A diagnostic study of the DOH health volunteer workers program

A 1993 study in the Philippines sought to 1) examine the characteristics of the Barangay (village) Health Workers (BHWs), 2) describe their recruitment and training, 3) reveal what their work entailed and how they felt about it, 4) identify the factors affecting their ability to deliver FP services, and 5) determine clients' attitudes towards them. Data were collected from structured interviews with 100 active BHWs and 150 clients in each of two regions. Most of the BHWs were women who had at least some high school education. They were longterm residents of their villages, were not gainfully employed, and their family incomes were below the poverty level. They were in favor of FP but considered three or more children ideal. Most had been BHWs for at least six years after being recruited (most often by a midwife). Most BHWs spent an average of 1.7 days assisting in the health centers and 2.0 days in the field. Their FP training was sketchy and largely centered on the use of various methods. The BHWs expressed a desire to learn more about natural FP, the IUD, and newer methods. Most received some monetary or other incentive for their work and were supervised directly by local midwives. FP service delivery was positively associated with education, experience, acquaintance with local residents, and cultural homogeneity with the clients. About half of the clients reported that they had consulted a BHW about FP, but an additional third were not familiar with the BHW program. The image of the BHW in the community was of a friendly, well-intentioned but not terribly knowledgeable person. The BHWs tended to provide follow-up services but often failed to refer clients to the health centers in the first place. Clients also reported that the BHWs gave them no choice about which method to use. This study points out the shortcomings in the BHW program. Improvement in outreach objectives could be reached by improved recruitment and training activities, the provision of more generous incentives, and improved logistics (such as contraceptive supply). The FP record-keeping system should also be improved.     

Ilocos region: BSPO paramedics: training in Abra pays off

The study entitled "the comprehensive Baragay Medical System in Arba: An Evaluation" analyzed the performance of trained paramedics and found that the effectiveness of barangay service point officers (BSPOs) as outreach workers depeded on: the knowledge and skills they acquired after traning, which helped them meet the medical needs of community residents; their acceptability to the community; and their positive attitude toward their job. The study indicated that adquate training for the job was crucial to the effective performance of outreach workers. The study compared the performance fo BSPO paramedics and BSPO nonparamedics in metting the health care and family planning needs of residents of the communities the served. BSPO paramedics fared much better as outreach workers in the tasks they were trained for -- rendering services in family planning and health care -- than BSPO nonparamedics wo were not given that kind of training. The study was conducted in the towns of Sallapadan, Pilar, and Danglas for BSPO paramedics and in Manabo, Villaviciosa, and La Paz for BSPO nonparamedics. Interviewed were a sample group of married adults in the areas, 15 BSPO paramedics, and 15 BSPO nonparamedics. The BSPO paramedics had undergone training in preventive medicine, environmental sanitation, and treatment of minor illnesses. The were taught advanced first aid techniques, over the cunter dispensing of medicines, and basic laboratory analysis. The nonparamedics were not trained in these functins. The residents preferred to approach BSPO paramedics for both family planning and medical servies, and more community members also derived the "highest degreee of satisfaction" from the paramedics' services. The BSPO paramedics also served more family planning clients and provided community residents more kinds of medical services. These included medical checkup, the distribution and sale of medicines, curing illnesses, and assisting in child delivery. In terms of job satisfaction, 13 out of every 15 BSPO paramedics interviewed indicated that they were "very satisfied" with their jobs, while only 6 of 15 nonparamedics gave the same rating. The survey findings suggest that the Arba Comprehensive Barangay Medical System can be a viable model for outreach workers in remote communities.     

The Barangay service point officers: their performance and potentials

The Strengthening BSPO (barangay service point officer) Operations project aims to strengthen the outreach structure at the BSPO level by hastening its attainment of self-sufficiency and making it more responsive to community needs and demands. It has 2 specific objectives: to provide policymakers and managers of the outreach project with a research-based assessment of current organizational procedures, practices, and factors taht hindet the effectiveness od organizations and operations at the BSPO level; and to provide Popcom's decision makers with alternative means for evolving regional and national action plans to improve BSPO operations. This discussion presents the highlights of a 3rd major project report on the "Qualitative Survey Research on BSPOs and BSPO Operations." The report covers the outcome of focus group discussions (FGDs) conducted in 3 selected regions, with resondents consisting of BSPOs, fulltime outreach workers (FTOWs), married couples of reproductive age (MCRA), and barangay captains. 6 priority issues were taken up in the FGDs conducted: selection and recruitment of BSPOs; taining; incentives and awards; perception of roles and functions; functional relationships of BSPOs and other workers; and BSPO associations. The FTOWs considered the following qualities when choosing BSPOs: influence in the community; accessibility to neighbors; approachability and friendliness; respectability in the community; belief in family planning; satisfaction with family planning use; and ability to motivate people. Before starting volunteer work, BSPOs are trained formally for 3 days. While BSPOs recognize the importance of their role in community development, they are hesitant to accept too many tasks. They perceive the replenishment of contraceptive supply to be their primary function. Record keeping, home visits, information dissemination, and motivation are considered secondary. Popcom regional offices have incentive programs meant to cover all BSPOs. There also are incentives for outstanding BSPO performances. The available incentives are not always enough. Some BSPOs experience strained working relationshiops with workers of other agencies. Coordination among the various groups is limited. Experience has shown that the performance of BSPOs in general has not come up to the program's expectations because of improper recruitment practices, inaccurate communication of roles and functions, poor trining, inadequate incentives, and lack of coordination.     

