RESUMO
PIP: The decision by the US Agency for International Development to terminate assistance to various family planning associations in the Western Hemisphere will reduce the budget of Colombia's PROFAMILIA by around 25% and force the association to replace the funds with local resources. Assistance is to be suspended as of July 1996. PROFAMILIA is in a phase of expansion as it seeks to increase its diversification activities, which comprise medical and surgical activities distinct from family planning. New national social security legislation and the tendency toward privatization of medical care have created a more competitive environment. PROFAMILIA must be cautious in raising its highly subsidized fees for family planning services because such increases could discourage contraceptive use by the target population of low income people. New, relatively well-remunerated contracts are being prepared with official and semiofficial agencies. The social marketing program is somewhat blocked by the appearance of new competitors. A new clinic for men near the PROFAMILIA headquarters in Bogota will offer a full range of medical and surgical services. PROFAMILIA is investing heavily in its Medellin clinic, which is second in importance only to Bogota, and is building a new and larger clinic in Cali. Facilities in other cities are being remodeled. The diversification program has been going well, but a slight slowing of growth in family planning programs has been noted in comparison with the record year of 1992. Contraceptive usage is at high levels but has not reached its maximum potential. Increasing coverage for large population groups in rural and marginal urban areas who are difficult and costly to serve will be the association's major concern for the coming months and years.^ieng
Assuntos
Administração Financeira , Planejamento em Saúde , Cooperação Internacional , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , América , Colômbia , Países em Desenvolvimento , Economia , Serviços de Planejamento Familiar , América Latina , América do SulRESUMO
PIP: This work constitutes a plea for the widest possible acceptance and encouragement of family planning throughout the world in order to avoid the irreversible environmental damage that will inevitably come with excessive numbers. Limitation of reproduction, preferably voluntarily, is possible by means of the effective and generally safe contraceptive methods now available. Preservation of the environment will require effective antipollution policies and an unwelcome control of the rampant consumerism of contemporary culture. Alarm among demographers in developed countries concerning exponential population increase developed about a half-century ago, only shortly after the feminist-led struggle for reproductive freedom provided a moral and juridical foundation for family planning. The demographic focus was not used to promote family planning among Third World countries, as that would have been viewed as heavy handed intrusion into the most intimate realm of domestic life. Instead, the nondemographic benefits such as improved maternal and child health and family well-being were stressed. It may be time to modify the focus. Ecologists must strive for a radical transformation of consumerist culture but must not ignore the pressure of numbers. Satisfying the needs of the world's most impoverished will greatly increase pressure on resources. Family planning has been accepted by the majority of the world's couples, but the unsatisfied demand has been estimated to amount to 100 million couples throughout the world. Providing information and services for such couples is the greatest challenge facing family planning programs. Many enemies of family planning have lost influence, but some critics from within family planning programs have deflected attention from the tasks of service delivery and may have postponed progress in some areas. Feminists who object to the concentration on female methods, developmentalists who believe that contraception will be accepted eventually as living standards improve, and integrationists who emphasize maternal-child health services to the detriment of family planning are examples. In view of the environmental threat as the twenty-first century dawns, the time may have come to view family planning not only as a right, but as a duty.^ieng
Assuntos
Estudos de Avaliação como Assunto , Planejamento em Saúde , Necessidades e Demandas de Serviços de Saúde , Filosofia , Controle da População , Crescimento Demográfico , América , Colômbia , Demografia , Países em Desenvolvimento , Economia , Serviços de Planejamento Familiar , América Latina , População , Dinâmica Populacional , Política Pública , América do SulRESUMO
PIP: Profamilia, the Colombian family planning association and the country's largest family planning provider, began diversifying its services in 1982 to offer prenatal care services as well as general medical consultations. The organization has since attempted to integrate quality assurance at all levels of operation. Specifically, Profamilia is aiming to provide care which is of sustainably high quality to satisfy present clients and attract new ones without overtaxing available organization resources, thereby prompting the eventual financial collapse of the programs and the failure to increase coverage especially among the middle and lower classes of the country. Drawing from the credo of modern corporate enterprise, "the client is always right," Profamilia listens and responds to clients' needs with the goal of making their satisfaction the ultimate objective. Moreover, organization staff receive regular training to motivate their receptiveness to client needs, while the pursuit of quality exists as a major goal at the managerial level. Profamilia regards quality maintenance and improvement as indispensable in program sustainability.^ieng
