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At least 73 records · Page 4Linked to original sources
PubMed1992

Restructuring federalism: the effects of decentralized federal policy on states' responsiveness to family planning needs.

The Reagan Administration sought to decentralize many federal programs by (1) consolidating categorical grants into black grants; (2) reducing their funding; and (3) relying more upon state fiscal support. This study examines the effects of this decentralist policy upon the federal family planning program. Two periods are analyzed: (1) FY 1976-1981, the period immediately prior to the Reagan Administration and (2) FY 1982-1987, the period during the Reagan Administration. Findings show that a more decentralized program produced less responsiveness to individual state needs for family planning, and that these effects could have been predicted from the previous period.

Family Planning Policy↗
PubMed1977

Successes and problems in family planning administration: experiences in two districts of Kerala, India.

The administrative organizations of the Ernakulam and Malappuram Districts' family planning programs during 1970-74 and the ways they dealt with typical problems of program organization are examined. Lack of personnel, poor staff morale, inadequate supplies, and political and religious opposition to various contraceptive methods, especially sterilization, existed to varying degrees in both districts' programs. The Ernakulam experience, involving mass sterilization camps that were part of an overall district development program, documents the effectiveness of a strong central leader. The Malappuram program illustrates, in contrast, the handicaps of poor areas where development programs were just beginning and administrative resources were overtaxed.

Community Health Workers↗
PubMedDate not supplied

The impact of service delivery frequency on family planning program output and efficiency.

Operations research is the study of factors that can be controlled by program administrators. Among such factors is the frequency of performing program activities. The present experiment, conducted in Lima, Peru during 1985-86, tested the impact of holding family planning post sessions once per month, twice per month, and weekly. Frequency was shown to have a major impact on program outputs, costs, and cost-effectiveness. Depending on the indicator, sessions held twice per month produced between 1.5 and 2.1 times the output of those conducted once per month. Weekly sessions produced between 1.3 and 1.6 times the output of those held twice per month. At an output level of nearly 11,200 visits per year, twice-per-month sessions were estimated to be 7-38 percent more cost-effective, depending on the indicator, than once-per-month sessions, and 6-28 percent more cost-effective than weekly sessions.

Community Health Services↗
PubMed1975

REALPOP: a mathematical model for resource allocation in population programs-results from a test in the Dominican Republic.

The structure of a computerized mathematical model for resource allocation in population programs (REALPOP) and its application to the Dominican Republic's national family planning program are described. The model integrates demographic and management science approaches in the analysis of resource allocation, program planning, goal evaluation, and growth strategies of a family planning program. It is designed primarily to aid administrative decision-makers. The Dominican National Population and Family Council (NPFC) established a goal of reducing the crude birth rate from its 1968 level of 48 per thousand population to 28 per thousand in 15 years. Further, the program has established a clear set of program plans and alternatives. This study investigates the implication of these plans for the program's stated goals.

Contraceptives, Oral↗
PubMedDate not supplied

Implenting family planning in a Ministry of Health: organizational barriers at the state and district levels.

1. Family planning occupied a subordinate position in the medical and health bureaucracy almost two decades after its introduction. Senior Ministry officials accorded low priority to formal program objectives, while the State Family Planning Officer, the highest state official concerned solely with the family planning program, suffered from a relatively subordinate position in the Directorate and a lack of authority and support. Within the medical profession, family planning was held in low esteem, and the medical and health bureaucracies did not have a mechanism for selecting personnel on the basis of interest and commitment. 2. Organizational adjustment to family planning in the Ministry of Health was a slow and painful process, absorbing the energy and attention of Ministry officials for almost a decade. The repeated reorganizations of the district setup revolving around the division of labor between medical, health, and family planning acitvities and between the rural and urban program, led to months of almost total inertia and detracted substantially from the supervisory capacity of the officials involved. 3. Decision making and guidance suffered from the quick turnover of the Secretary, the most powerful administrator in the Ministry. In Uttar Pradesh Secretaries stayed barely long enough to begin to understand the complex organizational setup of the program. 4. Multiple and often conflicting lines of authority characterized the relationships between the higher and lower echelons within the Ministry. This was accentuated when the District Family Planning Officer was placed under the administrative control of the District Magistrate. While intended to "energize" family planning through the association of the most prestigious and powerful district official with the program, this organizational arrangement resulted in conflicting instructions to the staffs of the primary health centers. 5. The organizational behavior of the Ministry of Health was shaped by the interplay of the various "professional cultures" of its key actors. The generalist administrators' short time horizon and eagerness to produce quantitative results clashed with the specialists' emphasis upon long-term goals and technical constraints; the politician's defense of the interest of his constituents clashed with the administrator's desire to defend his autonomy. The calculus of political survival made support for family planning goals a costly burden that few politicians have been willing to shoulder. As the party system does not reward the advocacy of family planning, ministers emphasize those programs within their ministry or those decisions within their discretion that correspond to the demands of their constituents.

