Comprehensive services at Fabella Center

The Jose Fabella Memorial Hospital Comprehensive Family Planning Center was the 1st family planning center to conduct minilaparotomy in the Philippines. It was also the 1st center to conduct research on family planning and to offer training in family planning to nurses, doctors, midwives, and medical students. The center is funded by the Philippine government with about 85% of hospital funds going to salaries of the staff. Supplementing the funding are medicine, equipment, and subsidies for sterilization given by the Commission on Population (Popcom). Research on chemical sterilization requires patients to take oral contraception (OC) or use the condom while under observation for about 4 months. In the case of female patients, this means until the fallopian tubes have been blocked due to the injection of an opaque solution. The patients are then checked for effects on health, sexual practices, and the regularity of menstruation. Dr. Apelo expects to implement this new sterilization method within 5 years. The center's objective is to support the National Population Program in its effort to reduce the country's population growth rate and promote family welfare. When the center was started, it occupied only 1 room of the hospital and was staffed by 1 full time doctor, 4 nurses, 4 midwives, 2 social workers, and 3 support staff. After 1 year of operation, the center recruited only 75 family planning acceptors. Information about the center's family planning services spread solely by word of mouth. During the 1st half of 1982, the center recruited 3490 acceptors of surgical and nonsurgical contraception, representing 96.94% of its 3600 target for the period. Minilaparotomy had the highest number of acceptors, 1742 or 49.92% of the total number of acceptors during the period. This was followed by the IUD with 1356 acceptors, OC, 245 acceptors; and other methods, 147 acceptors. In information and education, the center had 1882 motivational activities consisting of group discussions, ward lectures, field lectures, and mothers' classes. In training, the center conducted 10 courses, representing 100% of its target for the whole year. It trained doctors in performing voluntary surgical contraception and paramedics in assisting doctors in sterilization operations. The training courses were conducted under a subsidized contract with Popcom. The center also offers training in IUD insertion. In research, the center is active in investigating prospects for new contraceptive applications in the Philippine setting.     

NFP promotion in the Philippines: all program components covered

At least 50 of the 105 agencies in the Philippines listed in the "Directory of Agencies with Population Activities" are actively participating in the promotion of natural family planning (NFP). Of these, 40 offer instruction on its use, 22 provide training to clinic personnel or field workers, 19 conduct information/education/communication (IEC) activities, and 6 undertake research. The Population Center Foundation's (PCF's) Information Support to Population Projects (ISP) has prepared a preliminary inventory of programs and projects on NFP, covering some of those that were done in recent years, are being implemented, or have been proposed. Some projects described in the inventory are reviewed. Recent research or research proposals are showhow related, all leading to how the method can be effectively promoted and how couples can be taught its proper use. Instruction on NFP appears in all training activities of Popcom's regional offices, particularly in their refresher courses. Program managers are being trained in managing and monitoring activities to promote the method. In 1980 outreach workers, doctors, nurses, and midwives were trained by Popcom to motivate couples to practice the method and to teach them how to use it correctly. That same year, Popcom's office in the Ilocos region introduced the rhythm dial calendar, a simplified version of the rhythm slide rule. The Ministry of Health National Family Planning Office incorporates natural family planning instruction in its training seminars for the Ministry's health personnel in the regions. As in training, all regional offices of Popcom promote NFP along with other methods that they make available to prospective acceptors. This is in keeping with the program's "cafeteria approach" to family planning. In 1982 Popcom began intensifying the provision of services in NFP, allocating around 4 million pesos to preparations for its effective promotion. In support of service delivery efforts are IEC activities such as the development, production, and distribution of brochures and other reading material on NFP, schoolroom instruction, and lectures. The intensification of IEC efforts in the private sector to promote the modern and scientific techniques of NFP is most clearly evident in a fairly recent seminar sponsored by the Communication Foundation for Asia. Program agencies with activities in natural family planning are listed.     

The population program shifts to 'high-scenario' targets

The Philippine Population Program would like to achieve a replacement level of 1 daughter per childbearing woman by the year 2000 to reduce the population growth rate to 2% by 1992. Laing projected that high performance by the National Population Program would mean continued increase of sterilization prevalence at an average 1978-1983 rate. Strategies have been adopted to strengthen information-education-communication efforts, to attain higher contraceptive prevalence rates and use-effectiveness, to develop manpower, to achieve self-reliance, and to effect better program coordination, monitoring, research use. Effective service delivery will be a key to achieving the high-scenario targets. Effective use of natural family planning (NFP), will help in achieving the high-scenario goals. Apart from the heavy demand on NFP follow-up, need for prompt delivery of supplies, and lack of doctors and nurses, other factors may impede the high-scenario targets. Saniel believes that program workers should be allowed to insert IUDs and to dispense pills. Under the cost-recovery and cost-sharing schemes of the high-scenario targets, only sterilization will be done for free. It might affect the campaign for increased acceptors, but the start for self-reliance must happen now.     