Assuntos
Agentes Comunitários de Saúde , Planejamento em Saúde , Necessidades e Demandas de Serviços de Saúde , Motivação , Pacientes , Gestão de Recursos Humanos , Relações Públicas , Qualidade da Assistência à Saúde , América , Comportamento , Colômbia , Países em Desenvolvimento , Economia , Serviços de Planejamento Familiar , Pesquisa sobre Serviços de Saúde , Relações Interpessoais , América Latina , Avaliação de Programas e Projetos de Saúde , Psicologia , América do SulRESUMO
PIP: The Colombian family planning organization Profamilia was recognized at the 1993 annual meeting of the Western Hemisphere Region of the International Planned Parenthood Federation (IPPF) for its efforts to achieve financial self-sufficiency. Because of the announced termination of annual assistance from the US Agency for International Development (USAID), one of Profamilia's most significant external donors, the pressure to achieve self-sufficiency has intensified. Funds will be made available to Profamilia before the termination of assistance to improve infrastructure, equipment, and training. A large quantity of contraceptives will also be provided, and a new endowment will be created by USAID from which Profamilia may use the earnings. Profamilia's strategy for achieving self-sufficiency consists of five specific tactics. Recuperation refers to a cautious but sustained increase in family planning fees. Diversification refers to the medical and surgical activities apart from family planning that Profamilia will carry out for profit. The social marketing program will be expanded and improved. The fourth tactic involves a series of unrelated mechanisms to generate income, and the fifth refers to reduction of all nonessential expenditures. The measures will be made without hurting the quality of Profamilia's services or improving the average socioeconomic profile of users, who will continue to belong primarily to the less favored classes. The continued assistance of the IPPF is especially important to Profamilia as it prepares for the change.^ieng
Assuntos
Planejamento em Saúde , Avaliação de Programas e Projetos de Saúde , América , Colômbia , Países em Desenvolvimento , Serviços de Planejamento Familiar , América Latina , Organização e Administração , América do SulRESUMO
PIP: Funds available for family planning programs throughout the world are increasingly scarce, but the need for investment in family planning is enormous. Government and private donors must be selective in their assignment of resources. The countries with the most obvious need for family planning investment are usually underdeveloped, while countries whose family planning programs have proven their capacity to utilize investments to the fullest tend to be more developed. Although it may appear that priority should be given to countries with the greatest need, several factors may reduce the return on such investments. The long experience of Profamilia in Colombian family planning suggests some criteria that should help orient decisions on resource allocation. Programs that provide a significant share of their country's family planning services should receive preference. Programs that are able to use the funds in a timely and efficient manner through good administration and elimination of unnecessary expenses, and programs oriented directly to provision of family planning services should be supported. The funds provided to each program should be managed with complete integrity, open and comprehensible in any audit or inspection. An additional criterion is that programs that have demonstrated significant self-sufficiency are deserving of continued support.^ieng
Assuntos
Países Desenvolvidos , Países em Desenvolvimento , Administração Financeira , Alocação de Recursos para a Atenção à Saúde , Diretrizes para o Planejamento em Saúde , Planejamento em Saúde , Cooperação Internacional , Economia , Serviços de Planejamento FamiliarRESUMO
PIP: In the late 1992, PROFAMILIA, the Colombian family planning association, was informed by the US Agency for International Development (AID) that the success of the family planning program in Colombia rendered further assistance from AID unnecessary. A period of 3 years dating from October 1992 was fixed for definitive suspension of aid. Currently, USAID assistance represents about 25% of PROFAMILIA's budget. The challenge will be to increase local generation of funds by about 8% per year. Several strategies have been proposed for increasing local generation of funds, including increasing the fees for all family planning activities, while bearing in mind that increases should not hinder acceptance of methods by a user population with limited resources. Another strategy would be to diversify PROFAMILIA's activities in fields different from family planning but not too distant from the area of reproduction in which PROFAMILIA has gained greatest experience and recognition. Marketing programs could be explained, and unnecessary costs cut to a minimum in order to increase productivity and efficiency. This would require meticulous administrative monitoring of costs. The final strategy would be to increase local donations and investments by the resource committee.^ieng
