RESUMO
PIP: This article discusses the utility of performing cost analysis of family planning (FP) personnel resources by relying on a system analysis framework in developing countries. A study of a national provider that distributes 16% of all FP services in Mexico found that more efficient use of staff would increase the number of clients served. Nurses and doctors worked slightly more than 6 hours/day, and 38% of a nurse's time and 47% of a physician's time was spent in meetings, administrative duties, unoccupied work time, and personal time. The Mexican government proposed increasing the work day to 8 hours and increasing to 66% the portion of the work day spent on direct client activity. With this change, services would increase from 1.5 million couple-years of protection (CYP) to 1.8 million CYP in 2010, without additional staff, and CYP cost would decline. CYP costs could potentially be reduced by increasing the number of contraceptive units provided per visit and switching from a 1-month- to a 3-month-duration injectable contraceptive. A Bangladesh study found that CYP costs could be reduced by eliminating absenteeism and increasing work time/day by 1 hour. Cost studies can address specific human resource issues. A study in Thailand found that Norplant was more expensive per CYP than injectables and the IUD, and Norplant acceptors were willing to switch to other effective modern methods. The Thai government decided to target Norplant to a few target groups. Staff time use evaluations can be conducted by requiring staff to record their time or by having clients maintain records of staff time on their health cards. The time-motion study, which involves direct observations of how staff spend their time, is costly but avoids estimation error. A CEMOPLAF study in Ecuador found that 1 visit detected almost as many health problems as 4 visits. Some studies examine cost savings related to other services.^ieng
Assuntos
Agentes Comunitários de Saúde , Análise Custo-Benefício , Países em Desenvolvimento , Mão de Obra em Saúde , Organização e Administração , Fatores de Tempo , América , Ásia , Sudeste Asiático , Demografia , Economia , Equador , Estudos de Avaliação como Assunto , Serviços de Planejamento Familiar , Planejamento em Saúde , América Latina , México , América do Norte , População , Dinâmica Populacional , América do Sul , TailândiaRESUMO
PIP: Condom use is central to the prevention of AIDS among people at risk for contracting HIV. As such, condom use is increasing dramatically even though many men say that they do not like using them. Condom sales through social marketing campaigns have increased dramatically in some countries, where tens of millions of condoms are sold annually. For example, during the period 1991-96, annual social marketing sales increased about five-fold in Ethiopia to 21 million, and nine-fold in Brazil to 27 million. These sales reflect the success of condom social marketing campaigns in making condoms accessible and largely affordable. There is also a greater general awareness of AIDS than there used to be, and communication campaigns have shown that condoms are an effective solution. More condoms still need to be used in the ongoing struggle against HIV/AIDS. The author discusses the factors which affect the limited acceptance of condoms, condom use outside of marriage, social marketing, and family planning programs.^ieng
Assuntos
Síndrome da Imunodeficiência Adquirida , Preservativos , Comportamento Contraceptivo , Infecções por HIV , Comportamentos Relacionados com a Saúde , Marketing de Serviços de Saúde , Comportamento Sexual , Infecções Sexualmente Transmissíveis , África , África Subsaariana , África Oriental , América , Comportamento , Brasil , Anticoncepção , Países em Desenvolvimento , Doença , Economia , Etiópia , Serviços de Planejamento Familiar , Infecções , América Latina , América do Sul , VirosesRESUMO
PIP: Condoms must be used correctly and consistently in order to prevent sexually transmitted diseases (STDs) and pregnancy. However, consistent use demands sustained behavior patterns. In a project with International Planned Parenthood Federation affiliates in Brazil, Honduras, and Jamaica, the counseling of women has moved away from emphasizing contraceptive methods, side effects, and correct use, to the more broad context of women's sexuality and risk of STD infection as a means of promoting behavior change. Providers use a sexuality-based approach in which they confer with women about their current sex partners, past partners, whether their partners travel for work, whether they think their partners may have other sex partners, and how those factors relate to the risk of STD infection. The project has also aggressively taught men about STDs and condom use, and involves men in counseling. One study has found that people who choose condoms as their main contraceptive method need more counseling than people who use condoms as a backup method, since primary users may have underestimated the difficulty of using condoms at every act of sexual intercourse. Furthermore, counseling appears to increase condom use when it involves both men and women in a monogamous relationship.^ieng
