Reproductive Health

Social Franchising of Sexual and Reproductive Health Services in Honduras and Nicaragua

This document outlines the outcome of three franchising projects implemented by Partners of Marie Stopes International (MSI) in Honduras and Nicaragua. The projects were designed to pilot full and partial social franchising models as part of an initiative to test and develop alternative forms of delivering quality sexual and reproductive health (SRH) services by a non government organisation (NGO). [abstract]

Creating Conditions for Greater Private Sector Participation in FP/RH: Benefits for Contraceptive Security

Contraceptive security requires comprehensive and integrated approaches that go beyond the public sector. Private sector involvement is critical not only in helping respond to growing market demand but also in ensuring equity in the contraceptive market. Redirecting well-off clients to the private sector will free up scarce donor and public resources for those most vulnerable and in need. Governments and donors cannot mandate private sector expansion and roles; however, they can create favorable conditions that induce private providers to enter the FP/RH market. [author’s description]

Introducing Client-Centered Reproductive Health Services in a Pakastani Setting

Typically, provider–client interactions are brief, and providers often behave condescendingly toward clients. As a result, clients are unable to express their concerns or describe the limitations they face in trying to implement the providers’ suggested course of action. A training intervention was developed for providers that focused on addressing the problems inherent in this dynamic. This research was undertaken to assess whether providers in the experimental area delivered services in a different manner than they had prior to the training intervention. [adapted from author]

Quality of Care Management Center in Nepal: Improving Services with Limited Resources

This working paper evaluates th success of the Quality of Care Management Center in Nepal and highlights the fact that even in resource-poor settings, quality of care in health service delivery can be achieved. This model for a quality of care center that provides timely, appropriate, and ongoing support to clinical facilities may be especially useful in countries where centralized systems are in place for allocation of resources or where maintenance and supply capacity is limited to central locations.

Ensuring Privacy and Confidentiality in Reproductive Health Services: a Training Module and Guide

This [training] guide considers the constraints to protecting privacy in low-resource settings and provides an evidence-based rationale that services will be more effective if resources are invested in ensuring the privacy rights of clients. [This guide] is designed to enable clinic staff, service providers, and supervisors to better support and protect the right of clients to privacy and confidentiality.

Increasing Access to Reproductive Health Services Through Pharmacists

This issue of Outlook explores the role of pharmacists and non-pharmacist counter staff in primary health care, with a specific emphasis on reproductive health. It also presents programs that build the capacity of pharmacists to provide expanded services, thus improving access to quality reproductive health services. [author’s description]

Strategies for Building RH/FP Champions: the Role of Private Midwives

This presentation was part of the 2006 Global Health Mini-University. This session will provide an overview of factors that support or constrain the delivery of expanded services by midwives. It will discuss successful case studies to build sustainable practices. This includes a program to promote business training and access to financing to grow and improve private midwife practices in the Philippines. Presenters will also discuss the use of networks for private midwives for service expansion, quality improvement, and sustainability in Kenya. [adapted from publisher’s description]

Coping with Crisis: How to Meet Reproductive Health Needs in Crisis Situations

People caught in crisis situations have crucial reproductive health needs. The needs of pregnant women are most urgent. Complications of labor and delivery can be life-threatening when women lack adequate care. Risk for HIV/AIDS, other STIs, and unwanted pregnancy increases, particularly when disorder provides cover for rape and other sexual coercion. Health care providers understand people’s needs and have experience meeting them, but few have worked in humanitarian relief.

Client-Centered Approach to Reproductive Health: a Trainer's Manual

This manual provides useful information to help the trainer conduct a training program in the client-centered approach to reproductive health. In addition to the modules covering the step-by-step activities that will help participants master different concepts, the information presented ranges from a practical listing of the tools required to short presentations on topics that the trainer will want to be familiar with during the training. [from introduction]

Improving Reproductive Health through Community-Based Services: 25 Years of Pathfinder International Experience

Over the past 25 years, Pathfinder has learned many lessons about what makes community-based programs thrive. Outlined in this report are some of the lessons learned and examples of how these programmatic concepts are integrated into our work. [from introduction]

This report discusses issues such as compensation for community health workers, building partnerships, and alternate service delivery options.