Assuntos
Administração Financeira , Órgãos Governamentais , Planejamento em Saúde , Cooperação Internacional , Organização e Administração , Avaliação de Programas e Projetos de Saúde , América , Colômbia , Países em Desenvolvimento , Economia , Serviços de Planejamento Familiar , América Latina , Organizações , América do SulRESUMO
PIP: It is probably not possible to implant a family planning program that will have a reasonable demographic impact in areas lacking awareness of the disadvantages of overly high fertility. Rural-urban migration, increasing educational levels, women's labor force participation, and declining infant mortality are all factors that have been found to correlate with demand for family planning services. It has been recognized since the Bucharest World Population Conference in 1974 that development and family planning are both required for the fertility transition to begin. Where these conditions exist, a family planning program appropriate to the needs, limitations, preferences, and expectations of the target population has an excellent chance of success. Expanded and improved coverage results from tailoring programs to the specific groups served. Most programs are directed toward women. It has been found most effective to provide services for men in separate sessions. It is also useful to distinguish between services for adolescents, who require more information and fewer services, for mature women who require more services than information, and for premenopausal women whose needs for information and services are both declining. Contraceptive preferences vary with social class, but family planning programs in developing countries should concentrate on the lower middle and lower classes which comprise 80% of the population. Rural areas and marginal urban areas require special attention. In order to provide services that will attract all potential users, the maximum possible variety of methods should be available. A family planning program offering a variety of methods throughout the country and financially accessible to the population should be successful. Family planning programs, whether public or private, require adequate financial resources and the support or at least tolerance of the government. Knowledge of contraception is now almost universal. A major challenge of family planning programs is to prompt women who say they want to limit their reproduction but who do not practice family planning to adopt a method. Program leadership and interpersonal relations with clients should be competent. The experience of PROFAMILIA in Colombia suggests that charging fees for all services offered by the family planning program is a positive feature allowing the client to avoid feeling like a charity recipient and the program to account for materials and services more easily. Goals and objective indicators stimulate performance and allow progress to be assessed. It is recommended that client education focus on a synthesis of information concerning available methods and provision of somewhat greater detail on the method chosen. Integration of services is usually an enemy of family planning because, despite theoretical advantages, it usually means neglect of family planning in favor of curative care.^ieng
Assuntos
Países em Desenvolvimento , Diretrizes para o Planejamento em Saúde , Planejamento em Saúde , Organização e Administração , Filosofia , Desenvolvimento de Programas , Educação Sexual , Educação , Serviços de Planejamento FamiliarRESUMO
PIP: Until relatively recently, sheer survival has been a more pressing concern of most human populations than has control of population growth through contraception. Today family planning with its varied technologies has become an accepted behavior of the majority of fertile couples. Colombia has achieved a satisfactory contraceptive prevalence rate largely due to private institutions. The decline from 6.5 to 3.5 children per woman that required 58 years in the US (1842-1900) required just 15 years in Colombia, according to UN data. Other UN publications demonstrate that family planning prevalence is strongly correlated with quality of life as measured by income, life expectancy, and education, with family planning and quality of life tending to improve simultaneously and coherently. Reproductive health might more appropriately be considered sexual health, since most couples wish to continue sexual relations without fear of unwanted pregnancy. Reproductive health defined as referring to fertile-aged women and children under 15 concerns around 2/3 of the population in developing countries. Although the reproductive health of a country depends in large measure on the physical and mental well-being of its women, discrimination against women in education health, employment, and participation is a serious problem in many countries. Accessibility of family planning is another indicator of women's status. The potential health benefits of avoiding births before age 20 and after 35, high parity births, and closely spaced births are well known. Avoiding all such births would reduce maternal mortality by 20-25% worldwide, saving 100,.000-125,000 maternal lives. Proper spacing would also combat infant mortality. Infant survival programs that omit family planning as a component are short sighted. Family planning has the important benefits of reducing recourse to abortion and of allowing savings in public services including health care, education, and nutrition. In the area of family planning, Colombia's PROFAMILIA continues to prefer a cafeteria approach in which numerous contraceptive options are available. It has been demonstrated that each new method increases the number of acceptors by 6% on average. The especially for women who want to terminate childbearing. Morbidity and mortality rates of the different contraceptive methods, even in the worst conditions, are lower than they would be if contraception were not used. Oral contraceptives, for example, are 4-5 times less risky than nonuse of contraception. PROFAMILIA is currently seeking authorization to use a new combined monthly injectable contraceptive called Cyclofem. The subdermal implant NORPLANT has been well accepted in Colombia.^ieng
