Systematic offering of family planning and reproductive health services in Guatemala

Type Journal Article - Guatemala City: INOPAL project report
Title Systematic offering of family planning and reproductive health services in Guatemala
Publication (Day/Month/Year) 1997
Guatemala has one of the lowest contraceptive prevalence rates in Latin America. Only 31% of married women of fertile age use a family planning method, and only 27% use a modern method. Thirty seven percent of women do not want more children and 21.5% do not want one in the following two years. The 218 MOH health centers and 667 health posts provide services to only 3.2% of current contraceptive users (ENSMI, 1995). The unmet need for other reproductive health services is also very large. The main objectives of this project were a) to test the use of a job aid (an algorithm) to help MOH service providers to screen their clients• reproductive health needs, offer the required services and thus, increase the volume of services provided; and b) to test the use of job aids (segmentation forms) to help health volunteers to segment the population according to reproductive health needs, to give them basic messages to help them solve their need for services, and to refer them to services in health posts. A survey of missed opportunities for the delivery of reproductive health services found that these were few in the case of services that the MOH has traditionally emphasized (such as prenatal care and vaccination), but large in the case of family planning: 35% of all women of reproductive age visiting health centers were married, not pregnant, did not want a pregnancy and were not using a method, and 24% of all women said they would like to use a method. The algorithm seems to have been used asystematically in health centers and to have been perceived by health providers as a tool to promote family planning. For this reason, those who used it tended to adapt it for promoting family planning and not the other reproductive health services. In the last nine months of 1996, the health outlets that used the algorithm had 124% more new family planning than in 1995, compared with an increase of 21% in control group outlets. In terms of couple years of protection (CYP), control group outlets decreased their number by 64%, while experimental group outlets increased it by 41%. Partly, these large increases were due to the introduction of injectables during the project period. The differences observed in the case of other reproductive health services (prenatal care, postnatal care and well baby care) were not as consistent as those observed for family planning. These results showed that there is a need to teach service providers to screen their clients• need for reproductive health needs, and that the job aid tested is useful to achieve this objective. Areas of improvement could include an adaptation of the algorithm so that providers perceive it as a reproductive health rather than a family planning tool, as well as the introduction of training and supervision strategies to strengthen the commitment of program managers to the reproductive health program. The results also showed that the segmentation forms could be used to recruit health volunteers to provide basic messages and refer users to health posts. The data suggests that health posts using the forms had a larger increase in the number of new family planning clients than those that did not use them, but that this was not true in the case of other reproductive health services. Given the weak community outreach program in Guatemala, this strategy should be extended through the MOH system. It should also be expanded so that new services can be incorporated in the segmentation forms.

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