A new terminal judgment method for family planning: indistinct comprehensive judgment]

The purpose of family planning (FP) program evaluation is to make comparisons between different work units and between the past and the present. The evaluation covers the impact of programs in economic, social, and demographic terms. If the impact is not quantified, it is difficult to distinguish differences in program performance. It is also hard to determine the relative standing of different organizations if each one has different merits and deficiencies. A mathematical model is used to quantify the performance of each unit in a FP program. 4 variables are used as the program indicators in the model: 1) percentage of child births following planning, 2) percentage of deferred marriages, 3) birth control prevalence, and 4) percentage of one child pledges. Indicators of social impact include 3 variables: 1) the attitude of FP workers, 2) the efforts of FP workers put in FP and 3) the results of program implementation. The indicator of economic impact is the investment for evasion of the birth of a child. Grades are assigned to indicators of social impact for each organization. The values of each variable is put in a matrix. Weights are given to each variable based on the emphasis of the program or a specific evaluation. The weights are determined through discussion with people involved in the program. A weighted average of all the above factors is the final grade of an organization's FP program performance.     

Sarikaya: toward community self-reliance in health and family planning

The Sarikaya Project of the Philippine Ministry of Health's National Family Planning Office was conceived as an innovative approach to providing information, education, and communication on health, nutrition, and family planning using the services of neighborhood leaders who can gain the cooperation and participation of community members in health and family planning programs. The Sarikaya worker (SW) serves as the link between the community and the Ministry of Health. Selection of SWs is a collaborative effort of the Barangay Health Service midwife, the community, and the barangay council. SWs are trained by the BHS midwife in a 5-day seminar which includes an orientation to the role and function of the Sarikaya Project, health and family planning IEC, and 1st aid. SWs undertake activities in family planning, maternal and child health, nutrition, environmental sanitation, communicable disease control, and emergency treatment. As volunteers, the SWs receive no compensation except for a nominal training allowance. The SW relies on the BHS midwife for technical and logistical support, on the health committee of the barangay council for coordination and administrative support, and on informal community leaders for guidance and advice. Pilot testing of the sarikaya project was undertaken in 1979, when 241 workers were trained. Results of early evaluations were encouraging, and plans were made to expand the project in 1980.     

FP client-worker interaction as an ingredient of quality of care

In order to contribute to the improvement of the clinic-level management of the family planning (FP) programs of the Philippine FP Program, an assessment was made of client-staff interactions. Data were collected during May-June 1990 from 107 FP personnel and 1440 clients using a purposive sampling procedure which identified project sites on the basis of their FP performance; evenly divided the sample between government-sponsored programs and nongovernmental organizations; and randomly drew a sample of clients which included past users, never users, and current users. Data were gathered from a survey and from observations of at least 27 client-staff interactions in each of the four project sites. The observations were followed by in-depth interviews. While the interactions were positively viewed by the clients, some of the service providers (perhaps coping with an overly large case load) tended to shorten the duration of the interaction. The recommendations which arose from this study include: 1) FP personnel in this study, who indicated a preference for recruiting new acceptors rather than motivating past users, should be given a travel allowance and time to use the effective technique of home visits to try to reduce the number of drop-outs; 2) specific topics and counseling techniques should be included in the training courses for FP personnel; 3) the clinic setting must be improved to conform to quality standards and provide privacy for clients; and 4) clinic visits should be personally satisfying for the client as well as efficient.     