Assuntos
Anticoncepção , Serviços de Planejamento Familiar , Planejamento em Saúde , Medicina Reprodutiva , Direitos da Mulher , América , Colômbia , Comportamento Contraceptivo , Países em Desenvolvimento , Economia , Saúde , América Latina , Fatores Socioeconômicos , América do SulRESUMO
PIP: This work assesses proposed changes in conversion factors for the family planning program indicator "couple years of protection", with a discussion of the proposed changes and citation of references for each method. Unlike most service statistics, couple years of protection allows the total family planning contribution of different contraceptive methods to be totalled and compared. Recently, the US Agency for International Development and the International Planned Parenthood Federation have proposed new conversion factors for calculating couple years of protection for most methods based on careful scrutiny of the average fecundity of method users, rates of continuation and failure, and waste. The fertility of users is not the same for all methods; most candidates for sterilization for example are older than users of oral contraceptives (OCs) or IUDs, and consequently their average fertility has declined. Neither are all methods equally effective, and the couple years of protection indicator should reflect these differences. The proposed conversion factor for OCs has been increased from 13 cycles per couple year of protection to 15 cycles to take into account the 6-20% of users who have been found to use the method incorrectly. 15 cycles was arrived at by assuming that 13% of users employ the method incorrectly. The proposed conversion factor for IUD is 3.5 years of protection per IUD instead of 2.5, on the assumption that of each 100 users, 10 would use the device for an average of 6 months, 45 for an average of 42 months, and 45 for an average of 76 months. The resulting total of 5370 months of use divided by 100 would yield 53.7 months. Subtracting 7% for the expected accidental pregnancies still yields 4 years and 11 months. The old measure of 2.5 years per IUD is apparently outdated. The proposed conversion factor for sterilization has been lowered from 12.5 couple years of protection to 10 per operation to reflect the higher average age and lower fecundity of sterilization acceptors. The revised conversion factor should help combat the excessive enthusiasm for sterilization of some family planning programs that neglect reversible methods appropriate for younger and more fecund women in favor of sterilization, which accumulates many couple years of protection without the same demographic impact. The proposed conversion factor for the condom has been changed from 1 couple year per 100 condoms to 1 per 150 condoms, to reflect the well documented failure rate of 10% per year, plus wastage due to poor storage and the difficult to evaluate but significant use of condoms for purely prophylactic rather than contraceptive purposes. The proposed conversion factor for vaginal creams, foams, and other spermicidal methods was also increased from 100 to 150, largely because of their higher failure rate. The proposed factor for Norplant implants is 3.5 per implant.^ieng
Assuntos
Comportamento Contraceptivo , Anticoncepção , Estudos de Avaliação como Assunto , Filosofia , América , Colômbia , Países em Desenvolvimento , Serviços de Planejamento Familiar , Planejamento em Saúde , América Latina , Avaliação de Programas e Projetos de Saúde , América do SulRESUMO
PIP: The most recent contraceptive prevalence survey in Colombia indicated that over 2/3 of couples at risk of conception used some contraceptive method in 1990. This figure is close to the 80% or over common in developed countries and far exceeds the rates of 10% or even less in sub-Saharan African countries. Colombia's prevalence rate of around 15% in 1965, the 1st year of institutionalized family planning programs, included many users of ineffective traditional methods. Family planning, the possibility of determining the number and spacing of children, can be analyzed from various perspectives including its legal foundation as a human right and the demographic benefits of reproductive moderation. A stable population size would substantially simplify the problems of health, education, housing, and employment faced by developing countries. From a humanitarian perspective, family planning satisfies the ancient desire of human beings to separate reproduction and sex and also opens the door to different techniques of medically assisted conception. Some of the most significant benefits of family planning are those in the area of health. The positive effects on maternal and infant health and survival of avoiding pregnancy at the extremes of the reproductive period as well as pregnancies that are too numerous or closely spaced are now recognized. Colombia's infant mortality rate has