Quick Investigation of Quality (QIQ): a User's Guide for Monitoring Quality of Care in Family Planning

This user’s guide contains materials needed to design and implement the Quick Investigation of Quality (QIQ) in a given country. QIQ refers to the set of three related data collection instruments designed to monitor 25 indicators of quality of care in clinic-based family planning programs. This volume includes an overview of the QIQ (including objectives, short list of indicators, and methodological and ethical issues), guidelines for sampling and training of field personnel, instruments and guidelines for data collection and summary results from short list of indicators (tabular and graphic forms).

Advancing Reproductive Health and Family Planning through Religious Leaders and Faith-Based Organizations

Pathfinder has provided community-based family planning and reproductive health services to women and men throughout the developing world for over 50 years. Partnerships with local governments and Nongovernmental Organizations (NGOs) allow Pathfinder access into communities to provide information and services. These local organizations provide a solid, established network through which Pathfinder reaches people. Faith-Based Organizations (FBOs) are a vital extension of this network. [author’s description]

Costs of Reproductive Health Services Provided by Four CHAG Hospitals

The Christian Health Association of Ghana (CHAG) is a large faith-based NGO which currently serves an estimated 35 percent of the Ghanaian population, mainly in remote rural areas. CHAG’s financial sustainability is threatened due to declining donations from missionary groups and donor agencies, uncertain support from government, and low cost recovery in member facilities. Although knowledge of costs is essential to program management, CHAG members had no information on the costs of the services they provided. Thus, CHAG had no economic benchmarks for evaluating efforts to control costs, no denominator for calculating cost recovery for different services, and no empirical data on service costs that could be used to approach donors and the Ghanaian government with requests for funding.

Make Better Use of Provider Time in Public Health Clinics

Concern about increasing demand for reproductive health 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. Evidence from reproductive health programs across developing countries suggests that service providers are often underutilized. [author’s description]

Defining a Performance Improvement Intervention for Kenya Reproductive Health Supervisors: Results of a Performance Analysis

The competency-based approach used in JHPIEGO-supported training improves performance by ensuring that trainees go back to their worksites with the knowledge and skills required to provide FP services. Once back at the workplace, however, participants often face constraints that limit their ability to provide quality services. Factors that can affect the performance of the healthcare provider include: job expectations, performance feedback, supplies and equipment, motivation, possessing the knowledge and skills to provide services, and supervision.

Evaluation of the Institutionalization of Family Planning/ Reproductive Health Inservice Training in Bolivia

Beginning in 1992, JHPIEGO worked in close collaboration with the Bolivia Ministry of Health (MOH) to develop an integrated family planning/reproductive health (FP/RH) training network throughout the country. The focus of the assistance was the establishment of nine national training centers (NTCs) for inservice training conducted by physician-nurse teams and located at departmental maternity hospitals in departmental capitals. By 2000, the government of Bolivia and other stakeholders had shifted the training emphasis to preservice education efforts.

Establishing Integrated Family Planning/Reproductive Health Preservice and Inservice National Clinical Training Systems in Turkey

JHPIEGO has been working since 1991 to support the development of a national integrated clinical training system used for both family planning/reproductive health (FP/RH) preservice education and inservice training in Turkey.

Institutionalization of Reproductive Health Preservice Education in the Philippines: An Evaluation of Programmatic Effort, 1987-1998

From 1987 to 1998, JHPIEGO, through its Training in Reproductive Health (TRH) Project, collaborated with the Association of Deans of Philippine Colleges of Nursing (ADPCN) and the Association of Philippine Schools of Midwifery (APSOM) to strengthen preservice nursing and midwifery education in the Philippines. Between 1987 and 1994, JHPIEGO initiated activities to strengthen family planning/reproductive health (FP/RH) and enhance trainer/faculty development in five nursing schools and five midwifery schools.

Matched Case-Control Evaluation of the Knowledge and Skills of Midwives in Ghana Two Years after Graduation

JHPIEGO’s strategies for strengthening Ghanaian preservice education in family planning/reproductive health and essential maternal and neonatal care have included: developing and implementing a standardized, competency-based curriculum; improving knowledge and skills of tutors and clinical trainers/preceptors; reinforcing service delivery sites used for clinical practice; and providing schools and clinical training sites with anatomic models and supporting training materials. [adapted from author]

Performance Improvement: Developing a Strategy for Reproductive Health Services

During the past several years there has been a global trend in business and industry to move from training to performance improvement. This paper presents a review of selected performance improvement and training literature that has been helpful to JHPIEGO in identifying issues related to this trend and in shaping our performance improvement strategy. [author’s description]

Establishing a Nursing Student Learning Center for Women's Reproductive Health in Nepal

The goal of this paper is to describe the establishment of a self-sustaining Student Learning Center (SLC) employing humanistic anatomical models to aid in the teaching of family planning and reproductive health clinical skills to nursing students in Nepal.