Assuntos
Preservativos , Comportamento Contraceptivo , Aconselhamento , Agências Internacionais , Comportamento Sexual , Infecções Sexualmente Transmissíveis , Instituições de Assistência Ambulatorial , América , Brasil , Região do Caribe , América Central , Anticoncepção , Demografia , Países em Desenvolvimento , Doença , Serviços de Planejamento Familiar , Fertilidade , Planejamento em Saúde , Honduras , Infecções , Jamaica , América Latina , América do Norte , Organização e Administração , Organizações , População , Dinâmica Populacional , América do SulRESUMO
PIP: The Association Demografica Salvadorena, the largest family planning provider in El Salvador, added sexually transmitted disease (STD) prevention, diagnosis, and treatment to its program in 1993. Family planning and STD services are integrated in all 5 Association clinics, including a specialized adolescent clinic, and training in STD management has been provided to 40 physicians from other agencies. This process began in 1990, when the Asociacion established an STD clinic, the first in the country, an annex to a family planning clinic in San Salvador. Medical consultation, treatment, follow-up, contact tracing, and outreach to high-risk sites such as brothels were provided. There have been no problems with using the same waiting room for STD and family planning clients. Of concern, however, is the need for more aggressive outreach to youth under 20 years of age--the group at highest risk of STDs, including acquired immunodeficiency virus. Under the direction of the International Planned Parenthood Federation (IPPF)/Western Hemisphere Region's integration project, family planning programs in Jamaica, Brazil, Honduras, Antigua, Guatemala, Puerto Rico, and St Lucia have also added staff training in STDs, client counseling on STD prevention, and condom promotion to their program activities. STD diagnosis and treatment are not provided, however. Concerns that STD would dilute the effectiveness of the family planning programs by meeting the reproductive and sexual health needs of clients in a more comprehensive way.^ieng
Assuntos
Instituições de Assistência Ambulatorial , Planejamento em Saúde , Medicina Reprodutiva , Infecções Sexualmente Transmissíveis , Ensino , América , América Central , Países em Desenvolvimento , Doença , Educação , El Salvador , Serviços de Planejamento Familiar , Saúde , Infecções , América Latina , América do Norte , Organização e AdministraçãoRESUMO
PIP: Recent reviews suggest that the addition of programs aimed at preventing and controlling sexually transmitted diseases (STDs), specifically human immunodeficiency virus (HIV), to existing family planning programs does not necessarily dilute overall program effectiveness. In Colombia, Mexico, and Jamaica, where condom distribution and/or information to prevent HIV transmission was integrated into the activities of family planning field workers, no negative effect on the image of condoms as a pregnancy prevention method was observed and there was a great demand on the part of family planning clients for information about acquired immunodeficiency syndrome (AIDS). In Brazil, family planning staff are receiving training in HIV risk assessment and the counseling of women in partner negotiation skills. However, steps must be taken to reach men since it is their high-risk behavior that puts most women at risk of HIV. Both separate STD clinics for men and condom social marketing projects have yielded promising results. Obstacles to the addition of STD services to family planning programs include the need to treat male partners as well as female clients, a shortage of diagnostic tools and antibiotics for treatment, and the fact that the majority of women with STDs are asymptomatic. Indicative of the increased attention being given this approach, however, is the recent release of guidelines by the US Agency for International Development Office of Population on how family planning programs should approach integration. Suggested activities include condom promotion, behavior change, counseling, information, contraceptive development, and selected efforts at STD treatment.^ieng
Assuntos
Publicidade , Instituições de Assistência Ambulatorial , Preservativos , Infecções por HIV , Planejamento em Saúde , Infecções Sexualmente Transmissíveis , Ensino , América , Brasil , Região do Caribe , Colômbia , Anticoncepção , Países em Desenvolvimento , Doença , Economia , Educação , Serviços de Planejamento Familiar , Infecções , Jamaica , América Latina , Marketing de Serviços de Saúde , México , América do Norte , Organização e Administração , América do Sul , VirosesRESUMO