fallen from 100/1000 live births in 1965 to 24 in 1990. Many factors besides family planning were involved, and the exact contribution of higher educational levels of mothers, use of oral rehydration therapy, promotion of breastfeedings, greater availability of potable water, and vaccination programs as well as of family planning are difficult to assess. But it is clear that child survival programs that neglect to include modern contraception as a principal component are shortsighted. Infants of adolescent mothers face mortality rates that are 15-40% higher than those of mothers over 20. Beyond 35 years, the risk of producing offspring with genetic disorders or other serious pathologies begins to rise sharply. The mortality risk of these infants is 20% higher than among those of younger mothers. Too close spacing of infants increases the risk of mortality through 2 principal mechanisms; the mother's body has insufficient time to recover from the 1st birth, consequently increasing the risk of low-birth weight and associated morbidity and mortality, and the older child is prematurely weaned and otherwise displaced by the younger child. The maternal risk of death in developing countries is estimated to increase by 30% with each succeeding pregnancy. Simply avoiding births before 20 years and after 35 would lead to decline of 20-25% in the maternal death rate.^ieng
Assuntos
Anticoncepção , Serviços de Planejamento Familiar , Planejamento em Saúde , Mortalidade Infantil , Idade Materna , Mortalidade Materna , Bem-Estar Materno , Mortalidade , Fatores Etários , América , Colômbia , Comportamento Contraceptivo , Demografia , Países em Desenvolvimento , Saúde , América Latina , Pais , População , Características da População , Dinâmica Populacional , América do SulRESUMO
PIP: Rather than a commentary on a specific article, this work contains reflections on the concept of quality in provision of family planning services and its possible use to deflect family planning efforts. Quality is a difficult concept to define precisely. Applied to family planning, it may be defined as the totality of attributes possessed by a program that does not place impediments in the way of comfortable adoption of a contraceptive method. Another definition of quality, achievable only by a long list of ideal characteristics which are often expensive and sometimes unattainable, has been and continues to be used by enemies of family planning to slow its diffusion; they hold that if perfect quality is not offered, it is better to offer nothing. A specific tactic of this group is to oppose the quantity of services with their quality. The hard-fought campaign to discredit the measurement of concrete goals and results is part of this strategy. But it is apparent that without a reasonably satisfactory quality of service, no program would achieve significant growth. People would not continue to come, and in growing numbers, to a program where they received poor quality service. Each goal, each statistic, each percentage represents human problems confronted and resolved by programs and personnel. Profamilia has become 1 of the largest nongovernmental family planning organizations. Profamilia has always paid attention to the quality of its services and has conducted numerous studies to assess results and identify shortcomings. The high percentage of positive results attests to the quality of Profamilia programs. In an age of scarce resources and tight budgets, the objective of family planning programs is to provide an austere but acceptable quality of attention so that the quantity of services will be sufficient to meet demand. Program elements that have a real cost without offering a measurable benefit should be avoided. Another problem is that integrated programs that aim to combine family planning with maternal-child health or other services often end by neglecting the family planning component. Profamilia believes that good information should be provided with services, but it is limited to what is needed for proper and safe use of each method. And integration is not presently needed to disguise or dress up family planning programs. It is justifiable only when for political reasons there is no alternative or when it can provide other resources to subsidize family planning programs.^ieng
Assuntos
Eficiência Organizacional , Estudos de Avaliação como Assunto , Conhecimentos, Atitudes e Prática em Saúde , Planejamento em Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Avaliação de Programas e Projetos de Saúde , Qualidade da Assistência à Saúde , Projetos de Pesquisa , Educação Sexual , América , Atitude , Comportamento , Colômbia , Países em Desenvolvimento , Educação , Serviços de Planejamento Familiar , Pesquisa sobre Serviços de Saúde , América Latina , Organização e Administração , Psicologia , Pesquisa , América do SulRESUMO
