A USAID supported initiative with NGOs in Bangladesh is employing a variety of measures to improve the quality of services provided in clinics at the lowest level of the system, to make the services more responsive to clients, and to increase their sustainability. Door-to-door contraceptive distribution has been discontinued and family planning services are now provided as part of a package of essential health services. This paper presents findings from a multi-method, qualitative study which looks at these policy changes from the perspectives of those affected by them. The changes raise questions about the strength and nature of demand for family planning and other health services, and about balancing the goals of cost recovery with the needs of the poorest, most vulnerable groups. If the revised service delivery approaches are to result in more cost effective services and better reproductive health, substantial behavioral changes will be required on the part of clients families and communities, as well as service providers. Social, logistic, and direct costs to families increase when women must go out of their homes for services, and this raises issues regarding how much a particular service is valued by the intended clients and their families, and how much importance women's needs should be given. The paper documents the responses of communities and program staff to the policy changes, and shows how the initial responses are shaped to a large extent by the experiences and norms of the previous family planning program.
Learning Objectives: 1. Describe the changes in FP service delivery in Bangladesh 2. Understand the changes from the client perspective 3. Incorporate client perspective analysis in future program design
Keywords: Family Planning, Quality
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.