Family planning operations research in the Philippines

This essay introduces an issue of the Philippine Population Journal dedicated to the presentation of the results of operations research (OR) studies undertaken for the Philippine Family Planning (FP) Program as part of a program coordinated by the Population Council which seeks to improve FP services. The concept of OR was introduced to program managers and researchers at two workshops held in 1992. Five of the seven diagnostic proposals developed during these workshops were funded and are covered in this Journal. The results of earlier OR studies conducted under the sponsorship of the UN Population Fund are also included. The concept of OR was developed to provide managers with timely answers to their everyday problems through appropriate research. OR forces social scientists to overcome prejudices against this kind of applied research and forces program managers to learn to rely on research findings instead of on hunches. OR also forces both parties to work as a team. An important intent of this Journal is to encourage the dialogue which must precede the institutionalization of OR and to indicate to social scientists and program managers that OR has a personal relevance to their work. The research reported in this Journal will contribute to the building of theories through the many convergences in the conclusions reached about such issues as home visits, suboptimal clinic conditions, inadequate provision of FP information, and the role of outreach workers.     

Initially analyzing the characteristics and evaluated indexes in rural areas and making relative policies]

20% of rural family planning (FP) programs in China have an unsatisfactory performance. A study was conducted in four townships with poor FP program performance in Pengxi County, Sichuan Province. Some common characteristics of these townships are as follows. Lack of concern about the FP program on the part of the local leadership. 2) Resistance of local people to FP communication and education; 96% of 426 families interviewed wanted to have 2 children, and only 3.7% wanted 1 child. 3) Lack of enforcement of the incentives and disincentives stipulated in the FP policy. 4) Lack of service delivery back-up in FP programs with a shortage of trained professional staff to provide clinical services and a shortage of the necessary medical facilities or equipment to meet the needs of FP service delivery. 5) The large number of early marriages, early child-births, extra-marital child-births without quota. At the present time, there is not specific quantitative standard to evaluate the FP program performance in a particular district. 3 indicators are appropriate for comparison of program performance. 1) Has the annual birth control target for the district been met? 2) The percentage of births with in the FP quota. Under 60% of births within the quota should be considered poor performance. 3) Over 20% of unplanned pregnancies reflect poor performance in the areas of birth control education, and contraceptive service delivery. The following are suggestions for solving the problems of poor program performance. 1) Community leaders should be evaluated on a per capita production output value rather than on total value. Their achievements should also be linked with their salary increases, promotions and bonuses. 2) One-child families should have a priority in receiving financial aids for development. 3) Governmental and non-government organizations should work together to promote the implementation of FP policies. 4) Service delivery systems should be strengthened by promoting population and FP education to families and in schools. Funding should be made available to increase the capability of birth control service delivery in terms of staff training, provision of equipment and housing and improvement in the quality of services. 5. Full use should be made of the potential of village leaders to take personal responsibility for every aspect of the FP.     

World Population Day '93 observed

President Abdur Rahman Biswas inaugurated the World Population Day '93 at the Osmani Memorial Hall in Dhaka, Bangladesh, on July 11. He stressed the importance of reducing the national population growth rate from 2.03% in 1923 to 1.82% by the 1995. The event was organized jointly by the Ministry of Health and Family Welfare, the Directorate of Family Planning, and the United Nations Population fund (UNFPA). The president expressed his deep concern over the population growth rates in developing countries, which are much higher than resources. He noted with satisfaction that 40% of the eligible couples in the country practice family planning (FP) and expressed hope that this could be raised to 50% by 1995. If the program becomes successful, ideal families would consist of two children by 2005. He later presented prizes and certificates to field workers, ulemas, traditional birth attendants, FP depot holders, and the workers of nongovernmental organizations for their commendable services in Fp and maternal-child health services. The Health and Family Welfare minister in his speech warned that if the current population growth is not checked, the consequences would be disastrous, which could be averted by adopting new strategies. The deputy minister for Health and Family Welfare illustrated the threat of population escalation and recounted some of the recent government control measures. The secretary, Ministry of Health Family Welfare, said that at the present rate of growth the Bangladeshi population would double in 34 years. The director general, Directorate of Family Planning, said that the FP program has become accountable with a system of incentives and disincentives. Earlier, the UNFPA country director in his speech remarked that it was crucial for the entire world to solve the population problem. In the morning, in the main cities, hundreds of people involved in national FP activities paraded to demonstrate the social legitimacy of the Bangladeshi Fp program.     

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.     

