Integrated family planning/parasite control project: a different approach to community health problems

An obstacle to the acceptance of family planning is the fact that its advantages are not immediately apparent or tangible. A way to get around this obstacle is through the use of "entry points"--projects which yield tangible results in a relatively short time. Through these entry points, the fieldworker builds credibility and wins the confidence of the people in the community he or she is serving. Thus, when the time comes, the people will be receptive to the family planning message. This strategy of the use of entry points is common to integrated projects with a community development program becoming a sort of entry point for family planning fieldworkers. 1 such project, begun quite recently by the Family Planning Organization of the Philippines (FPOP) in 4 pilot sites, uses deworming as an entry point. It is officially known as the Integrated Family Planning/Parasite Control/Nutrition Project. It is 1 of several projects cosponsored and financed by the Japanese Organization for International Cooperation in Family Planning (JOICFP) and the Asian Parasite Control Organization (APCO) in almost a dozen other Asian and Latin American countries. The immediate objective of the project is to establish or increase the credibility of family planning fieldworkers among the people in a target area. Fieldwork connected with family planning is conducted alongside a related community health effort that can produce immediate and visible results. The ultimate goal is to encourage community participation to such an extent that there will no longer be a need for the fieldworker. Strategic planning involves thinking up the "backbone" and molding the "skeleton" of the project, i.e., its concept and basic policies. As the project goes into the design and development stage, additional people are drawn into it. Project experience in Thailand underscores the need to consult with local leaders. The earliest projects were initiated in 1976, but some are already showing successful results. The overall Philippine experience provided support to JOICFP Director Kunii's reiteration of his belief in the effectivity of parasite control as an entry point for population planners. Integration of the nutrition element in the project is regarded as essential.     

Pop-ed programs for the out-of-school youth

39% of the Philippines youth are not in school and these youths receive no training for responsible parenthood and community life. A number of agencies try to reach these members of society, including the Bureau of Youth Welfare (BYW), the Family Planning Organization of the Philippines (FPOP), the Foundation for Youth Development in the Philippines (FYDP), the Rizal Youth Development Foundation (RYDF), the Philippine Rural Reconstruction Movement (PRRM), and the Philippine Youth Welfare Coordinating Committee. BYW conducts informal group sessions including discussions among 13-24 year old members who have started self-employment projects. FPOP's youth program, SIGLA, aims at developing out-of-school youths social y and having them disseminate information to other out of school youths. This information includes family development, family planning, and population-related information, and is disseminated through activities and workshops. FYDP aims at functional literacy but also disseminates family planning information to out-of-school youths. RYDF conducts week-long seminars in topics such as birth processes, family relations, and care of babies. PRRM integrates population and family planning into its nonformal education program for out-of-school youth and adults in Nueva Ecija Province. Problems encountered in these programs are 1) suspicion of parents, and 2) feelings of inadequacy on the part of teachers. While emphasis has been on unemployed youth, efforts should be made to reach those youth who are employed.     

The participation of non-governmental organizations in the Philippine population program

In 1957 the National Council of Churches in the Philippines (NCCP) established the Family Welfare Center, offering an educational program in family planning; it was subsequently expanded and reorganized into the Planned Parenthood Movement of the Philippines. Since its creation in 1970 the Philippine Population Program has brought together government, private, and religious activities. Under the 1987-92 development plan nongovernmental organizations (NGOs) will be taking a more active role in the implementation of the population program by contributing to the maternal and child health/family planning and the information, education, and communication (IEC) components. There are more than 50 private organizations engaged in such population activities. These include national women's organizations and development NGOs with a mass base. The Family Planning Organization of the Philippines is carrying out a 3-year comparative study of the effectiveness of community volunteers in the acceptance of natural family planning. The Reproductive Health Philippines has completed a follow-up of Depo Provera defaulters in a previous clinical study of Depo Provera acceptors conducted in 1985-87. IEC support from various medical and social organizations also helped advance family planning and population awareness of the program. The Mary Johnston Hospital and Iglesia ni Kristo have been front-runners in sterilization through their mobile teams and regular clinics. On the negative side, funding constraints are threatening the very existence of some NGOs. Even those that do not face such constraints face problems related to cost effectiveness, priority setting, capability building, and staff development. A survey of the Population Center Foundation identified some urgent concerns: sharing experience in self-reliance, enhancement of the managerial skills of staff, and funding problems. NGOs complement the family planning services of the government as well as focus on the smooth flow of IEC activities.     

