Family Welfare Centres Research Articles

The quality of care provided at union health and family welfare centres in Bangladesh: Clients’ perspectives

The Government of Bangladesh attempts to provide reproductive health services that emphasize maternal and child health (MCH) and family planning at different service delivery tiers through a variety of service providers. For this purpose, it has established an extensive network of reproductive health services that reaches almost every village in the country. Female field workers, known as family welfare assistants (FWAs), work at the grassroots level and provide information and counselling on various aspects of reproductive health and refer clients when necessary to clinics. They also distribute oral contraceptives and condoms at the homes of married women of reproductive age, identify pregnant women and refer them to static points of service delivery, i.e. health and family welfare centres, for ante-natal care and for obtaining clinical contraceptives.

Management of reproductive tract infections in rural Bangladesh.

This study was undertaken to identify existing reproductive tract infection (RTI) treatment practices of the government family planning (FP) paramedics in rural Bangladesh. It also assessed the knowledge and perceptions of the clients about RTIs as well as the service-seeking behaviour of the clients and their husbands. Data on paramedic treatment practices were collected by observing paramedic-client interactions at the family welfare centres (FWCs) and satellite clinics (SCs). One hundred clients seeking RTI treatment were observed. The same clients were interviewed at departure from the health-care facility to assess their knowledge and perceptions about RTIs as well as service-seeking behaviour of the clients and their husbands. Twenty-four village practitioners were also interviewed to assess their knowledge on the subject. Results of the study showed that in the treatment of RTI, paramedics of government FP services commonly: (i) did not do a physical examination, (ii) used a substandard dosage of drugs, and (iii) made no attempt to notify or treat male partners. Thirty-one of the 97 clients reported that their husbands had some kind of genital problem. It was revealed from the study that as an alternative to the government FP services, the clients and their husbands often seek RTI treatment from the village practitioners though the village practitioners' knowledge concerning RTI is poor. Based on the findings of this study, it is recommended that the knowledge and skills of the paramedics and village practitioners for RTI treatment be strengthened. Prevention of RTI through awareness campaigns is essential for the control of RTIs, and especially of STDs.

Utilisation, Excess Capacity, and Performance of Family Welfare Centres in a District of Punjab

The Eighth Five-Year Plan has allocated Rs 9.1 billion to the Population Welfare Programme (PWP) which constitutes 0.5 percent of the total plan size of Rs 1700.5 biIlion (in 1992-93). During 1992-93, a total of Rs 828.9 miIlion was allocated to PWP, of which 85 percent was reported to be utilised, which amounts to Rs 702.87 million. Service delivery of family planning is a major focus and component of the PWP. The major service delivery sources include Family Welfare Centres (FWCs) in both the government and NGO sectors, Mobile Service Units (MSUs), Reproductive Health Services (RHS), Village-based Family Planning Workers (VBFPW), Hakeems, and Private Medical Practitioners, etc. All sources of delivery of family planning during the three decades of programme efforts have achieved the maximum extent of effective coverage, estimated to be between 15-20 percent in early 1990s but no more than 5 percent to rural population [Rukanuddin and Hardee Cleveland (1992)]. Besides limited coverage, the low level of accessibility and limited contraceptive availability, particularly to rural populace, have also seriously affected the performance of the PWP. These concerns have been addressed in the Eighth Five-Year Plan, which aims at increasing the urban coverage from 54 percent to 100 percent and the rural coverage from 5 percent to 70 percent. The major mode of service delivery to increase the rural coverage is the ViII age-based Family Planning Worker (VBFPW) scheme that would offer FP services to approximately 12000 villages. This scheme, however, focuses on non-clinical and temporary methods only.

A Situation Analysis of Public Family Planning Service Delivery in Pakistan

A nationally representative sample of 8 percent of the Government of Pakistan's primary family planning service facilities, the Family Welfare Centres (FWC), was carried out at the request of the Ministry of Population Welfare in mid-1992. The "situation analysis" approach used involved: 1) observation and inventory of services, facilities, supplies and record keeping reviews; 2) observation of interaction between service providers and FP clients at FWC's; 3) interviews with service providers; and 4) exit interviews with FP clients after service provision. This one-day on-site observation by teams of three interviewers provided a unique overview and baseline assessment of the availability of services, the staff functioning and the quality of service. Significant findings include a low caseload, inadequacies of facilities, some stockouts, lack of educational materials, insufficient outreach, unnecessary medical and social barriers to providing contraception as well as in some cases insufficient information to clients about contraindications to contraceptive usage and possible side-effects. The need to bolster in-service training and supervision is emphasized.

Information, Education and Communication Needs in Family Planning: The Case of Pakistan

In spite of three decades of national family planning programmes, Pakistan's contraceptive prevalence rate was only 12 percent in 1991. Furthermore, the government family planning service delivery systems, primarily the family welfare center (FWC), cover less than 10 percent of the people in rural areas. Although there are cultural and religious constraints to social change, it can be argued effectively from recent surveys that there is a considerable need for family planning that has yet to be met. Certain barriers to, and options for, meeting this need are reviewed, particularly in terms of strengthening information, communication and education (IEC) at the community level.