Bangladesh

In Bangladesh the Population Control and Family Planning Division of the Ministry of Health and Population Control has decided to delegate increased financial and administrative powers to the officers of the family planning program at the district level and below. Currently, about 20,000 family planning workers and officials are at work in rural areas. The government believes that the success of the entire family planning program depends on the performance of workers in rural areas, because that is where about 90% of the population lives. Awareness of the need to improve statistical data in Bangladesh has been increasing, particularly in regard to the development of rural areas. An accurate statistical profile of rural Bangladesh is crucial to the formation, implementation and evaluation of rural development programs. A Seminar on Statistics for Rural Development will be held from June 18-20, 1980. The primary objectives of the Seminar are to make an exhaustive analysis of the current availability of statistics required for rural development programs and to consider methodological and operational improvements toward building up an adequate data base.     

Satellite outreach in Asia and the Pacific

Communication by satellite is rapidly changing information exchange in Asia, especially for rural areas. The integrated education planned for satellite networks includes family planning as part of general development. A series of conferences has already been held successfully via satellite for family planning associations who are members of the East and Southeast Asia and Oceania Region of the International Planned Parenthood Federation. These included a conference on nursing training. In India the Satellite Instructional Television Experiment (SITE) made history during its 1-year trial. By 1981 the entire nation is to be linked by satellite. The question is whether the television education will truly change rural life or whether it will become merely a diversion. In Indonesia, satellites were chosen as the fastest way to obtain interisland communication. The Domsat system links the entire 13,000-island archipelago and is already being used for emergency communications. The system, which was developed in 1 1/2 years by the Hughes Aircraft Corporation will be used for teaching basic health, hygiene, and family planning. It will be several years before Domsat is fully operational, but it bears watching.     

Milk collection,rural development,and a town called Jala-jala

Underdeveloped Jala-jala was selected by the Dairy Training and Research Institute (DTRI) of the University of the Philippines at Los Banos as the pilot area for a program of integrated rural development based on milk collection. The scheme was originally launched in 1967 but only recently has become a fullfledged protram including an evaluation function and in a new baranguay (village), Pagkalinawan, the Milk Collection Program (MCP) was established not just for its own sake but with total development as its orientation. Local farmers are taught how to milk animals and how to maintain proper hygiene and the milk is collected and processed at the DTRI plant. Farmers are paid in cash and in kind. The program has increased family income and improved nutrition. Spinoffs from the program include breeding services to improve productivity of milking animals; the Applied Nutrition Project, which provides both nutritional education and food; a family planning program which has made some headway in motivating acceptors; and a training program for baranguay health workers. Final evaluation is still awaited but the MCP can be considered an initial success.     

Massive drive to reenergize the family planning programme

A massive drive has been launched throughout India in an effort to reenergize the family planning program. The Prime Minister has made a special appeal to the nation from radio and television networks and through the press to adopt the small family norm as a way of life. The Chief Ministers and the Health Ministers in the States have made similar appeals to the people and the doctors. The current drive was preceded by 18 months of concentrated efforts to vitalize the family planning program. The change in nomenclature from "family planning" to "family welfare" created some misunderstanding regarding the government's own commitment to the program, but it is now widely understood that while family welfare aims at the total welfare of the family, family planning is an essential part of it. The government has tried to involve all sectors of society in program efforts. The mass media is now focusing attention on "family welfare" almost continuously. In villages, a large-scale program of organizing education camps of opinion leaders is now underway. The rural health scheme, initiated in October 1977, promises to bring about increased participation of the people in village programs. 54,000 community health workers have already started serving the rural population in their areas. In 2-3 years there will be 1 trained community health worker in every Indian village.     

