Elements of Family Planning Success

"The encounter between a knowledgeable, empowered client and a skilled, motivated service provider, taking place in an appropriately staffed, managed and functioning clinical facility, is central to ideal services."

-Jan Kumar, EngenderHealth

 
Client-centered care means that clients’ needs guide the planning, implementation, and evaluation of family planning services. High-quality care also requires provider expertise. This dual focus ensures that family planning services meet medical standards and client concerns simultaneously.

 
Q. Why is client-centered care important?
A. Client-centered care creates a positive relationship between clients and providers. When providers respond to clients’ needs with respect and empathy, clients are more likely to:
• Find a satisfactory contraceptive method
• Continue to use family planning services
• Return when they need help or another method

 
Q. What are the characteristics of client-centered care?
A. In order to address client needs,
Family planning services should be:
• Responsive to each client’s specific needs, circumstances, and wishes
• Affordable
• Convenient
• Informative
 
Providers should:
• Be competent
• Be friendly
• Be both respectful and empathic
• Be able to explore clients’ needs and individual circumstances
• Maintain privacy
• Give adequate time to each client without detaining clients unnecessarily
• Tailor the interaction to the individual client
• Help clients make informed and voluntary choices
• Help clients who wish to switch methods
• Address clients’ questions and concerns

 
Facilities should be:
• Clean and hygienic
• Well-staffed
• Organized for the convenience of clients

Clients should feel that the staff treats them well. They should be well-informed as to method choices, side effects, risks and danger signs, and how to use their method. Discussion of a clients' risk of HIV and need for protection against infection is part of a truly informed choice. Clients should always make their own decisions, with providers’ help, whether to practice family planning and which method to use.
[Decision-making tool for family planning clients and providers]
 
Q. What impedes client-centered care?
A. Client-centered care is often difficult to achieve because of its many-sided nature. Challenges to achieving client-centered care include:
• Inadequate budget
• Insufficient staff
• Poorly supervised staff
• Limited method mix
• Ill-trained staff
• Lack of supplies
• Unsupportive government policies

In addition, providers and program managers may focus on reaching their own goals or improving program statistics instead of meeting the needs of individual clients.
 
Q. Who is responsible for client-centered care?
A. Programs, providers, and clients all play roles in achieving client-centered care.
 
Programs: Programs can create guidelines and policies that foster client-centered care. They can seek client input about the organization and quality of services and train providers accordingly. Programs can ensure that providers are motivated and trained. They can make client-centered care part of staff job descriptions, performance appraisals and reward systems. Programs can also create a work environment conducive to client-centered care.
[Guidelines development], [Client rights and provider needs]
 
Providers: Providers can assess and meet clients' needs, tailoring the interaction to the individual. Providers can show clients that they care. They can encourage clients to ask questions and listen respectfully to clients. Providers can give clients clear information and explain potential side effects. They can also help clients to consider how different contraceptive methods fit clients' reproductive goals, individual circumstances and lifestyles, thus enabling clients to make their own well-informed decisions. Resolving client concerns can be a top priority for providers.
 
Clients: For client-centered care to function, clients need to participate in the discussion with providers. They can ask questions, express concerns, give providers medical information, and make decisions. Clients should understand that their own preferences and needs can guide their decision-making.
[Global health technical brief]
 
 
Case Study
 
Peru Builds Bridges Between Providers and Clients

The Building Bridges for Quality: Puentes Project was a joint effort between the Peruvian Ministry of Health, Johns Hopkins School of Public Health and Save the Children to improve the quality of health services in the Puno region of Peru. The project employed a community mobilization strategy that invited clients and providers to dialogue about quality of care and improvement of services. Providers and clients discussed and defined good-quality care through the production and discussion of videos and sociodramas – reenactments of real life conflicts. These methods enabled the groups to understand each other’s viewpoint and to identify areas for improvement. Together, the groups then developed action plans.
 
To ensure actual improvement, the groups held quarterly monitoring sessions. The Ministry of Health reported the following benefits:
• Increased utilization of family planning services
• Improved treatment of clients and interpersonal relations
• Increased community demand for and attendance at health education sessions
• Facility-level changes such as greater privacy and increased availability and affordability of drugs

 
Community members and providers have continued to hold planning, monitoring and coordination meetings. The Ministry of Health has expanded the project to two new regions. Read more about the Case study...
 

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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