PIP: A recent $168 million 5-year cooperative agreement funded by the US Agency for International Development combines elements of its earlier AIDSTECH and AIDSCOM projects under the AIDS Control and Prevention Project (AIDSCAP). Instead of working to effect broad-scale behavior change toward the prevention of HIV transmission, AIDSCAP strategically targets locations for condom distribution, behavior change messages, and the treatment of sexually transmitted diseases. In Lagos and the states of Cross River and Jigawa where the AIDS epidemic is firmly established, for example, AIDSCAP is intervening to increase condom demand and accessibility; alter sexual behaviors which carry a high risk for HIV transmission; and reduce the prevalence of STDs which enhance the transmission of HIV. The project began in fall of 1991 and has expanded to include Ethiopia, Kenya, Malawi, Nigeria, Rwanda, Senegal, Brazil, Haiti, Jamaica, India, and Thailand; limited assistance is also provided to 7 other African countries, 4 Latin America countries, and 1 in Asia. 4 more countries are in the final stages of negotiations to be included in the project. The USAID mission in the host country and the government must invite AIDSCAP involvement in order for the country to attain priority status. Countries are selected based on the HIV prevalence rate, population size and distribution, level of commitment to HIV prevention/control, capacity to respond to the AIDSCAP plan of action, level of other donor support, the USAID Mission's development priorities, and the Mission's commitment of substantial funds from its own budget. Once involved, AIDSCAP is mandated to implement interventions through in-country agencies.^ieng
Assuntos
Síndrome da Imunodeficiência Adquirida , Preservativos , Comportamento Contraceptivo , Atenção à Saúde , Órgãos Governamentais , Infecções por HIV , Acessibilidade aos Serviços de Saúde , Cooperação Internacional , Pesquisa , Comportamento Sexual , Infecções Sexualmente Transmissíveis , Terapêutica , África , África Subsaariana , África Oriental , África do Norte , África Ocidental , América , Ásia , Sudeste Asiático , Comportamento , Brasil , Região do Caribe , Anticoncepção , Países em Desenvolvimento , Doença , Economia , Etiópia , Serviços de Planejamento Familiar , Administração Financeira , Haiti , Planejamento em Saúde , Índia , Infecções , Jamaica , Quênia , América Latina , Malaui , Nigéria , América do Norte , Organização e Administração , Organizações , Ruanda , Senegal , América do Sul , Tailândia , VirosesRESUMO
PIP: The UN Population Fund contends that it is the need for family planning (FP) information and services instead of lack of interest that prevents men from participating more in FP. 3 pilot projects in Pakistan, Zimbabwe, and Colombia have acted on this belief. In geographically isolated Mardan, Pakistan, the all male Urban Community Developing Council (UCDC) started a community education project to involve men in FP. 5 UCDC member form 1 community educator team of which there are 60. The teams visit families in Mardan. In 1988, 1 team reported that some men in the households wanted a women to inform their wives about FP. Eventually UCDC located enough women free to be members on 40 teams. In 4 years, contraceptive prevalence among married couples rose from 9% to 21%. Initially the methods tended to be temporary methods but are now longer lasting methods (IUDs, sterilization, injectables, and even a few vasectomies). Other community groups donate about US$541/month to the project. In 1988, the Zimbabwean National Family Planning Council (ZNFPC) began its national education/male motivation project which included sending messages via popular radio soap opera, discussions, and leaflet distribution. The program reached many rural men since they tend to have radios. In 1 year, more men were taking part in decisions about FP (25-35%). ZNFPC has learned it needs to design 2 campaigns to promote condom use: 1 for single and 1 for married men. PROFAMILIA in Colombia began its 1st male clinic in 1985 in Bogota. By 1992, it had 8 male clinics. The key to its success is attractive clinics, low cost vasectomy, individualized care, wide range of services such as condom distribution and treatment of sexually transmitted diseases, and Saturday hours. Despite the 3 projects' successes, they face many obstacles that need to be addressed.^ieng
Assuntos
Comunicação , Anticoncepção , Tomada de Decisões , Estudos de Avaliação como Assunto , Planejamento em Saúde , Motivação , Projetos Piloto , África , África Subsaariana , África Oriental , América , Ásia , Comportamento , Colômbia , Países em Desenvolvimento , Serviços de Planejamento Familiar , América Latina , Paquistão , Psicologia , Pesquisa , América do Sul , ZimbábueRESUMO