Managing Reproductive Health Services with a Gender Perspective

The roles that women and men play should guide the ways in which clinic staff assess their clients’ needs and provide care. This edition of The Manager shows how awareness of gender issues can improve the design, mangement, and delivery of health services, and takes you step by step through the process of assessing the influence of gender on organizational management. [editor’s description]

High-Performing Reproductive Healthcare Facilities in Kenya: Why They Exceed Expectations

This report summarizes findings from Phase 2 of a two-phase case study to determine why certain reproductive healthcare facilities in low-resource settings perform better than others. The study examined the characteristics, behaviors, and coping strategies of high-performing reproductive healthcare facilities in Kenya, exploring elements of resilience and factors influencing performance.

Making it Happen: Using Distance Learning to Improve Reproductive Health Provider Performance

This publication is for training managers, trainers of health providers, decision-makers, and those who fund and support training actvities. It examines distance learning as an effective training approach for reproductive health providers in developing countries. In addition to describing the components of distance learning, this publication will provide illustrative examples for training health workers, outline steps for starting a distance learning program and suggest additional resources. It will help readers plan and implement effective distance learning. [author’s description]

Performance Improvement

The Performance Improvement approach gives organizations the tools they need to find out which essential components of good performance are missing, and then match interventions to root causes, closing the gaps between the performance they are experiencing and the performance they desire.

This document is in English, French and Spanish.

Facilitative Supervision: a Vital Link in Quality Reproductive Health Service Delivery

AVSC defines facilitative supervision as an approach to supervision that emphasizes mentoring, joint problem solving, and two-way communication between the supervisor and those being supervised. This definition recognizes that supervisors play an essential role as intermediaries who can facilitate the implementation of institutional goals and who can facilitate local-level problem solving and quality improvement.

Operations Research to Improve Financial Sustainability in Three Bolivian NGOs

Many NGOs providing reproductive health (RH) services are facing reductions in donor funding, requiring them to generate more of their own resources. Prosalud, CIES and APSAR, Bolivian NGOs, wanted to build skills in costing and market research to support efforts to improve financial sustainability. Staffs attended a one-week workshop, followed by implementation of three operations research (OR) studies designed to reinforce skills and generate information for decisionmaking. The Prosalud and CIES studies included the calculation of unit cost per service; measurement of client willingness to pay (WTP) higher prices for services, and a market segmentation assessment in selected areas where Prosalud clinics are located.

Cost Analysis of Reproductive Health Services in PCEA Chogoria Hospital, Kenya

Presbyterian Church of East Africa (PCEA) Chogoria Hospital is a faith based non-governmental organization providing a wide range of healthcare services. The organization faces a number of challenges related to sustainability: declining donor support (especially for reproductive health services), low cost recovery levels, and increasing poverty levels among its clientele. In response to these concerns, a team from Chogoria Hospital attended a one-week workshop held in Ghana on financial sustainability and developed a small scale operations research project to determine the cost of providing a selected number of reproductive health (RH) services and to evaluate their cost recovery levels.

Intersection of Gender, Access and Quality of Care in Reproductive Services: Examples from Kenya, India and Guatemala

This paper describes the experiences of three types of programs (government, reproductive health NGO, and women’s health NGO) in Kenya, India, and Guatemala that integrate gender in their work and examines how they integrate gender into programs that improve quality of care and access to care. It should be emphasized that this report does not document whether gender integration results in higher quality and access, but rather documents how gender integration can take place. [author’s description]

Managing Programs to Maximize Access and Quality: Lessons Learned from the Field

This paper focuses on lessons learned about building quality improvement into service delivery programs. Addressed to the program leaders and donor agencies that allocate resources for service delivery programs, the paper offers guidance on the actions that must take place to improve the quality of reproductive health and child survival programs. This guidance is based on the field experiences of members of the Management and Supervision Subcommittee of the MAQ Initiative. [publisher’s description]