Prototype for health education program on utilization of family planning
- 1. Prototype for Health Education Program on Utilization of Family Planning Services Through Short Lecture Mohammad Aslam Shaiekh Sarmila Baral MPH(HPE), 3rd Semester SHAS, P.U. 1
- 2. Introduction • Family planning (FP) refers to a conscious effort by a couple to limit or space the number of children through the use of contraceptive methods. • FP services are part of essential health care services and are provided free in all public sector outlets. • Modern methods include minilap, vasectomy, IUCD, implants, injectable, condoms, LAM. • The main aim of the National Family Planning Programme is to ensure that individuals and couples can fulfill their reproductive needs by using appropriate FP methods voluntarily based on informed choices. 2
- 3. Introduction Cont… • In Nepal, FP information, education and services are provided through the government, social marketing, NGOs and the private sector (including commercial sectors). • In the government health system, short acting reversible contraceptive methods (SARCs: male condoms, oral pills and injectables) are provided through PHCCs, health posts and PHC-ORCs. • FCHVs provide information and education to community people, and distribute male condoms and resupply oral contraceptive pills 3
- 4. Introduction Cont… • Long acting reversible contraceptive (LARC) services such as intrauterine contraceptive devices (IUCDs) and implants are only available in hospitals, PHCCs and health posts that have trained and skilled providers. • Access to LARC services is provided in remote areas through satellite clinics, extended visiting service providers and mobile camps. 4
- 5. Problem Statement • National family planning programme (FP) in 2074/75 experienced a downturn in uptake of family planning services. National and Provincial mCPR has decreased. • The modern contraceptive prevalence rate (mCPR) for modern FP at national level is 40%. mCPR of Terai (45%) is higher than national average. • Province 2 has the highest mCPR of 46.9% while Gandaki Province the lowest (32.7%). Nationally, current users (absolute numbers) of all modern methods have decreased by 174,705 in 2074/75 than in previous year 5
- 6. Problem Statement • The trends of current users of permanent methods are in decreasing trend while that of long acting reversible contraceptive (LARCs) currents users is almost stagnant at national level but is in increasing trend in Provinces 1 and Sudur-pashchim Province. • There has been a decline in the unmet need for family planning from 28% in 2011 to 24% in 2016 • Female sterilization is popular in Terai and male sterilization is more popular in Mountain and Hill than Terai. 6
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- 8. 1. Social Diagnosis NON HEALTH RELATED • Poor transport facilities • Under-development • Poverty • Unemployment • Illiteracy • Discrimination • Social exclusion • Difficult geography 8
- 9. 1. Social Diagnosis Cont… HEALTH RELATED • Early marriage and Teenage pregnancy. • Unsafe abortion. • Over Population and High fertility • High maternal, neonatal, infant and child mortality • Unwanted pregnancy 9
- 10. 2. Epidemiological Diagnosis • Overall, 53% of currently married women use a method of family planning, with 43% using a modern method and 10% using a traditional method. • Among currently married women, the most popular methods are female sterilization (used by 15%), injectables and withdrawal (each used by 9%), male sterilization (used by 6%), and the pill (used by 5%). • Women in urban areas are more likely to use a contraceptive method than women in rural areas (55% and 49%, respectively) 10
- 11. 2. Epidemiological Diagnosis • 10% of women want to have another child soon (within the next 2 years), and 14% want to have another child later (in >2 years). • Currently, women in Nepal have an average of 2.3 children. • The median age at first marriage for women age 25- 49 is 17.9 years, compared to 21.7 years among men age 25-49. • In Nepal, 17% of adolescent women age 15-19 are already mothers or pregnant with their first child. Teenage fertility is higher in rural areas (22%) than in 11
- 12. 3. Behavioral & Environmental Diagnosis • Behavioral: – Use of FP as a means of abortion services (Emergency contraceptive Pills). – Less priority to condom as no more feeling of satisfaction – Not using any family planning method – Irregular use of family planning methods – Improper use of Family planning methods – No Health seeking behavior for information regarding FP – Not using FP due to fear of side effect – Discussing with peers about family planning methods – Spousal communication about family planning12
