Bangladesh has achieved much success in raising the prevalence rate of contraceptives and reducing fertility over the last two decades. Use of community based field workers for doorstep delivery of contraceptives, has been credited as the major contributor to this success. Several thousand field workers were used to provide family planning education and services through regular home visits. However, this approach has been considered ineffective to deliver broad reproductive and family health services and unsustainable due to high cost. As a result, USAID's new population and health program in Bangladesh adopted a clinic based services delivery approach.
Under a cooperative agreement with USAID, John Snow, Inc. (JSI) has designed and is currently implementing a clinic based family health program in the urban areas of Bangladesh, in accordance with USAID's new policy. A one-stop-shopping approach was adopted to deliver a basic package of family health services and a fee for services was introduced in place of free services at the door step. This clinic based service program is implemented by the NGOs who previously delivered free-standing family planning services through field workers. This program is in operation for approximately two years.
This paper will examine the challenges the program is facing in getting the clients to take an active role in their own health care, visit the clinics and pay for services. It will also examine how the shift in strategy has affected the access to services, coverage, and client satisfaction by comparing current project performance with base-line data.
Learning Objectives: 1. Analyze the dynamics of moving from door-to-door to clinic based services 2. Discuss how the changes in service delivery mechanism effected the access to services
Keywords: Access and Services, Quality of Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: John Snow, Inc. (JSI)
United States Agency for International Development (USAID)
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.