Quality makes a difference: Experiences from family planning services for the urban slum population in Bangladesh

Increasing access to quality family planning (FP) services for the urban slum population is of increasing demographic importance because the slum population is the fastest growing segment of urban populations. In urban slum areas NGO clinics provide services, but these clinics have often been on the fulfillment of the quantitative targets. A recent urban health survey has observed that half of the method acceptors are using pills, one-fourth injectables, and almost one in fifteen clients adopted sterilization. Effective programs to address the imbalance in the contraceptive method choice have not been implemented. Further, the NGO clinics are not widely used for obtaining FP methods as less than one-fourth clients obtain FP methods from these clinics. In this context, an operations research study is being conducted to enhance quality of FP services provided by NGO clinics in urban slums. A quasi-experimental separate sample pre-test post-test design is being used. Pre-intervention information on quality of services was collected through 495 exit client interviews and 100 observations of client provider interactions. The evaluation phase will use the same instruments. The study implements three broad interventions: capacity building of service providers; strengthening service delivery points; and improving counseling services. Process indicators suggest that informed counseling increases use of more effective contraception. Further, the introduction of systematic screening procedure helps the service providers to identify unmet needs of clients and provide services during the same visit. Findings also suggest increased satisfaction with the services among clients.