Quality of care in Peru: measuring its impact. Field report

A report published in 1995 by the Population Council described the impact of the quality of family planning services on the incidence of unplanned pregnancy in Peru. This report followed a 1994 study that assessed the impact of quality on contraceptive usage by linking data from Peru's 1991-92 Demographic and Health Survey (DHS) and a 1992 Peru Situational Analysis study of the status of family planning (FP) services at 3000 individual service delivery points. The 1995 study added data from a follow-up survey of a sample of the DHS respondents. The 1994 study used an innovative quality of care index that measured the quality of FP services available in a geographic area to women with partners living nearby. This index was then assigned to every woman in the area and correlated with her use of modern contraceptives. The analysis revealed that availability of high-quality FP services greatly increased the number of women using modern contraception. The 1995 study analyzed the impact of quality of care on rates of unintended pregnancy and found that the percentage of unwanted births was significantly higher in areas with low-quality FP services. The researchers note that these results only hint at a relationship between quality of care and reproductive behavior and that the findings should be interpreted conservatively. However, the studies support the importance of investing in quality FP care.     

The differential effects and considerations of family planning programs in basic units]

It has been discovered that the grassroots units that did not well in family planning (FP) programs in China were short of funding, while those units that performed poorly had more funds at their disposal. One of the reasons is that communities which did a good job in FP have less violations of the birth policy, and therefore, fewer fines could be collected by the FP unit. But in those grassroots units were the FP policy was not well implemented, there were more cases of births exceeding the birth quota, and more fines could be collected. Such an outcome was penalizing the diligent and rewarding those who did not work hard. This phenomenon was caused by a severe short fall of funding for the FP program. The program budget allocated by the local government was only 1/5 of what was needed, the remaining part was to be provided by fines. The negative consequences of such a practice was damaging to the morale of FP workers. The following suggestions were make for solving the problem. First, the government budget allocation to the FP program should be increased, and part of the budget allocation should be determined by the performance of the FP program. Second, the spending of income from FP fines should be closely monitored to prevent misuse of the fund. Third, fine collection should not be used as means of income generation for the program, and not other agencies should reallocate the funds from fines. Fourth, the government and FP agencies at all administrative levels should pay attention to the management of funds from fines. FP organizations at higher levels should be able to reallocate the funds from fines collected by units with a poor performance to the units with good program performance as an incentive and to supplement their income.     

Family planning for new mothers in the Philippines

From November 1997 to February 1998, a survey was conducted to evaluate postpartum family planning (FP) services in the Philippines. Data were gathered from records at 86 clinics in 28 provinces and from interviews with 338 FP providers and 3452 clients who began to use FP within 6 months of delivery. Only 7% of women began using FP within 6 months of delivery, and most postpartum attention was devoted to child care issues. Among the women surveyed, most resumed sexual intercourse at 2.4 months postpartum and experienced a return of menses at 4.4 months postpartum despite breast feeding for 6.2 months. The most commonly recommended method to space births was the IUD followed by the injectable contraceptive. Very few providers recommended use of barrier methods. The results indicate that many breast-feeding women are receiving hormonal contraceptives too soon and that IUD insertion may not be occurring at the ideal time postpartum. While a significant percentage of providers recommended use of the lactational amenorrhea method (LAM) and 16% of the women relied on it, the providers lacked sufficient understanding of LAM. In addition, many women switched or discontinued methods. The study led to the recommendations that postpartum FP services be promoted as an essential part of maternal-child health care and that FP providers receive improved training about contraception and LAM.     

Reinforcement of family planning service strategy in India

The efforts of the Center for Population Studies at the Administrative Staff College of India offer an excellent example of the way in which resources available in the public and private sectors can be brought together to strengthen national population programs. Since the late 1960s the Administrative Staff College of India has been involved in population programs, and these activities coalesced into the Center for Population Studies which was formally established in 1972. The 1st task of the Center for Population Studies was to provide management inputs into the State of Karnataka for the India Population Project. The attempt was made to build up expertise through research and to subsequently transfer this to operating programs through management training and management consultancy. The delivery of services was identified as the priority area for the Center. The Primary Health Center (PHC) is the biggest component of the delivery system, yet there was little understanding of the working of the PHCs and their problems. Studies were launched to correct this deficiency and this led to a series of training programs for PHC doctors. Along with studying PHCs, the Center was asked to look into the program at higher levels, and this led to a study of the Health Department of the State of Karnataka and its subsequent reorganization. Similar efforts are now underway in several other States of India. The 3rd area of the Center's efforts is hospital administration, and studies have been conducted concerning the management fo hospital systems and training programs offered.     