PIP: Voluntary sterilization is the chosen family planning method of more couples worldwide than any other, evidence of its acceptability and lack of serious shortcomings. This work offers observations on training, counseling, supervision, cost-effectiveness, and acceptability of voluntary sterilization programs, and presents some results of Profamilia's program. Training of qualified medical personnel in the available techniques is a relatively simple. Profamilia has trained almost 1000 medical professionals, nearly half of whom were from other countries, but a legal technicality has forced Profamilia to curtail training of foreign professionals. It is much more difficult to train personnel to identify and inform potential clients about sterilization, promote the procedure, and provide follow-up, yet these program activities are crucial to a successful sterilization program. Counseling of couples is necessary and should include discussion of the greater convenience of vasectomy compared to tubal ligation. Sterilization should be presented as a permanent method. This permanence, often viewed as a disadvantage, has a positive side in freeing couples of the need for further consideration of family size or contraception and in protecting them against family and social pressures to have more children. Raising marriage age or family size requirements in the hope of avoiding regret does not appear justified. Assuring that sterilization is truly voluntary is a preoccupation of donors, but has not been a problem in Profamilia programs. All clients are required to make some payment and to sign a detailed consent form. Profamilia has been persuaded to discourage mental defectives from undergoing sterilization because of possible legal problems. Periodic, unannounced visits to clinics are recommended for quality control and supervision. Profamilia employs salaried medical personnel for sterilization when careful supervision is available to ensure that they do not unjustifiably reject applicants, and pays on a per-case basis otherwise. It is estimated that each Profamilia sterilization provides 12.5 couple-years of protection. Each sterilization costs US $ 33.20 on average, 60% of it for personnel costs. Profamilia offer highly subsidized services for its lower middle class clients and almost free services for its poorest 40% of clients. The financial strain is considerable for Profamilia, which carries out some 70,000 sterilizations each year at a cost of US $ 2.25 million, only 1/7 of it directly paid for by clients. Since 1973, Profamilia has performed over 700,000 tubal ligations. There have been 19 deaths, 9 attributed to surgical and 5 to anesthetic problems. There are minor complications in about 1% of cases. 26,401 vasectomies were performed through 1990, with 2 cases requiring hospitalization.^ieng
Assuntos
Análise Custo-Benefício , Aconselhamento , Educação , Emoções , Planejamento em Saúde , Administração de Serviços de Saúde , Consentimento Livre e Esclarecido , Organização e Administração , Aceitação pelo Paciente de Cuidados de Saúde , Gestão de Recursos Humanos , Avaliação de Programas e Projetos de Saúde , Esterilização Reprodutiva , Esterilização Tubária , Ensino , Vasectomia , Instituições de Assistência Ambulatorial , América , Comportamento , Colômbia , Anticoncepção , Comportamento Contraceptivo , Países em Desenvolvimento , Estudos de Avaliação como Assunto , Serviços de Planejamento Familiar , América Latina , Psicologia , América do SulRESUMO
The findings of three surveys and three studies used by Profamilia to evaluate and improve their voluntary female sterilization program are presented. The surveys measured sociodemographic characteristics of users, factors behind the sterilization decision, and user satisfaction with the operation in the short run and over time. The studies explored methodologies for more accurate cost-effectiveness analysis. Results of the projects were used by Profamilia management to identify areas of program strengths and weaknesses and to implement operational changes.
PIP: Profamilia is a nonprofit, private family planning organization based in Bogota, Colombia. To improve program performance, the findings of 3 surveys and 3 studies were used by Profamilia to evaluate and improve their female sterilization (FS) program. The surveys measured socio- demographic characteristics of users, factors behind the sterilization decision, and user satisfaction with the operation in the short run and over time. The studies explored methodologies for more accurate cost- effectiveness analysis. Results of the projects were used by the Profamilia movement to identify areas of program strengths and weaknesses and to implement operational changes. In 1970, Profamilia offered vasectomy; FS was offered in 1972. The vasectomy program was ineffective; however, FS was very successful. Approximately 72% of all procedures performed in Colombia are done by Profamilia. In 1972, 2 Colombian gynecologists, (1 from Colombia) were trained in Colombia to do FSs by doctors from Johns Hopkins Hospital. At present, Profamilia uses about 40 doctors directly, and contracts with others. Program evaluation is done by using cost-effectiveness evaluation to measure financial efficiency, survey analysis to measure general program efficiency and client satisfaction, and collection of service statistics to measure program output. The 1st survey was done in 1976 and 1977 to learn about user characteristics. The 2nd project was a 2-phase (retrospective-prospective) survey carried out in 1978-83. In 1985, Profamilia decided to do a follow-up survey in conjunction with Association for Voluntary Surgical Conception (AVSC). It emphasized factors influencing the decision to be sterilized. Sterilization acceptors were interviewed in 8 clinics in a nonrandom sample. 3 cost- effectiveness studies have been done on Profamilia's FS program. A departmental study determined the cost per couple year of protection offered by the 5 service departments of Profamilia; an accounting study determined the full unit cost per sterilization; and an organization-wide cost study determined how to assign indirect and shared costs of support divisions to service departments like sterilization.