Total maternal and child care: an approach to the population problem

This article describes the Bohol Province Maternal Child Health/Family Planning Project, a 5-year project financed by the United Nations Fund for Population Activities and the Philippines Department of Health. The objectives of the project are to improve general health services, introduce family planning services in the context of the MCH program, improve training of personnel and evaluated the results of the program. 88 barrio health centers have been established, offering a range of maternal, child health and family planning services. 34 boticas (drugstores) have been set up in local variety stores, dispensing drugs at low cost. A strong research unit collects data for program evaluation and has so far published 23 reports, which are listed at the end of this article. Community acceptance of the program has, in general, been good; midwives have been welcomed. The program has encountered problems of religious conservatism and insufficient contraceptive supplies and has learned the need for good relations with the barrio leaders and residents. The 5-year limit needs to be extended. Progress in health services has been excellent. The effect on family planning, while encouraging, cannot yet be evaluated.     

Magdamayan: drawing the family into community work

Magdamayan is an old word meaning to help one another; it has been chosen as an acronym for a program currently being undertaken by the Family Planning Organization of the Philippines (FPOP) that addresses itself to family life and community development -- a departure from previous FPOP projects. It aims to reach out to rural villages through 44 chapters covering selected communities in the 3 major island groups. Its main objectives are to reach the majority of the eligible population in each village, increasing the awareness, knowledge and understanding of family planning; to enlist 80% of eligible couples; and to maintain a 90% continuation rate. The 1st cycle of the project activities was begun in July 1975, divided into 3 phases spread over 18 months. Phase 1 involved preparations for the project in the villages, including a baseline survey. Phase 2 was the actual program phase, including a mass information drive, contraceptive promotion, identification of target groups, training of motivators, and provision of backup services. Phase 3 involved the phasing out of FPOP staff and turning the project over to community volunteers, and evaluation. Among the activities employed to facilitate integration of family planning into community life were 57 vocational skills training courses, various income generating activities (dances, sporting events, raffles) and community development projects. Preliminary evaluation of the 1st cycle indicates impressive success, but below the 80% acceptance and 90% continuation rates. Community development activities were seen as much enhanced, and basic health services and vocational skills training were successfully introduced. Constraints identified as limiting the success are discussed, and it is concluded that the program's performance this far is good enough to warrant its use as an alternate or model for similar family planning projects.     

Integrating family planning with nutrition and parasite control

At the Inter-Governmental Coordinating Committee Workshop on an Integrated Approach towards Family Planning and Health Programs held at Kuala Lumpur from March 23 to 25, 1977, the feasibility of integrating family planning with nutrition and parasite control through the proper planning of motivational considerations, resource allocation and coordination was studied in detail. Discussion focused on the experience of participating countries in generating community participation in total health programs. Malaysia reported that in the expansion of the national program into the rural areas functional integration has been the approach. In Indonesia nutrition has been an important objective of maternal and child health services. A total integrated development approach has been the objective in the Philippines where family planning information-education-communication has been integrated with nutrition programs and a pilot project on integration of family planning and parasite control has been conducted. Thailand reported on the introduction of an integrated family planning and parasite control program, while Sri Lanka reported on an integrated approach that included family planning with maternity and child health services. A recommendation of the meeting was that experimental pilot projects be established which include nutrition and parasite control elements within the framework of family planning services.     

The Catholic response to the population problem

A survey of efforts led or sponsored by the Catholic church in response to the population problem in the Philippines. These efforts stem from the Church's belief that population growth is related to the overall picture of development, and that priority must go to social and economic justice. The Catholic Church of the Philippines (to which 85% of the population belong) views it as a problem basically involving care of people, and directs its efforts primarily at internal human sexual control rather than external contraceptive control. Family Life Education began as a program in the church in the 1960s. Efforts by priests, nuns, and lay leaders in Mindanao eventually resulted in counseling in husband-wife relations, marriage commitment, human sexuality, parent-child relations, and responsible parenthood, and to the creation of college courses to prepare teachers in tackling sex education. A program offering natural family planning was also started, initially for employees of a packing firm and later expanding throughout the province. In 1975, the program was launched in Manila, and a year later had 3 family life centers. The ovulation (or Billings) method is offered -- an advantage to low income people because it does not require purchase of a thermometer. Success of this method requires a sense of responsibility on the part of both husband and wife. Widespread international interest in the ovulation method has led to formation of an International Federation for Family Life Promotion, to which the Philippine Federation for Natural Family Planning has applied for membership. The IFFLP is working with the WHO Human Reproduction Unit on 2 projects, part of one of them (a field trial for evaluation) being conducted in Iligan City, Iloilo City, and Manila. Among the concerns of the IFFLP-WHO collaboration is developing a standardized Natural Family Planning curriculum or educational package.     