Family planning programs in industrial establishments: an operations research study

An operations research study in the Philippines sought to uncover determinants of the sustainability of employment-based family planning (FP) programs offered in industrial settings where the Philippine Center for Population and Development (PCPD) had provided assistance in implementing Responsible Parenthood/FP-Maternal Health (RP/FP-MH) Programs. Qualitative data were gathered through observations and interviews with the target population and with company management and program implementers. Based on this study, the following recommendations were made: 1) training outputs should be echoed to employees immediately; 2) RP/FP-MCH team members should be recruited from each level of the work force; 3) an appropriate IEC (information, education, and communication) strategy should be devised to respond to the short time-frame in which employees can participate; 4) team-building training should be incorporated as a regular activity early in the contract period; 5) sectoral targeting should be used within a given company; 6) training programs should be designed for each of the three types of team members and should overlap the basic topics; 7) teamwork and mutual assistance should be encouraged; 8) the work of the teams should be rewarded; 9) commendable initiative of liaison officers should be sustained; 10) representatives of the PCPD should maintain a close relationship with the teams through PCPD staff visits to the companies; 11) management requires more intensive orientation on the RP/FP-MH program; 12) PCPD support should be withdrawn gradually until the companies are able to sustain the program themselves; 13) it may be helpful to require a company to meet rigid criteria in order to take part in the PCPD project; 14) OR should be continued; and 15) the concept and practice of quality of care should be introduced to service delivery and training of staff and motivators.     

Perceived factors of family planning clinic performance and service quality

As part of a larger operations research project, this 1990 study analyzed the performance of the Philippine Department of Health's (DOH) family planning (FP) clinics. Specific study objectives were 1) to measure acceptor targets, servicing capacity utilization, outreach, and costs; 2) to determine what providers believed affected performance; 3) to record which quality indicator providers use; and 4) to determine the perceptions of acceptors about clinic personnel, the clinic as a FP outlet, FP service processing, and FP service quality. Data were gathered from clinic records and from sample surveys in 25 clinics in four specified locations. Eight clients were sampled from each of the 100 clinics. It was found that clinic staff accepted low attainment of FP acceptor targets and that clinic capacity utilization levels were at 25% of capacity. Providers were unaware of the number of potential FP acceptors in their areas and had no information about the costs of running their clinics. The FP clinic managers identified 34 major determinants of clinic performance, but more than half reported that they had very little control over these determinants. The providers described quality service from the point of view of the acceptors and described the quality of a clinic in terms of the minimal physical characteristics required. The acceptor survey revealed that acceptor satisfaction depends upon 1) clinic accessibility and lay-out, 2) intensive personal contact, and 3) clinic infrastructure. The study uncovered a need for the DOH to institute management training programs for clinic managers and to provide managers with the resources and personnel to shift priorities in favor of FP coverage and prevalence. Managers, who are resource allocators, must also receive information about the costs of FP services in their clinics. In addition, the DOH's determination that its FP program would be facility- rather than community-based should be modified to incorporate community outreach elements. The DOH can also make a big impact on perceptions of quality (of both providers and acceptors) by improving clinic conditions to meet basic standards. Once these basic needs are met, additional needs of acceptors can and must be addressed.     

Emotional labour and aboriginal maternal infant care workers: The invisible load

Background

The term ‘emotional labour’ has been used to describe the competing demands on midwives to empathize with clients whilst maintaining a level of professional detachment. Previous research indicates that when individuals experience difficulty managing these emotions, burnout may result. Aboriginal health care workers often have roles with large emotional demands, as they are relied upon heavily to engage clients in care. However, the concept of emotional labour has received little attention in relation to this group.

A diagnostic study of Department of Health training courses for family planning providers

A study in the Philippines sought to observe and describe the family planning (FP) training program in two regions. This program trains physicians, nurses, and midwives as a team and includes a Basic/Comprehensive (B/C) course in FP with didactic and practicum elements, training in interpersonal communication skills (ICS) for those who have completed with B/C course, and a Preceptors Course for those who will supervise the practicum phase of the B/C course. The study gathered specific information on 1) trainee absenteeism and drop-out rates, 2) course content and effects, 3) the trainee selection process, 4) the practicum requirement for the B/C course, and 5) service delivery values and quality of care. Data were collected through observations, questionnaires, exit interviews with clients during the practicum phase, interviews with supervisors and public officials (mayors), and focus group discussions with regional trainers. This assessment led to the following recommendations: 1) maintain the current team approach; 2) reserve basic orientation-type subjects for office-based training to allow more time for FP topics in the training programs; 3) use caution in making a switch to "competency-based" training because of the possibility that supervision is inadequate for such a training method; 4) improve scheduling; 5) enforce the prerequisites for participation in the ICS and Preceptors Courses; 6) assign only one trainee to a preceptor area during the practicum and reduce the quota of IUD insertions to reduce pressure to obtain IUD acceptors; 7) create a "model" FP clinic each time a preceptor is trained; 8) pay more attention to natural FP methods; and 9) maintain an emphasis on quality of care.     

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.