This multi-method qualitative study assesses the effects of a major programmatic reorientation in family planning service delivery currently underway in Bangladesh. The study elicits perspectives of clients and communities as new service delivery strategies are implemented, examining decision-making regarding the use of services, patterns of utilization, client-provider relations, and client satisfaction.
The hallmark of the government's family planning program has been the use of community-based female workers to provide contraceptive information and methods to women in their homes. A new USAID-supported initiative is shifting from domiciliary to clinic-based services and introducing new strategies to improve sustainability and access, and to increase the range and quality of services offered. Service charges have been introduced, providers' skills have been upgraded to support the expanded service package, and staff have been reoriented, based on the idea that their ability to recover costs will depend on their success in attracting clients by offering what clients want, and by putting "quality first."
Our study documents a number of lessons from this program transition about the factors that shape client perceptions of quality. Clients appreciate many aspects of the new service delivery model, including the greater reliability and "orderliness" of the services, and the respect and courtesy shown by programs staff to rich and poor clients alike. But in some contexts the institutional norms of the previous program continue to influence interactions among staff, and between providers and clients, and, thus constrain the implementation of strategies to improve quality.
Learning Objectives: 1. Develop a broader definition of quality which includes the client perspective 2. Assess the effects of service delivery reorientation in Bangladesh 3. Incorporate client perspectives on quality into future program design
Keywords: Family Planning, Quality of Care
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.