Upgrading IEC strategy: the happy family coupon campaign

The Information, Education and Communication Division of the Family Planning Organization of the Philippines launched a Happy Family Coupon Campaign, a project to test the feasibility and the potential of a scheme whereby materials were distributed in response to individuals' expressed needs and interest. The project aims were: 1) to reach specific target groups, represented by readers of commercially printed materials; 2) to explore the potential of the mail system as a medium for the distribution of family planning materials; 3) to test the effectiveness of commercial publications as a vehicle for creating demand for family planning information; and 4) to secure feedback regarding preferences for the various family planning materials. The campaign had 2 major components: 1) advertising as a means of informing readers about the availability of certain family planning information materils, and 2) mail service as a channel for delivering requested materials to the respondents. 12 types of informational materials were distributed, each written in English, Filipino, and the Ilocano, Cebuano, and Ilongo dialects. These pamphlets and leaflets are described. The campaign drew a total of 24,226 respondents from August 1974 to December 1975. 58.7% of the respondents had 1-4 children, 26.4% had 5 or more children, and the remaining 14.9% gave no information concerning the number of children. It appears that the project has already achieved a measure of success as indicated by: 1) specific target groups were reached, 2) the potential of the mail system as a channel for the distribution of family planning was not confined to the buyers of the publications, 3) the potential of commercial publications as vehicles for creating demand for family planning information was tested, and 4) feedback regarding preferences of various groups for different family planning materials was obtained.     

Prevention and Treatment of Reproductive Tract Infections

Reproductive tract infections(RTIs)prevention and treatment is one of the three major projects organized by the National Population and Family Planning Commission.The author,based on the practice of this project and the China/UNFPA reproductive health and family planning project,made some suggestions on how to improve the effectiveness of the efforts made to prevent and treat RTIs.1.Focus on people’s needs and improve public awareness about RTI prevention and treatment Reproductive tr…     

Adolescent fertility programs: responding to the needs of today's youth

The 1983 conference on Adolescent Fertility Management in Asia and the Pacific provided a forum for sharing information and experiences. The project was designed to stimulate interest in and strengthen existing programs on adolescent fertility in participating countries, i.e., Bangladesh, Fiji, India, Indonesia, Nepal, Philippines, Sri lanka, and Thailand. Specifically, the conference sought to identify adolescent fertility problems and share experiences in managing adolescent fertility programs, identify gaps in the development and implementation of adolescent fertility programs and projects, and formulate plans to meet the adolescent fertility needs of the participating countries. Capsule presentations of the experiences of the participating countries are presented. Focus is on the projects they have undertaken and proposed activities. In Bangladesh Jatio Tarum Sangha, the national youth organization, seeks to get youth involved in family planning activities through information/education/motivation programs and community development projects. Fiji proposes to establish a youth center to be operated by the Ministry of Health to reduce the incidence of unplanned pregnancy and sexually transmitted diseases in adolescents and to make them more aware of sex-related health problems and the importance of responsible sex. India's Family Planning Association has initiated population education programs for youth. Several projects have been launched in Jakarta to cope with adolescent fertility problems including the adolescent health project, the Consultation Center for Adolescents, and the university-based family health project. The Family Planning Association of Nepal has completed some major programs under its youth project. The Philippines' proposed youth centers are planned to respond to the fertility related needs and problems of Filipino adolescents. Innovations of the center are: the operation of several youth-serving government and private agencies under 1 roof, and encouragement of youth participation in designing and running the center. Sri Lanka does not have much of an adolescent fertility problem. Virtually all fertility is said to occur within marriage. A study on adolescent fertility is planned. Thailand has launched several government and nongovernment programs to reach adolescents both in and out of school. Government programs include counseling services and the National Family Planning Communication for Premarriage adolescents. Key issues are identified and recommendations are made.     