Assuntos
Serviços de Planejamento Familiar/organização & administração , Esterilização Reprodutiva , Adulto , Colômbia , Custos e Análise de Custo , Aconselhamento/métodos , Estudos de Avaliação como Assunto , Serviços de Planejamento Familiar/economia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/organização & administração , Estudos Prospectivos , Estudos RetrospectivosRESUMO
PIP: Statistics and supervision are the basis of evaluating family planning programs (FPP), while sustaining the administration of the program on a day-to-day basis. Statistics permit administrators to diagnose and treat the problems found in FPP administration. A good administrator of FPP must know in the beginning of the year what will occur 12 months later. This knowledge assures the availability of funds, personnel and good management practices. PROFAMILIA of Colombia is used as an example of a private FP organization that is addicted to the collection and analysis of data for its operation. This institution has a very complete statistical base for its 48 clinics nationwide, its 3 basic programs, and its 18 grants from 16 donors. Reports are never more than 1 month behind, reflecting the philosophy of the institution. (Author's modified).^ieng
Assuntos
Coleta de Dados , Estudos de Avaliação como Assunto , Planejamento em Saúde , Organização e Administração , Filosofia , Avaliação de Programas e Projetos de Saúde , Instituições Filantrópicas de Saúde , América , Colômbia , Países em Desenvolvimento , Serviços de Planejamento Familiar , América Latina , Organizações , Pesquisa , América do SulRESUMO
PIP: Frequent surveys have produced detailed information on demographic trends in Colombia and the use of various contraceptive methods. The annual rate of population growth declined from 2.5% in 1974 to a projected 1.65% in 1987. The decline of 34% is 1 of the most significant in Latin America. The number of fertile aged women increased by 53% between 1974 and 1987, from 3,036,000 to 4,660,000, as the large cohorts born 15-25 years ago reached childbearing age. The distorted age structure represented by the large cohorts is a serious demographic challenge for the country and a logistical challenge for family planning programs. Although young fertile aged couples exhibit more moderate fertility behavior than their parents did, their larger numbers will cause the crude birth rate to increase. Contraceptive use has increased from 38% in 1974 to 63% in 1986 and possibly 65% in 1987. The number of women who must be supplied with contraceptives has increased from 1,150,000 in 1974 to a projected 3,000,000 in 1987. Among women using contraception in 1986, 25.4% used pills, 28.6% used sterilization, 17.4% used IUDs, 3.2% injectables, 3.2% each vaginal methods and condoms, 7.9% rhythm, 9.5% withdrawal, and 1.6% other methods. In 1976, 37.2% of women using contraceptives used pills, 11.6% sterilization, 23.2% IUDs, 14.0% rhythm, 11.6% withdrawal, and 2.3% other methods. In 1986, 17.4% of couples used the less effective methods of rhythm and withdrawal. In 1987, 9-10 million cycles of pills will be used, 110,000 IUDs will be inserted, 122,000 sterilizations will be performed, and 12 million condoms and the same quantity of vaginal tablets will be distributed. Much time consuming and complex training for natural family planning users will also be required. Colombia's success in family planning over the past 2 decades, despite a relatively unpromising start, was not due simply to the existence of demand for contraceptive information and services, which also was present in other Latin American countries which have not had such great success in family planning. Colombia's government has never openly opposed family planning, although successive administrations have varied in their degree of support. The success of Colombia's family planning program may have been due to the early creation of a dynamic and efficient private organization which introduced modern family planning the country and confronted the church, politicians, and physicians each time it was necessary. PROFAMILIA was created as a nonprofit nongovernmental organization in 1965 and has grown steadily ever since. At present it operates 40 family planning clinics and some 4000 community distribution posts. It provides about 60% of contraceptive services in Colombia. Another 20% is provided by the government and the rest by private physicians. 4 population subgroups are still underserved and require special program efforts: the very young, the rural population, the coastal population, and urban squatters.^ieng
Assuntos
Distribuição por Idade , Fatores Etários , Comportamento Contraceptivo , Atenção à Saúde , Demografia , Fertilidade , Planejamento em Saúde , Serviços de Saúde , Medicina , Características da População , Densidade Demográfica , Dinâmica Populacional , Crescimento Demográfico , População , Distribuição por Sexo , Fatores Sexuais , Comportamento Sexual , América , Colômbia , Anticoncepção , Países Desenvolvidos , Países em Desenvolvimento , Serviços de Planejamento Familiar , Saúde , Administração de Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , América Latina , Desenvolvimento de Programas , América do SulRESUMO
PIP: Human reproduction and development are contrasted; they are intimately linked despite the fact that they may be considered antitheses of each other from many points of view. Presently technological development and the advance of humans into every available corner of living space threaten to place the whole world environment in danger. The Green revolution of the 1960s addressed problems of underproduction of food for the world's population, without providing for the effective distribution of the new surpluses, and without addressing the problem of the ecological impact. 2 trends which are regarded by some with alarm: the migration of populations to the cities and the aging of the population with the connected burden on health care systems, are inevitable, and it is not clear that they are completely negative trends. Addressing these issues will have positive effects in the long run: congestion in the cities, the result of mechanization of rural industry which also results in a greater abundance of agricultural products necessary to society, should force serious consideration of problems such as solid waste management. Coming to terms with the costs of intervention to save lives among the very frail elderly and the prematurely born will have the effect of bringing controversial topics such as euthenasia and eugenics to discussion. The important role played by economic development in the braking of population expansion is underlined.^ieng
Assuntos
Países Desenvolvidos , Países em Desenvolvimento , Economia , Planejamento em Saúde , Filosofia , Dinâmica Populacional , Mudança Social , Planejamento Social , Problemas Sociais , Seguridade Social , Demografia , PopulaçãoRESUMO
Sterilization failure rates were computed using lifetable methods for sterilizations occurring between 1973 and 1982 in the Profamilia family planning clinic in Bogota, Colombia. Out of a total of nearly 45,000 sterilizations occurring during this period 503 sterilization failures were detected. Comparing methods, laparoscopy with the silastic band method had a significantly higher rate of failure, 1.5% after 5 years compared to 0.9% for laparoscopy with cautery and 0.6% for minilaparotomy.