PIP: STD prevention efforts in Latin America, particularly in the Dominican Republic, have begun to stress the need for behavioral changes. Traditionally, the professional public health community has focused on secondary prevention of STDs -- detection and treatment of the disease in order to prevent complications from developing. But in light of the AIDS epidemic, greater attention has been paid to primary prevention. Hoping to prevent the disease from occurring, primary prevention efforts target high risk groups (prostitutes and their clients and young people) with health education and promotion of behavioral change. Such changes include using condoms, seeking medical care for STDs, and decreasing the number of sex partners. An example of primary prevention programs is the Avancemos Project in the Dominican Republic. Launched in 1989 by the country's Ministry of Health and Family Health International's AIDSTECH Division, the project targets sex workers with several intervention measures. Initially, the Avancemos Project trained 16 sex workers to serve as peer educators to distribute condoms and educational materials. These 16 volunteers have in turn trained more than 300 other peer educators. Among the educational materials distributed by the peer educators are 2 comic books entitled "Martiza's Advice" and "The Triumphs of Maritza." A handsome, well dressed, and street-wise sex worker, the title character in these comic books instructs on a range of issues, including how to negotiate with clients how to use a condom. As those involved with the project attest, the comic books have become extremely popular among the target group, tapping into the women's buried feelings of self-worth.^ieng
Assuntos
Síndrome da Imunodeficiência Adquirida , Preservativos , Atenção à Saúde , Comportamentos Relacionados com a Saúde , Educação em Saúde , Necessidades e Demandas de Serviços de Saúde , Meios de Comunicação de Massa , Grupo Associado , Pesquisa , Infecções Sexualmente Transmissíveis , Ensino , América , Comportamento , Região do Caribe , Comunicação , Anticoncepção , Países em Desenvolvimento , Doença , República Dominicana , Educação , Serviços de Planejamento Familiar , Infecções por HIV , Conhecimentos, Atitudes e Prática em Saúde , Planejamento em Saúde , Infecções , América Latina , América do Norte , Organização e Administração , Comportamento Sexual , VirosesRESUMO
PIP: Approximately 75 prostitutes have been working in Cuidad Juarez as peer health educators for the past 2 years, talking with other prostitutes in bars and brothels about how to prevent the spread of HIV infection and persuade customers to use condoms. Recently, however, they have begun moving beyond their regular work sites to a different section of the city where prostitutes work independently on the street and in dance halls. This project is just one of 28 efforts in 22 developing countries around the world supported since 1987 by AIDSTECH. Through the programs, approximately 600 peer educators have taught 21,000 prostitutes about AIDS. In all of the projects, the peer educators promote condom use and, in many projects, they also distribute condoms. The peer education model may be the best way to change high-risk behaviors among groups of people not easily reached through formal institutions.^ieng
Assuntos
Síndrome da Imunodeficiência Adquirida , Países em Desenvolvimento , Infecções por HIV , Educação em Saúde , Organizações , Grupo Associado , Pesquisa , América , Comportamento , Comunicação , Doença , Educação , Conhecimentos, Atitudes e Prática em Saúde , América Latina , México , América do Norte , Comportamento Sexual , VirosesRESUMO
PIP: The Mexican Institute of Social Security (IMSS) provides a postpartum family planning program offering information and available contraceptive options. 356,000 postpartum women received contraception through this program in 1989. It is estimated that 136,000 of these women would not have received any contraception without the assistance of this postpartum program. 40% of the family planning services in Mexico are currently being provided by IMSS. Contraception is recommended for postpartum women with and without reproductive risk factors. Staff training, prenatal contraceptive counseling, and selection of contraceptive methods are essential in implementing a successful program. IMSS consists of 311,000 employees, 900 outpatient clinics, and 200 hospitals offering obstetrical and gynecological services. Counseling is provided in prenatal care regarding available contraceptive methods and their side-effects. Available methods offered through IMSS postpartum services include IUDs, female sterilization, and progestin-only oral contraceptives. In 1989, 79% of urban contraceptor acceptors chose IUDs, 30% chose sterilization, and 1% chose the mini- pill. IMSS hopes to expand this selection to include injectables, implants, and male sterilization. Future expansion of these new methods is dependent upon physicians accepting and encouraging their use.^ieng