Fresh impetus to family planning programmes planned in India. APPN interviews Mr. B. Shankaranand Union Minister for Health and Family Welfare,India

Mr. B. Shankaranand, Union Minister for Health and Family Welfare in India, speaking on new policy measures planned to give family planning a major boost, stated that programs related to population and family welfare should be interwoven with the minimum needs program so that the message of the small family norm becomes attractive to acceptors. The new incentive measures, outlined by Shankaranand, are based on the understanding that the existing infrastructure for service delivery must be fully utilized. The new package of incentives places equal emphasis on state level campaigns which will be suitably dovetailed with services and supplies. Monetary rewards in the form of community assets will be given to organized and identifiable groups actively engaged in the implementation of the Family Welfare Program. Cash awards will be given to the best performing states. A new incentive scheme will be introduced for industrial labor groups in the organized sector. Innovative publicity campaigns in selected areas will be conducted. Reorganization of the service delivery outreach system will include establishing health posts staffed by nurse midwives and health workers in urban slums and congested areas. A scheme is in preparation to issue green cards to acceptors of terminal methods after 2 children. The card holders will be entitled to priority attention and preferential treatment in schemes where such practices are feasible. Currently, there are 5000 Primary Health Centers and 50,000 subcenters offering integrated health services. Family planning statistics provide supportive evidence of programmatic response to the achievement of longterm goals of population stabilization. During the 1st 10 months of the current financial year 2,800,000 sterilizations were performed, a 43% higher achievement rate than the corresponding period last year. The number is likely to rise to 4,000,000 by the end of this financial year. Similarly, the number of IUD acceptors is 760,000, 35% higher than last year. Another encouraging sign has been the formulation of a National Health Policy.     

Satisfied users clubs: family planning acceptors as model agents of the program

The National Population Program in the Philippines has encouraged family planning acceptors to shift from their passive role as recipients of family planning services into an active role as program participants. In the mid 1970s the Commission on Population (Popcom) began setting up satisfied users clubs in various regions of the country with the aid of the Ministry of Social Services and Development (MSSD). Other government institutions like the Ministry of Labor and Employment (MOLE) formed similar family planning groups. So did private agencies participating in the Program. There were indications at that time that community based family planning clubs could help the Program in informing couples about family planning and in motivating them to practice contraception. In 1977 a study conducted by the University of the Philippines Institute of Maternal Clinic found that family planning acceptors in Dumaguete City received social and psychological support from local barrio women's clubs. A 1978 Community Outreach Survey indicated that full time outreach workers (FTOWs) found statisfied users clubs helpful in increasing the number of new acceptors in their areas and in bringing down the number of family planning dropouts. Once a decision to create a club is made, club organizers meet with the barangay captain and his council to get their approval and seek their cooperation in inviting people to join the proposed club. Once the approval is given known family planning users in the community or mothers of reproductive age are invited to attend a community assembly. Of 59 clubs surveyed, only 10 had a formal constitution and bylaws. All clubs elected their officers and conducted monthly meetings which lasted from 2-4 hours. The main selling proposition of the clubs is the involvement of members in nonfamily planning activities like income generating schemes, skills training, nutrition seminars, and immunization of children. 81% of the officers of all 59 clubs were family planning acceptors. The majority of officers had undergone voluntary sterilization. Only 8 of the 59 clubs considered themselves single purpose clubs committed to the promotion of family planning. The other 51 were multipurpose organizations, with both family planning and nonfamily planning activities. In the area of family planning, the club's objectives were to increase family planning acceptors, disseminate family planning information, and maintain current users.     

Bicol hospital reaches out to rural folk

The Ago General Hospital in Legaspi City of the Philippines was opened in 1965, antedating the national family planning movement by 5 years. The 180 bed hospital integrates family planning into the overall hospital service; sterilization is the main method used. Of the 3600 patients per year, 15% are family planning acceptors. The hospital employs 3 family planning strategies: inhospital, out patient and supportive. Inhospital strategies center on sterilization counseling and motivation. The counseling sessions include patient education. Primary targets include high risk pregnancies and young couples with a lot of children. Outpatient strategies include a referral system involving hospitals and agencies with family planning programs, lectures for community organizations and personal visits to other clinics and rural health units. The hospital's mobile clinic, staffed mainly by students, provides information, deworming, and pediatric services to the community. Supportive program strategies consist of mass communication, and an acceptor's club for previous acceptors of sterilization. These clubs meet regularly to share and discuss experiences.     

Health worker pilot project

In a survey conducted by the Kavar Village Health Worker Project in Iran, among married women, aged 15-44, residing in 16 villages served by project trained, auxillary rural health workers, 28% used oral contraceptives, while only 13% of the women who resided in 16 control villages served by untrained rural midwives used oral contraceptives. Among women in the 25-35 age bracket, the % of oral contraceptive users in the project villages was twice as great as in the control villages. Surprisingly, despite the strong Muslim tradition extant in these villages, no significant differences in usage were found between those villages served by male auxillary health workers and those served by female workers. The auxillary health workers had been trained to provide a wide variety of preventive and curative medical services, in addition to providing family planning and contraceptive distribution. At the time of the survey, these workers had been serving the 16 villages for 21 months. In the 16 control villages the nonresident midwives had received no training but had been provided with oral contraceptives for distribution.     