Family Planning Services↗
PubMed1988

Which patient education strategies will pay off under prospective pricing?

As cost containment pressures mount under prospective pricing, patient education managers need to assure that appropriate educational strategies are implemented. This article reviews the evidence for nine educational strategies which demonstrate cost-saving potential under prospective pricing: pre-operative education, medication self-administration programs, outpatient education, discharge planning education, family education, peer educators, cooperative care units, early discharge programs and home health programs. Whenever possible, the diagnosis related groups (DRGs) to which these strategies apply are indicated. Finally, issues of patient education and quality of care are discussed.

Cost-Benefit Analysis↗
PubMedDate not supplied

Incentives and disincentives in the Indian family welfare program.

The Indian family welfare program has offered financial incentives since the early 1960s to both family planning motivators and acceptors of sterilization and the IUD. This article reviews the available evidence regarding the impact of incentives on the quality and quantity of family planning services in India. Administrative concerns related to the implementation of incentive programs are discussed, and the current debate on disincentives, as well as the brief period when disincentives were used, is summarized. The studies reviewed, though few in number and varying in quality and methodology, indicate that incentives to acceptors help to increase the level of contraceptive acceptance, especially when they are part of a well designed strategy of service delivery and client motivation. Incentives do not appear to have an adverse effect on quality of services and acceptors, and they do not seem to influence method choice. Disincentives, if they are used, should not impinge on fundamental individual rights of either the parents or the child.

Birth Intervals↗
PubMed1980

Teaching family planning management and evaluation skills.

In the last several years the need for training schemes in family planning programme administration has become increasingly apparent with the rapid growth of family planning services throughout the world. This paper reports on the development and use of a series of 16 practical classroom training exercises designed for teaching planning, management and evaluation skills. Each exercise can be introduced, worked and discussed in a morning or an afternoon. It is available in an individual booklet, which contains worksheets, blank tables and step-by-step instructions for working the exercise, along with a discussion of the skills being taught. Topics covered include demographic rates and concepts, the Dryfoos-Polgar-Varkey formula, risk factor analysis, target-setting, case load forecasting, service statistics, contraceptive supplies, manpower planning, couple-year of protection, cost-effectiveness, contraceptive use-effectiveness, life table techniques, numerator analysis, fertility pattern method, sampling methods and questionnaire design. These curriculum materials concentrate on imparting through the medium of actual experience a series of specific management techniques of a quantitative nature that will enhance the ability of the trainees to plan, administer and evaluate any family planning programme anywhere in the world. The exercises in this series have been tested in the family planning training programmes at Columbia University and at Downstate Medical Center in New York. They have also been used in WHO workshops in Thailand and Tanzania and in training programmes in France, Kenya and Nicaragua.

Family Planning Services↗
PubMedDate not supplied

Community participation in national family planning programs: some organizational issues.

Increasing the involvement of communities in implementing national family planning programs has been advocated as a means of increasing the acceptability, availability, and sustainability of services provided. This article reviews the nature and extent of community participation in the national programs of Bangladesh, China, the Republic of Korea, the Philippines, and Thailand by analyzing the structures and processes through which participation is organized. Across all five countries a similar pattern of participation has emerged in which a community-based delivery system is supported by the involvement of community leaders in activities that promote family planning. Active participation in planning and management functions is, however, virtually nonexistent. This limited form of participation is attributed to the bureaucratic organization of national family planning programs that seek to implement policies with explicit demographic goals. Given these goals and organizational structures, however, the pattern of organizing participation observed is probably the most appropriate. Consequently, policymakers should be wary of expecting greater involvement by community members in program implementation activities or in contributing resources unless consideration is given to reorienting the goals and organizing programs that meet needs that are directly relevant to families and communities.

Attitude↗
PubMedDate not supplied

Characteristics of contraceptive acceptors in Lusaka, Zambia.

This paper reports on a study conducted in Lusaka, Zambia in which 2,912 client records were examined in 22 randomly selected clinics throughout Lusaka Province. The purpose of the study was to assist the government and the local family planning association in targeting future efforts to extend services to underserved populations. Among newly enrolled acceptors in 1984, the study revealed a surprisingly low median age of 24 and a median parity of 3. The majority were married, had some secondary education, were unemployed housewives, and were breastfeeding at the time of the first visit. Nearly half had used contraceptives before. Over three-fourths of the clients received contraceptive pills when they enrolled. They returned to the clinic an average of 2.4 times during the first year, but only 24 percent were still active after 12 months. The availability of recently released census data allowed a comparison of contraceptive acceptors with women in the general Lusaka population. Data from urban clinics and smaller clinics in rural parts of the province revealed few significant rural-urban differences. Finally, the study examined trends in age, parity, and education of contraceptive users over a ten-year period.

Adult↗