- 13. 3. Behavioral & Environmental Diagnosis • Environmental: – No family and Spouse Support – Religious Beliefs on utilization of FP services – Lack of Trained HR for FP services – Hard to reach geographical area – Gender Sensitivity. – Unmet need – Lack of access to family planning methods – Lack of information on family planning methods – Non availability of appropriate family planning methods – No confidentiality – No female staff at health facilities – Rude behavior of health worker – Visiting with FCHV/ health person for family planning methods 13
- 14. Inventory of Behaviors Positive Factor • Using FP method regularly • Properly use of family planning method • Regular Health seeking behavior • Using FP methods despite some side effect • Discussing with peers about family planning methods • Spousal communication about FP methods 14
- 15. Inventory of Behaviors Negative Factor • Irregular use of family planning method {Use of FP services (ECPs) as a means of Abortions} • No Spousal and family supports. • Unable to use family planning method properly • Poor health seeking behavior • Discontinuing FP methods due to minor side effect • No spousal communication about FP method • No discussion about FP methods among peer • Shyness 15
- 16. Decision Matrix Lists of behaviors Importanc e Changeability Total Score Regular use of FP method 5 4 9 Proper use of FP method 5 3 8 Peer discussion about FP method 4 2 6 Spousal communication 5 4 9 16
- 17. 4. Educational Diagnosis Predisposing Factors: • Almost all women and men knowing at least one method of contraception. • On average, both women and men have heard of more than eight methods, most commonly modern methods. • The most well-known method among women is injectables (99%), followed by female sterilization (98%), male condoms (96%), and the pill (93%) • Among men, the most commonly known method is the male condom (100%), followed by injectables (95%), female sterilization (95%), and male sterilization (94%). 17
- 18. Predisposing Factors • Knowledge about emergency contraception and the lactational amenorrhea method (LAM) is relatively poor, with only 36% of women and 55% of men having heard of emergency contraception and 25% of women and 15% of men having heard of LAM. • Women with a secondary education or higher are less likely (34%) to use modern contraceptive methods than women who have no education (52%) 18
- 19. Predisposing Factors • 72% of nonusers age 15-19 did not discuss family planning either with a health worker or female community health volunteer or at a health facility. • 11% of men agree with the statement that contraception is women’s business 19
- 20. Re-enforcing factors • Supportive Husbands and Family Support • Family and Spouse against use of family planning • Friends encouraging to adopt family planning method • Supportive Behaviour of health worker to clients • Less priority of FP education and Less discussion in school and Campus • Less discussion among friend circle • Shyness • Availability of different media: TV, FM 20
- 21. Enabling factors • Trained and Skillful health worker • Availability of FP methods. • Strengthening of HFs at all wards level • Different I/NGO, CBOs working in the field of family planning • Functional PHC/ORCs in VDC • Availability of FCHVs at ward level • People having access to health facility • Good referral mechanism for family planning methods • Regular supply of FP commodities in HFs 21
- 22. 5. Policy & Administrative Diagnosis Policy Diagnosis: • In July 2017, Nepal revitalized its commitment to maintaining and sustaining the efforts already initiated through the implementation of its initial 2015 commitment to FP2020. • In the newly devolved and federalized structure, Nepal is committed to ‘leaving no one behind’ and ‘reaching the unreached’ to accelerate the progress of increasing the number of additional users of family planning by an estimated 1 million and the proportion of demand satisfied to 71% by 2020. 22
- 23. Policy Diagnosis NHSS-IP (2016-2021) • The programme contributes to ensure the reproductive right through helping the individuals and couples to regulate their fertility. • Expand equitable access and utilization of high quality FP services, strengthening public and private sector health system and social franchising approach • increase availability of modern FP methods to enable couples and individuals to exercise informed choice through FP counseling and satisfy the demand for FP and attain the desired family size, have healthy timing and spacing of pregnancy and infertility management. 23
- 24. Policy Diagnosis ASRH Implementation Guideline: provision of family planning services, safe abortion services, counseling and treatment services Priorities should be given. • RH strategy-1998: include family planning as a essential component • Family planning program is a key element of EHCS • FP services are available at each level of Health facility • The policy encourages partnership among NGOs, INGO, social marketing organizations, as well as private sector to complement and supplement government efforts. • FCHVs are to be mobilized to promote re-supply of oral pills. • Awareness programs on FP is to be increased through various IEC/BCC intervention • Active involvement of FCHVs and Mothers groups as envisaged by the revised National strategy for FCHV program 24