关于计划生育干部培训形式的几点思考

目前我国人口与计划生育工作已进入稳定低生育水平、综合治理人口问题的新阶段 ,要求全面提高计划生育干部素质 ,教育培训工作越来越显示出其重要性。本文探讨了原有培训形式存在的问题和今后计划生育干部培训形式的多元化发展     

Thinking about several problems of the research of our family planning strategy]

On the basis of 1982 census data, it is estimated that from 1987-1997 13 million women will enter the age of marriage and child-bearing each year. The tasks of keeping the population size around 1.2 billion by the year 2000 is arduous. Great efforts have to be made to continue encouraging one child/couple, and to pursue the current plans and policies and maintain strict control over fertility. Keeping population growth in pace with economic growth, environment, ecological balance, availability of per capita resources, education programs, employment capability, health services, maternal and child care, social welfare and social security should be a component of the long term development strategy of the country. Family planning is a comprehensive program which involves long cycles and complicated factors, viewpoints of expediency in guiding policy and program formulation for short term benefits are inappropriate. The emphasis of family planning program strategy should be placed on the rural areas where the majority of population reside. Specifically, the major aspects of strategic thrusts should be the linkage between policy implementation and reception, between family planning publicity and changes of ideation on fertility; the integrated urban and rural program management relating to migration and differentiation of policy towards minority population and areas in different economic development stages. In order to achieve the above strategies, several measures are proposed. (1) strengthening family planning program and organization structure; (2) providing information on population and contraception; (3) establishing family planning program network for infiltration effects; (4) using government financing, taxation, loan, social welfare and penalty to regulate fertility motivations; (5) improving the system of target allocation and data reporting to facilitate program implementation; (6) strengthening population projection and policy research; (7) and strengthening training of family planning personnel to improve program efficiency.     

Corporate clinics take on a new role

The Philippines Department of Labor, in conjunction with the U.N. Fund for Population Activities, is sponsoring a pilot family planning program. The industrial program, supervised by the Labor Management Coordinating Council, aims at integrating family planning services into the health services or clinics of 1000 corporations with at least 200 employees within the 2-year period ending June 1977. Family planning seminars are conducted at 3 levels within the corporations and include training sessions for medical personnel. Companies have found that provision of family planning services is more economical in the long run than provision of family welfare services for employees and families.     

Agricultural production responsibility system and the work of family planning in the rural area]

With the establishment of the agricultural production responsibility system, the entire agricultural management and economic system has undergone great changes, and family planning in rural areas has met with many difficulties. Because of this responsibility system, households with more manpower seem to become wealthy more rapidly than others. An existing belief among the rural population is that more children will provide a larger labor force and thus more income. Birth control and family planning are therefore becoming more difficult. In order to change existing beliefs, a comprehensive ideological education for peasants is needed so that they may understand the question of birth control from the viewpoints of national interests. Economic rewards and administrative restrictions may be used as necessary birth control measures. Agricultural production and family planning can be managed well if there is close contact and cooperation between the cadres and the masses. Extra care and benefits should be given to women of childbearing age who undergo birth control operations and agree to a single child in each household. Welfare programs for the masses, such as kindergartens and nursing homes must be established in order to reduce their worries. In addition, efforts are needed to study the new situation and solve new problems. The goal of controlling the rural population growth should be achiefed through practical work and experience.     

Family planning as preventive health measure

The link between health and family planning efforts in the Philippines goes back to the beginnings of the National Population Program. In this interview, Dr. Dumindin of the Ministry of Health (MOh) discusses the impact of family planning on health. The family planning program of the MOH, since its inception in 1970, has undergone expansion and taken new initiatives and directions to meet the changing needs of the target clientele. Family planning information, education, and motivation is provided and maintained during routine prenatal, natal, and postnatal clinic and field activities. As of January 1986, the MOH had a total of 2100 clinics--rural health units, medical centers, hospitals, mobile clinics, and special clinics--all over the country. It is estimated that the Ministry's family planning activities have averted around a million births. It is hoped to extend the coverage of the programs to areas that have not been reached before, through further community involvement, by enlisting the participation of more workers in the community, training them on integrated health and family planning services, setting up more service facilities and clinic extensions, and by improving contraceptive use-effectiveness. Hopefully, the Philippine people will become less program-dependent and more self-motivated, and they will recognize the need for birth spacing, birth limiting, and total health care--not as suggested from the outside, but coming from within themselves.     

