To maximize the performance of the community health workers, increase revenues, and ensure the sustainability of the community-based programs, it will be necessary to conduct an operations research study on the best mode of association or integration of family planning and health products into these programs in the Senegalese social context

Comment promouvoir l\u27utilisation des résultats d\u27une analyse situationnelle à l\u27échelle nationale: Expérience du Sénégal

Avec cette dissémination des résultats de l’Analyse Situationnelle (AS) de 1998 le Ministère de la Santé réalise la troisième activité de ce genre. Au sortir de la dissémination, plusieurs enseignements sont tirés: Une bonne préparation de l’activité est nécessaire et, dans ce sens, la place de l’atelier de planification et l’établissement concerté d’un calendrier des activités par les niveaux national et régional sont prépondérants. L’organisation pratique des ateliers de dissémination doit compter avec l’utilisation des professionnels de la santé des régions et des médias locaux. Cette initiative a permis de crédibiliser les résultats ce qui a favorisé leur appropriation par les autorités médicales. Les quelques limites qui peuvent entacher la dissémination régionale des résultats de l’AS de 1998 portent principalement sur la durée d’un jour-atelier, qui peut compromettre une bonne analyse des résultats et la formulation de recommandations pertinentes de la part des régionaux, et la petite taille des échantillons régionaux qui peut compromettre l’appréciation de la qualité des services. --- This dissemination of findings from the 1998 Situation Analysis (SA) on Reproductive Health Service Delivery Points constitutes the third such activity organized by the Senegal Ministry of Health. The report lists several lessons learned after this dissemination of findings: good planning is essential, especially the workshop location and the creation of a detailed activity calendar at the regional and national levels. The practical organization of the dissemination workshops should involve health professionals in the regions as well as the local media. This initiative improves the credibility of the SA results and facilitates their utilization by medical authorities. The few limitations of the 1998 SA results\u27 regional dissemination are related to the duration of the one-day workshop, which can compromise a good analysis of the findings as well as formulation of relevant recommendations by the regions. Also, the small size of the regional samples can weaken conclusions regarding the quality of services

Improving quality of care and use of contraceptives in Senegal

In the 1990s, the government of Senegal implemented a series of policy changes for the provision of family planning services through the public sector. A strategy to provide high quality services through reference centres was adopted. This paper presents findings from a longitudinal survey of 1,320 Senegalese women who had sought family planning services at ten public sector facilities—five reference centres and five health centres. Information was collected on the quality of care they received at the time they adopted family planning. One thousand one hundred and ten of the respondents were followed up sixteen months later to ascertain their contraceptive status. The first principal finding was that attendees at reference centres reported receiving relative better care than those who attended health centres. On average, clients at reference centres received 4.3 out of five units of care, compared to 3.8 units as reported by health centre clients. Second, multivariate analyses indicated that quality of care received at the time of adopting a contraceptive has a significant influence on subsequent contraceptive use. Those who received good care were 1.3 times more likely to be using a method than others

L\u27Approche de l\u27Analyse Situationnelle pour l\u27évaluation des services de planification familiale et de santé de la reproduction: Manuel de recherche

Une bonne prestation de services de planification familiale mettant l\u27accent à la fois sur l\u27accès et la qualité est la clé des objectifs interdépendants de satisfaction des besoins individuels et la réalisation du succès programmatique. L\u27analyse de situation (AS) fournit un lien nécessaire entre le responsable de programme et la cliente qu\u27il essaie de servir. Les données recueillies par l’AS offrent une image représentative du fonctionnement des composantes et permettent de «voir» l\u27expérience de la cliente. Les analyses situationnelles aident le responsable de programme à atteindre le plus grand but en termes de gestion—celui d’une administration efficace d\u27un service de soins de santé vital; tout en gardant fermement le regard fixé sur l\u27ultime but—fournir des soins de qualité aux individus qui les sollicitent. Le manuel «L\u27approche de l\u27analyse situationnelle pour l’évaluation des services de planification familiale et de santé de la reproduction» est un outil pour aider à la mise en œuvre des études AS. Certaines des sections pourraient être utiles et intérresantes pour les décideurs et les responsables de programmes, d\u27autres pour les chercheurs, et encore d\u27autres pour les enquêteurs de terrain. Le manuel comprend quatre chapitres: la méthodologie de l\u27étude de l\u27analyse situationnelle; exécution de l\u27étude; instruments et guides question par question; et analyse des données et rédaction des rapports. --- Good family planning service delivery emphasizing both access and quality is key to the related goals of satisfying individual needs and achieving programmatic success. Situation Analysis (SA) provides a needed link between the manager and the client he or she is trying to serve. The data marshaled for SA offer a representative picture of how subsystems are working and provide a way to “see” the client’s experience. Situation Analyses assist managers in achieving the broadest management goal—that of efficient administration of a vital health care service while keeping in view the ultimate goal—providing good care for those who seek it. “The Situation Analysis Approach to Assessing Family Planning and Reproductive Health Services” handbook is a tool to help implement SA studies. Some of the sections are more valuable for policymakers and program planners, others for researchers, and still others for field interviewers. The handbook consists of four chapters: The Situation Analysis Study Methodology; Conducting the Study; Instruments and Question-by-Question Guides; and Data Analysis and Reporting