- 25. Administrative Diagnosis • MoHP, NHEICC, NHTC, Hospital, PHC, BHCC PHC/ORC, FCHVs and community Health Workers and Volunteers are key implementer for FP. • Timely supply of FP commodities at HFs • FP focal persons to guide the FP activities at district • Supportive Supervision and Monitoring. 25
- 26. Program Goal • To increase Utilization of both temporary and permanent family planning services among the men and women of Rupa rural municipality of Kaski district. 26
- 27. General Objectives • To encourage the eligible couple to utilize the FP services through practice of using FP methods in Rupa rural municipality of Kaski districts. 27
- 28. Specific Objectives • Participant will be able to know and list out different temporary and permanent family planning methods • Participant will be able to compare advantage and disadvantage of both types temporary & permanent family planning method • Participant will be able to identify common side effect contraceptive methods. • Participant will be able to choose appropriate family planning methods on their need of choice • Participant will be able to demonstrate appropriate ways of using temporary family planning method (like condom) • Participate will Start to practice of using FP methods. 28
- 29. Target Groups • Reproductive age of women of Rupa rural Municipality of Kaski District. • Total Participants will be 30 29
- 30. Methods and Media Methods: • Group Discussion and Short Lecture Media: • Flip Chart, • Poster, • Pamphlets • Success Story videos 30
- 31. Resources Management • Local Health facility staff will be used as facilitator. • School hall or VDC hall will be used for the Group discussion and Short lecture. • The Short lecture and group discussion program will be for 60 minutes. 31
- 32. 6. Implementing Strategies • The Health education program will be conducted on 2nd of Shrawan, 2076 for 1 days. Implementation of Health education programme will be done as described in Schedule. • Program will be implemented through the coordination of Health coordinator of Municipality, HF, HMG, FCHVs at community level. • Trained and skillful facilitator will be mobilized for the program • Required logistics/commodities will be managed and allocated for the program implementation on timely • Community engagement and participation for the program planning and implementations • Monitoring, recording and reporting of the program 32
- 33. Detail Plan of Action S.N Area of Messages Messages Materials Time 1 Introduction about FP - Meaning of FP - Situation about FP in Nepal - Discussion about local issues - Importance of FP Poster, Pamphlets, 15 Minute 2 Types of Family Planning Services/meth ods - Temporary and Permanent Poster, Pamphlets, flipcharts 15 Minute 3 Benefits and Limitations of the services and use of FP services - Pro & cons of FP methods (Including side effects - Techniques of use of FP Flipcharts, Demonstration 33
- 34. Detail Plan of Action S.N Area of Messages Messages Materials Time 4 Service availability - Services from Hospital, PHCC, BHCC - Services from PHC/ORC Clinics - Services by FCHVs - Services by Private and NGO/INGOs 15 Minute 5 Distribution of IEC Material -IEC materials - - 6 34
- 35. 7. Evaluation of Health Education Program 7. Process evaluation • Immediate activities at the time of group discussion and short lecture • Use of appropriate methods and materials for the sessions • Evaluation of the strategy/approaches used by the facilitator to conduct the discussion & lecture • Evaluation of the systematic way of presentation and the sessions. 35
- 36. 8. Impact Evaluation – Assessment of knowledge (through Pretest and post test evaluation) – Increase in utilization of both temporary & permanent family planning methods ( through reviewing health facility record monthly) – Impact Evaluation through community survey. 36
- 37. 9. Outcome Evaluation – Decrease early and teenage pregnancy – Population Control. – Enhancement in quality of life – Improvement in Maternal and Child Health status – Decreases the defaulter (drop out ) from temporary family planning methods – Increasing the contraceptive prevalence of temporary FP methods – Increase Use status of temporary family planning methods ( through reviewing health facility record at the end of year) 37
- 38. Follow up Without proper follow up, the program cannot be sustainable. So follow up will be done every month for two years by the help of FCHVs and health facilities staffs. 38
- 39. Bibliography • Nepal Demography Health Survay-2016 • Annual Report 2074/75 • National Health Sector Support Implementation Plan (2016-2021) • Essential Health Care Services report • ASRH Implementation Guideline-2002 39