Family Welfare Programme

Tamil Nadu is the first Indian State to recognize the basic relevance of family planning to national planning. It was given national awards for outstanding work in family planning for every year except 1964 from 1961 to 1967, and from 1973 to 1976. Family planning activity was initiated in large maternity hospitals as a postpartum program. The Medical Termination of Pregnancy Act was first implemented in Tamil Nadu. 141 institutions have been certified for the operation. An oral pill program is being implemented in all the rural and urban family welfare centers including the hospitals. The family welfare program has been fully integrated with the Maternal and Child Health (MCH) program which has created confidence among people that their children will be protected from health hazards. The MCH Schemes are conducted through primary health care (PHC) centers, urban family welfare centers, MCH centers, hospitals, and dispensaries. Dais are trained to improve the techniques of midwifery and aid delivery in a hygienic manner. Dais can also use their influence in the local community to further family planning. It is proposed to establish additional subcenters in selected districts to average 1/center/5000 population. The government continues to sponsor and fund equipment, facilities, and infrastructure to facilitate sterilization operations in primary health centers.

Health service resources as determinants of infant death in rural Bangladesh: An empirical study

Using empirical data collected from a rural area of Bangladesh, this paper examines the relative importance of availability of health care resources on infant death. Following many health care studies, this paper hypothesizes that the likelihood of infant death is a function of accessibility to different types of health facilities and personnel. Both univariate and multivariate analyses of data indicate that the distance to a qualified physician of Western medicine exerts significant influence on infant deaths. Other variables considered are distance to Upazila Health Complex (UHC), Family Welfare Center (FWC), and non-qualified doctors.

B. An Evaluation Study of a Health Education Programme for Rural Women in Bangladesh

In the 1980s, 21 Health and Family Welfare Centres (HFWC) in Munchiganz district in Bangladesh extended health and family planning services and health education to satellite clinics in private homes. A family welfare visitor (FWV) would visit each clinic 2 times/week to conduct health education sessions and treat patients. HFWC also promoted 70 mothers' clubs to promote small family size. Some mothers' clubs even provide basic health services. In March 1985, HFWC designed a study to evaluate the effectiveness of its health education component. Interviews and observations constituted the methodologies used. Interviewers and staff who were to observe health education lessons attended an introductory workshop in which they designed questionnaires. Next participant conducted 1-2 interviews while doing their regular work to pilot test the questionnaires. They then went to another workshop where they received feedback and discussed problems before the main evaluation. The study coordinator made spot check observations while interviewers spoke with women after a session on safe childbirth or diarrhea. The coordinator also held weekly meetings with the interviewers to identify problems and maintain a common base. HFWC managers used the study results to design and implement a simple monitoring system, manageable by supervisors, and others in the same or in a similar position. A very important lesson learned was that any monitoring system should not disrupt the routine of regular supervisory work or the already tight working schedules. The system should be uncomplicated so supervisors can easily monitor the health education component. Finally monitoring standards need to be founded on a common understanding and feedback between planners and health educators.

Discriminant Analysis as a Method for Differentiating Potential Acceptors of Family Planning: Western Samoa

This study used discriminant analysis as a method for identifying characteristics that differentiate potential acceptors of family planning in Western Samoa from those who are unlikely to be receptive to modern methods of fertility control. The survey was conducted in 1979 at the Family Welfare Center in Apia Western Samoa. The 90 respondents ranged from 17 to 46 years of age (mean age 26 years). Respondents were interviewed regarding their knowledge attitude and practices in the areas of fertility and family planning child care nutritional practices and medical issues. The discriminant analysis was aimed at identifying the criterion variables that would classify women as modern vs. traditional. Women who cited no more than 3 children as their ideal family size were considered modern whereas those who desired more than 3 children were regarded as traditional. The following composite portrait of the modern woman emerged from the analysis: 1) she is relatively young 2) she has access to a car owned by her family 3) she has several relatives living or working overseas 4) she has attended some high school 5) she believes that a doctor should be seen early in pregnancy and 6) she is aware of some modern method of fertility control. It is estimated that family planning interventions based on these variables will be correct in 75% of cases: women who meet these criteria are likely to be receptive to acceptance of modern methods of contraception. Women who meet the description of traditional women are likely to require extensive education before accepting family planning. This model should be a valuable adjunct for health workers.

Book Reviews

Book reviewed in this article:On Being a Parent of a Handicapped Child: By Benjamin Spock The Mentally Retarded Child and His Parent: By Stella Stillson Slaughter Family Welfare Centre: By Nancy Lingard, Margaret Platt and Barbara Oldham Hobbies for the Housebound By Brenda Morton Growing Up By Mildred Shriner More Than Fun: A Handbook of Recreational Programming for Children and Adults with Cerebral Palsy By Sylvia B. O'Brien Clinical Neurology By Lord Brain The Child with a Handicap Edited by Edgar E. Martmer The Tutoring of Brain‐injured Mentally Retarded Children By James J. Gallagher Early Identification of Emotionally Handicapped Children in School By ELI M. BowerQueen Square and the National Hospital

Family Welfare Centres in Manchester

Family Welfare Centres in Manchester