Premarital information efforts under way

Premarital couples are among priority targets of family planning information in the Philippines national population program as they can serve a pivotal role in slowing population growth. Applicants for marriage licenses are required to attend a family planning session as a prerequisite. Following recommendations of a training effort and seminar on Premarital Family Planning Counseling, on July 20, 1976, premarital information was institutionalized in the country by Presidential DEcree 965 which made family planning counseling obligatory to the marriage license applicants. Shortly after that, a multiagency effort gathered information on the status of the Premarital information program in the Philippines, which showed that there is no full-time specialist for the work. Medical officers; social workers; community welfare supervisors; and program and training officers do this work of information in addition to their usual duties. Distribution of the applicants varied greatly in age groups, educational levels, and professional category. The size of the group, length of session and topics of discussion varied greatly. Necessary efforts should be made to solve the major problems by selecting better sites for group sessions and training more personnel for the purpose. There is a great need fordeveloping more effective and research oriented information, education and communication materials, according to the needs and cultural traits of the target audience.     

Pakistan: FPAP projects reflect integrated approach

The Family Planning Association of Pakistan has conducted a number of projects reflecting the government's integrated approach to family planning. The youth project aims at alerting young people to the need for family planning. A full-scale feasibility scan was conducted prior to implementation of the project to determine the best way to reach people. Volunteers were recruited among college students. The project's strategy for 1979 included organization of a youth leadership national workshop and oratorical contest on the topic, "Whatever your cause, it is a lost cause without population planning." Other FPAP projects include a group of "better living projects" which aim to educate young mothers in child care and family nutrition. Projects in the organized sector include a program at the Pakistan Mint, where a motivation center and clinic are set up. Training projects concentrate on fieldworkers and traditional birth attendants (dais). A 3-day course for dais includes reorientation on septic deliveries, child care, maternity care, and record keeping. In the cities, FPAP has a network of multipurpose centers in slum areas, where adult education and income generating activities are integrated with family planning.     

Pakistan: family planning expands in non-governmental organizations

The Family Planning Association of Pakistan has begun a program of integration of family planning activities with other voluntary welfare agencies. 1 of the more successful projects has been in cooperation with the Family Welfare Cooperative Society of Lahore. Volunteers have provided facilities to very low-income women to help supplement income. At 1st it was knitting, embroidery, and cloth manufacture, but over several years it developed into a complex of several buildings with a comprehensive vocational training center, a showroom, schools for the children of mothers in training, a secretarial school, and a hostel for homeless women there. There is a medical unit, a full-time doctor, and family planning services.     

Cagayan de Oro taps own resources to cope with population problem

In 1972, the Model City Population Planning Project (MCPPP) was begun in the Philippine city of Cagayan de Oro. The MCPPP was an attempt to encourage family planning on the community level. Funding was provided by the Ford Foundation for the program in 1974, for 2 years. There were 5 main objectives of the program: to provide family planning information to parents, to test small scale projects which could be applied elsewhere in the country, to actively involve local government, to reduce the birthrate, and to facilitate, coordinate and strengthen population and family planning services of the different agencies of Cagayan de Oro. While the MCPPP's efforts to reduce the birth rate were mostly concerned with coordinating and facilitating prexisting family planning services, evaluators of the project credit it at least partially, for the cities' declining birthrate. In 1971, the birthrate was 36.5 per 1,000 and in 1975, it had dropped to 29 per 1,000. In mid 1976 the program was incorporated into the nationwide Outreach Program. Although some evaluators felt that private citizens were not sufficiently involved with it, the program has been judged successful in demonstrating a city's capacity to work toward solving it's own problems. Particularly successful were efforts at educating the population and dissemination of family planning information.     