Bangladesh: programs geared to meet population goals; communication as a major factor in UNFPA funded projects

The population policy of Bangladesh is aiming for a zero population growth rate at a suitable level of equilibrium. It is hoped that a net reproductive rate of 1.0 will be achieved by 1990, and that by 1985 fertility will be reduced to replacement level. Various measures to attain these goals have been suggested and they include such ones as the integration of family planning programs with other development efforts through a multisectoral approach and the introduction of incentives and disincentives for acceptance of the idea of the small family. Communications by radio and television play a critical role in the program to reduce fertility. UNFPA-funded projects emphasize education, motivation, and communication with the hope of creating a favorable attitude towards family planning and the concept of the small family. Numerous projects in progress are mentioned with regard to their current status. These projects include: rural development cooperatives and population education; pilot projects for family planning motivation and services in industry and on plantations; population education in agricultural extension; strengthening (IEM) information, education, and motivation and training; population awareness for out-of-school youth; a population education program for the Ministry of Education; and a national population information service.     

Beyond population,beyond family planning: the Commission on Population's total integrated development approach

The Philippine Commission on Population (Popcom) after 5 years of operation has succeeded in reducing the national population growth rate from 3.01% in 1970 to 2.66% by the middle of 1975. More than 50% of the country's eligible couples are practicing family planning or have received services at some time. New acceptors recruited during the fiscal year 1974-1975 totaled 716,650 as compared with 191,426 in 1970. As of December 31, 1975, continuing users amounted to 22% of the population. Despite the accomplishments, however, the following operational problems exist: 1) 57 out of every 100 married women of reproductive age have not been reached by the program; 2) in all regions, only 2 out of 3, or even fewer, women are aware of the existence of a family planning clinic to serve them; 3) there is a definite shift from the more effective to the less effective methods of contraception; and 4) there is a large disparity between knowledge and practice of family planning among both urban and rural women. Additionally, the clinic-based system limits the program's outreach to urban areas, and the doctor-centered approach limits the provision of services. In response to these problems, Popcom developed the Total Integrated Development Approach in 1975. This approach is currently being implemented in 7 pilot provinces and under the auspices of this approach, various strategies have been developed to improve service delivery and to expand coverage of the rural areas. 1 such strategy is the establishment of barrio resupply points which are complemented by mobile clinics which service remote and inaccessible areas. Eventually, depending on the success of the program, the approach will be implemented in all provinces within the next 3 or 4 years. Each Total Integrated Development Approach will include the 4 components of services delivery, IEC (mass and interpersonal communication and special projects), training, and research and evaluation.     

Publicity and education on family planning information in Keshan County

In 1984 the Keshan (Northeast China) County Government and the Family Planning Committee initiated an education campaign to disseminate family planning information to farmers. The team of propagandists consisted primarily of full-time family planning workers. Village cadres, school teachers, and rural physicians, who are properly educated and positive about family planning work, enjoy high prestige among the workers. They were invited to be team members after training and are supported by the villagers because they come from among the local people. All the childbearing women aged 15-49 in each village were classified by the propagandist into 5 groups according to their marital and childbearing status, i.e., women at the age of puberty, women of new marriage, pregnant and lying-in women, women with children to be reared, and middle-age and old women. The women were organized into groups to attend lectures on different subjects such as population policy, relationship between population growth and socioeconomic development on the 1 hand and individuals and environment on the other. Also included were physiology, the health birth and rearing of children, and health care for women and the aged. The publicity effort included broadcasting, films, video aids, and slide shows. Increased classs were during the slack seasons, and lectures were given once a week. By 1986, about 80% of the population at childbearing age in Keshan County had attended the family planning lectures.     

Community-based contraceptive distribution: a Korean success story

The results of a community-based contraceptive distribution program using village women canvassers in Cheju Island province, Korea, are evaluated. This rural province had the highest fertility and lowest contraceptive use before the project began. After pre-testing in another area, township-level family planning field workers recruited 365 new female canvassers per 150 women at risk of pregnancy, compared to 10,000-25,000 per worker in the previous scheme. The canvassers were to contact every household, offering them pills or condoms, or vouchers for an IUD or sterilization from the clinic. The former target system, which in reality had limited the numbers of acceptors, was suspended, necessitating an increase in budget outlays for family planning in Cheju province. By 1985 the contraceptive prevalence had doubled, and fertility fell 40.1 and 32.4% in the 2 Cheju counties. Costs per couple-year for the Cheju program were lower than those in other areas. The results of this project suggested that increasing the number of community workers or canvassers in rural areas helps reduce barriers to the use of contraceptives.