Elements of Family Planning Success

"The way I see it, one of the performance factors for providers to be able to provide quality services is that they need updated information about the contraceptive methods that they are going to be providing to their clients. They also need the skills in order to provide them safely. Training can also be motivational for them, that if they know they are being supported to improve their performance, if they need information, if they need to update their skills, there is always a way to do that."
-- Dr. Ricky Lu [Listen to this interview]
 
Good quality services require motivated providers who are well-trained in clinical procedures, have up-to-date knowledge of contraceptive technology, and who have good interpersonal communication skills. Supervisors using positive techniques to improve staff performance, rather than fault-finding or accusatory approaches, find that their workers are much more satisfied with their jobs and perform more efficiently. Activities including in-service trainings and ensuring supportive supervision can be ways to promote well trained, supervised and motivated staff.
 
Q. Why is training important?
A. Well-trained providers have up-to-date knowledge of latest techniques, guidelines, procedures, and counseling methods. Family planning training may cover a variety of topics depending on a program’s specific needs, including contraceptive technology, clinical procedures, and counseling techniques. Training can take several forms, but effective training methods share these four characteristics:

• A specific focus,
• Individual attention from the teacher,
• Hands-on exercises, and
• Positive reinforcement during training and on the job.

 
Evaluations of training programs find that training has improved quality of services and thus helped to attract more clients. Programs can decide how often to conduct trainings. Newly hired staff may benefit from pre-service training, while all staff may benefit from periodic refresher trainings. It is critical that all cadres of health workers receive a strong grounding in their pre-service education before assuming service delivery responsibilities.
 
Q. Why is supervision important?
A. Effective supervision emphasizes mentoring, joint problem solving, and two-way communication between supervisors and providers. Supervisors who use positive techniques to improve staff performance, rather than inspection and fault-finding, find that workers are more likely to be satisfied with their jobs and perform more efficiently. A variety of approaches may be used, such as group supervision, team-based supervision, and self-assessment.
 
Q. Why is motivation important?
A. Motivated providers are those who have incentive, are driven, and have inspiration to provide quality family planning services. Staff need to feel recognized and rewarded for their efforts. Even in low-resource settings, managers can take action to understand staff issues and reward them for a job well done. Strategies to improve job satisfaction and worker morale may include praise, financial incentives, or inspiring role models.
 
“We’re trying to look into motivation in terms of being really good at what they do and having some sort of recognition."
-Irina Yacobson, Assistant Medical Director, FHI [Listen to this interview]
 
Q. Why is it important to keep service delivery guidelines up to date?
A. Program guidelines include service policies and standards that specify the services offered, provider qualifications, and acceptable levels of performance, as well as clinical protocols and management procedures. Well-designed guidelines improve consistency of service delivery, reduce barriers to access, and guide training and supervision. Guidelines should be feasible, easily understood, broadly disseminated, and reinforced by training, job aids, and supervision.
 
Q. How can programs keep technical guidance up-to-date?
A. In recent years concerted international effort has gone into developing evidence-based guidelines for family planning practice and service delivery. According to contributors in a recent global discussion forum, keeping service delivery guidelines up-to-date is not an easy task. Programs often struggle with dealing with bureaucratic obstacles, which may hinder incorporating new research and guidelines. In addition, other programmatic challenges may outweigh the importance of keeping guidelines up-to-date. Nevertheless, up-to-date service delivery guidelines that incorporate the latest evidence-based information and guidance is one of the most important components of family planning programs.
 
Recommended List of Quality of Care Indicators for Providers
The Maximizing Access and Quality Initiative considers the provider-related indicators below to be the most important to achieving quality of care outcomes.
 
The Provider:
• Demonstrates good counseling skills
• Assures client of confidentiality
• Asks client about reproductive intentions (asking whether the client wants more children, and when)
• Discusses with client which method he or she would prefer
• Mentions HIV/AIDS (initiates or responds)
• Discusses methods for preventing pregnancy and sexually transmitted infections
• Treats client with respect/courtesy
• Tailors key information to the client’s needs
• Gives accurate information on the method accepted (explaining its use, side effects, and possible complications)
• Follows infection control procedures outline in guidelines
• Recognizes/identifies contraindications, consistent with guidelines
• Performs clinical procedures according to the guidelines
 
[MEASURE Evaluation Quick Investigation of Quality]
 
Case Study

Updating Service Delivery Guidelines
 
Many family planning professionals agree that keeping service delivery guidelines up-to-date can be difficult. Despite obstacles, several countries have proven that, with determination and collaboration, guidelines can be successfully updated. Jamaica’s Ministry of Health (MOH) and the National Family Planning Board (NFPB) recently updated guidelines to incorporate the latest international family planning standards and technology. They removed outdated eligibility requirements and expanded services to include all reproductive health issues.

First, the MOH and NFPB met and agreed upon the updating process and the final desired product. To ensure buy-in from all parties, key leaders and stakeholders were identified and asked to participate in a development group. After reviewing extant data, the development group determined which technical issues to include in the new guidelines. In an effort to base guidelines on evidence-based standards, the group compared international standards with the country’s existing standards. The Quality Assurance Project (QAP) then developed a set of revised guidelines.

Representatives from the development group attended a technical workshop where they reviewed the guidelines for cultural appropriateness, technical content, and consistency with Jamaica’s MOH standards. As part of a field test, the guidelines were then taken to each of Jamaica’s regions where regional supervisors and service providers met to offer structured feedback. The development group held a second technical workshop to integrate suggested changes. Finally, the MOH and NFPB reviewed and approved the guidelines for general use.

Representatives from various organizations met to identify who should receive the guidelines and what activities should be carried out to promote their use. As part of a media event, the Minister of Health presented the guidelines to more than 50 public health professionals during National Family Planning Week. Subsequently, key leaders, representatives and professionals in the family planning community received copies of the guidelines. The QAP also disseminated the guidelines via a national workshop on contraceptive technology where they prepared trainers and service providers to train their colleagues on the updated service delivery guidelines. As a result, most health providers reported having received a copy of the new guidelines.
 

Each of the 10 elements was chosen based on online survey results and was discussed in an online forum hosted by the Implementing Best Practices (IBP) Knowledge Gateway. Read more about the survey, forum and results in the Forum Synopsis. Learn more about IBP Knowledge Gateway, and join their Initiative here.
 
 

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