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 National Conference of Propaganda Work on Family Planning held Beijing]

The National Conference on Propaganda Work in Family Planning, held in Beijing from November 1-6, 1982, was sponsored by the the Propaganda Department of the Chinese Communist Party Central Committee and the National Family Planning Committee. Among the 136 participants were representatives from various provincial, city, and autonomous region propaganda and family planning units, the General Political Department of the People's Liberation Army, general trade unions, All China Women's Federation, Communist Youth League, and propaganda reporters. The purpose of the conference was to discuss how to organize family planning propaganda in meeting China's goal of limiting the population to 1,200,000,000 by 2000, and how to arrange a Family Planning Propaganda Month for early 1983. The Chairman of the National Family Planning Committee made 3 points: family planning is a basic national policy, greater propaganda efforts must be made towards peasant family planning, and everyone must work hard to create a new situation in family planning work. The Vice Minister of the Propaganda Department remarked that family planning propaganda was foremost among the 12 national propaganda topics; these sentiments were supported totally by the representatives of the women and youth groups. The Vice Chairman of the Advisory Committee of the Central Committee said that family planning work was longterm, and that its success lay in the countryside. Finally, the Vice Chairman of the National Family Planning Committee encouraged all delegates to take the spirit of the conference back to their home. During the conference delegates also met to discuss important points in planning the Family Planning Propaganda Month.     

Seminar on information,education and communication

A major decision of the 7th Seminar on Information, Education and Communication organized in Tokyo by the Japanese Organization for International Cooperation in Family Planning (JOICFP) held in June and July 1977 was to recommend that the term "family planning" be replaced by "family welfare." The intention of this change is to reflect the current trend of combined programs which have the objective of improving the quality of life. The major theme stressed by the seminar speakers was the importance of information, education and communication in launching improved innovative approaches and strategies in support of the integrated approach. 4 topics were selected for special consideration: 1) interpersonal communciation; 2) incentives; 3) organizational approach in family planning programs; and 4) integration of family planning with maternal and child health.     

Hong Kong: The Family Planning Association continues its pioneering role

Vital population statistics for Hong Kong are mentioned. The 1st efforts at providing birth control services in Hong Kong began in 1936 with the Eugenics League. The League was reorganized and formed into the Family Planning Association of Hong Kong (FPAHK) in 1950. The government began providing family planning services in 1974. Although there is no governmental incentive/disincentive policy, certain laws and practices do have the effect of encouraging population growth limitation. These are described. The FPAHK directs its efforts toward motivational activities. The Association is encouraging the concept of male responsibility for family planning. Personal visits to fisherfolk families have been instituted to combat their tendencies toward large families. Various separate activities of the government program and the FPAHK are discussed.     

ASEAN projects reviewed

The ASEAN Population Expert Group met in Manila and was followed by a meeting of the ASEAN heads of population programs, during the period November 5-10, 1979. Heads of population programs from Indonesia, Malaysia, Singapore, Thailand, and the Philippines attended. The meetings were held to review progress-to-date on phase 1 projects and to consider the development of an expanded population program. 5 projects funded by UNFPA are reviewed in tabular form with the project, the sponsoring country, date of implementation, data analysis, and date of completion. Suggestions were made for improving and extending these projects and it was also suggested that all projects being developed and proposed should include a section on use of research. 7 new projects were proposed as phase 2 projects. The 1st, sponsored by Malaysia, deals with women in development; project 2, lead by Thailand, will investigate population movement and its effect on development; project 3, led by the Philippines, will develop and strengthen national population information systems and networks in ASEAN countries; project 4, led by Indonesia, is directed towards institutional development and exchanges of personnel; project 5, led by the Philippines, will examine population and development dynamics and the man/resources balance; project 6, led by Thailand, will develop ASEAN social indicators; and project 7, led by Indonesia and Malaysia, will make a comprehensive analysis of existing medical/health care and family planning systems. It was recommended that an executive director of the proposed ASEAN population coordination unit should be appointed to expedite the recommendations of the meeting related to preparation and submission of phase 2 project proposals.     

Natural family planning works in a Bukidnon town

Natural family planning is being actively promoted in a pineapple plantation of the Philippine Packing Corporation (PPC) located in northern Bukidnon province. Prospective acceptors attend 4 seminars which cover sex education and instruction on natural family planning methods. The goal of the program is family life and marriage enrichment rather than family size limitation. Thus, there is no target number of acceptors. Early acceptors used the basal body temperature method, but this was subsequently replaced by the sympto-thermal method. Participants report that the close observation of physical changes required by the natural family planning method has enabled them to be more aware of their bodies and more appreciative of themselves. Laypersons work closely with acceptor couples. There are 6 fulltime grassroots motivators and 23 camp motivators. Affiliated with the Family Life Commission of the Catholic Bishops Conference of the Philippines, the program is also supported by the Phillips Memorial Hospital and is part of the PPC's barrio assistance program. The corporation actively supports self-help projects in the plantation areas.