Service Delivery Sites Research Articles

Family centres: a focus for the children in need debate

The development of child care policy has been characterized by debates organized along various intersecting constructs such as universal vs. selective services and prevention vs. treatment. Family centres, as a site of service delivery, represent a point of intersection of many of these arguments. Their role is contested between protagonists of all positions within the child care policy debates: whether they should be professionally managed, led by service users, provide a service to referred families, or offer a universal resource for local communities. This paper argues that a needs‐led approach to family centre development may supersede the sterile dichotomies of many of these debates. A case study is presented of an evaluation research project, designed to inform a needs‐led family centre policy for an urban unitary social services department. The methodology utilizes an approach combining quantitative analyses of geographical distributions of family need with qualitative presentation of the perspectives of actual and potential centre users, and agency stakeholders. The outcome is a family centre model which, by focusing on need, seeks to transcend the limited oppositions of the child care debates.

Female Sterilization in Nepal: A Comparison of Two Types of Service Delivery

Outreach camps have played an important role during the past 30 years in making sterilization accessible to rural women in Nepal. In 1996 42% of all sterilization clients (50% of males and 39% of females) received services from camps. Concerns have been raised however about the quality of care in these camps. The present study compared the social and demographic characteristics and sterilization experiences of 445 women who had been contraceptively sterilized in public hospitals and 372 women who underwent the procedure in temporary camps. Study respondents were drawn from a nationally representative sample of 8429 ever-married women who participated in the 1996 Nepal Family Health Survey. Both groups were similar in terms of age and parity at the time of sterilization and educational attainment but camp patients were more likely to be rural and from the Terai plains region. 80% of hospital and 82% of camp clients reported that sterilization was the first contraceptive method they had used. 12% of women who underwent sterilization in hospitals and 10% who received the procedure in camps expressed post-sterilization regret but this outcome was unrelated to attributes of the service delivery site. These findings suggest that camps do not imply less careful screening of sterilization clients or an inferior quality of services. Rather they appear to represent an important means of meeting couples demand for sterilization services in rural areas where hospital- or clinic-based services are not available throughout the year.

Informed Choice and Decision-Making in Family Planning Counseling in Kenya

This study analyzed client interviews and observations of interactions between female family planning (FP) clients and staff from clinic and community-based providers in Kenya. Audiotapes were made of 176 counseling sessions over a 9- to 15-day period in 1993 at 17 service delivery sites: 24 community-based distributors (CBDs) and 37 clinics. The authors identified four key processes that assure informed and knowledgeable decision-making about FP: understanding personal circumstances considering alternatives choosing the best option and implementing the decision. Specific client and provider behaviors were associated with each of the preceding four steps in decision-making. Findings were aggregated per counseling session. 88% of clients were aged 20-34 years. Providers had an average of 7 years of FP experience. 78% of providers were nurses and the rest were doctors and counselors. Data on contraceptive methods was available for 153 women of whom 59 left with pills and 41 left with injectables. The 25 remaining women were asked to return after completion of menses. New clients left more often with condoms or foaming tablets. Findings suggest that FP staff can play a more active role by relating contraceptive information to a womans personal circumstances and by assisting women in considering options. Information on reproductive and marital history was collected in only 60% of the counseling sessions. Only 55% of counseling sessions asked continuing users about side effects. Sessions included discussions about four methods with new clients and two methods with continuing clients.

Using situation analysis to assess women's perceptions of quality of maternal-child health and family planning services

Situation analysis is one method of measuring the quality of health services and was developed to assess the readiness of family planning service delivery sites to provide quality contraceptive services. Although situation analysis has also been used to describe the quality of contraceptive services delivered, the information ithas been able to provide to date is more limited. Using mainly the example of three studies ofmatemal-child health and Family planning services in Botswana, Tanzania, and Kenya, this paper describes how the methodologyis used and its strengths and limitations for assessing quality of non-contraceptive reproductive health services. These include the costs women have to pay, privacy, provision of information to women and other inter-personal interactions, provider performance and training, and women's satisfaction with services. VVhile situation analysis could benefit from several improvements, its primary role should continue to be highlighting broad areas of deficiency in quality of service provision, to which other, more specific instruments can be applied to gain in-depth information.

Schools as Health Service Delivery Sites: Current Status and Future Directions

Summary The health of our nation is inextricably linked with the health of our children. While families and professionals alike have recognized this truth for decades, current social reform movements in education and health services have provided an unprecedented opportunity for schools to become equal partners in addressing the needs of children, families, and communities in a wholistic, boundary-free, and collaborative manner. Since schools are the one social institution with which every child has contact, they offer a natural environment for assessment, services, and follow-up to promote the convergent education and health agendas articulated in Goals 2000 and Healthy People 2000. This article examines the components of education and health care reform with particular attention to a recon-ceptualization of health care services in schools. Within this framework, special services professionals are highlighted as leaders in service coordination and delivery for students, staff, and the community at large.

Tax exempt financing for nonprofit mental health organizations

Some nonprofit mental health organizations are buying real estate in order to own service delivery sites and to provide housing for clients. Owning real estate generally requires long-term financing to conserve cash. This article explores tax exempt financing methods available to nonprofit mental health organizations.

Modelling Effectiveness-Equity Trade-Offs in Public Service Delivery Systems

Distributional equity is a particularly salient objective in public sector decision making, in general, and decision making concerning the delivery of public services such as education, libraries, sanitation, and public safety, in particular. In this paper two related bicriteria mathematical programming models are developed for identifying the trade-offs between overall output (effectiveness) and equity that result from alternative allocations of service resources among different service delivery sites (branches). The models developed here incorporate equity in a more satisfactory manner than have previous efforts. An illustrative application of the models to the allocation of new books among the branches of a public library system is presented.

Obtaining Parental Perceptions of the Quality of Services for Children with Special Health Needs

Analyzed responses from 295 parents across two service delivery sites to identify specific factors of satisfaction. Although General Satisfaction accounted for most variance, Clarity of Communication, Preappointment Wait and Information, and Clinic Efficiency were also identified as factors. Results are discussed in the context of a collaborative relationship between parents and providers. A shortened questionnaire that efficiently taps these areas of satisfaction is appended.

CMHC's and elderly services: an analysis of direct and indirect services and service delivery sites.

This study identified significant sources of variability in the utilization of CMHC services by the elderly. Program and staff specialization were examined as they critically influenced the rate of service utilization as well as the types of services made available. Data from a 1984 national survey of CMHC's were analyzed and statistically significant differences were found in overall utilization, types and amounts of direct and indirect services, and number and types of separate service delivery sites. These results suggest that variability in services utilization may be attributable to programmatic differences between CMHC's and may constitute a significant aspect of services designed to address the special needs of the elderly.

Contraceptive Prevalence in the Slums of Rio de Janeiro

A community-based family planning operations research project was undertaken in selected low income communities of Rio de Janeiro; project field work began in February 1982. Prevalence data were collected and service delivery strategies were tested, including home visits promoting family planning, home distribution of condoms, and the introduction of community family planning depots. A high baseline contraceptive prevalence rate (CPR) of 70.1 percent was found for nonpregnant women currently in union, as well as substantial use of the private sector for contraceptive supply, despite the presence of free or subsidized sources within the communities. However, the most economically disadvantaged subgroups made the greatest use of the subsidized sources. The provision of additional service delivery sites may have contributed to a small increase in contraceptive prevalence noted over the life of the project; however, the high baseline CPR precluded a large increase in contraceptive use as a result of the program.