Assuntos
Esterilização Tubária , Análise Atuarial , Colômbia , Feminino , Humanos , GravidezRESUMO
PIP: The question of whether family planning programs should be integrated with other activities or limited strictly to contraception has been debated for years without achievement of consensus. Profamilia, the Colombian family planning organization, has been a firm advocate of a vertical program without other activities. A large body of economic and demographic data and evaluations of numerous programs in numerous places support the Profamilia position that both economic development and family planning programs are important in achieving demographic objectives, but if only 1 is possible in a given country, a good family planning program gives better results. Profamilia, a private, nonprofit organization, is responsible for 2/3 of the contraception practiced in Colombia. Profamilia's success appears to demonstrate that an effective program, even in a country no more promising otherwise than any of its neighbors, can achieve excellent results. For government-run programs, it may be politically impossible to avoid an integrated family planning program; the public is likely to question the emphasis on family planning if other urgent health needs go unattended. But even government-run programs may create separate structures with separate funding and personnel for specific problems such as malaria control, suggesting recognition of their greater efficiency. A nongovernmental organization such as Profamilia, faced with a continuing struggle for funding, must concentrate its resources on fulfilling its mission of allowing couples to decide freely on the timing and extent of their reproduction. Vertical programs, tolerant if not enthusiastic governments, and abundant demand are the 3 factors that have led to high rates of contraceptive usage in some countries; sthe contraceptive prevalence rate is 60% in Colombia. A number of studies in the late 1970s and early 1980s have shown that funds directed to family planning have a far greater demographic impact than do equal amounts directed to rural female education, nutrition, or control of infant mortality. Verticality in a family planning program should be understood to include all activities that attract potential family planning acceptors, as well as all services which generate funds that can be channeled to family planning programs and that contribute to program efficiency. Pregnancy tests, Pap smears, gynecological or urological consultations, social marketing, antiparasite campaigns, and treatments of infertility, sexually transmitted diseases, or sexual dysfunctions are all appropriate components of a vertical family planning program. True and unacceptable integration views contraception as a remote and secondary goal, while the type of "false" integration described above views family planning as its epicenter and does everything possible to promote and facilitate contraception.^ieng
Assuntos
Atenção à Saúde , Estudos de Avaliação como Assunto , Instituições Privadas de Saúde , Planejamento em Saúde , Administração de Serviços de Saúde , Pesquisa sobre Serviços de Saúde , Serviços de Saúde , Medicina , Organização e Administração , Controle da População , Avaliação de Programas e Projetos de Saúde , América , Colômbia , Países Desenvolvidos , Países em Desenvolvimento , Política de Planejamento Familiar , Serviços de Planejamento Familiar , Programas Governamentais , Saúde , América Latina , Política , Política Pública , América do SulRESUMO
PIP: The problem of the unwanted child is a most grievous aspect of the complex of negative factors associated with underdevelopment. Although the problem of the unwanted child exists in industrialized countries as well, the incidence is much higher in the 3rd world. In industrialized nations modern contraceptives are widely available, public awareness of them is high, and legal abortion may be an option in the event of contraceptive failure or nonuse. In Colombia alone, nearly 1 million women are living in immediate danger of an unwanted pregnancy. In the 3rd world as a whole there are an estimated 150 million who do not want another pregnancy but who lack access to contraceptive information and services. Research from a variety of sources suggests that being unwanted and unloved can have a lasting effect on a child's development. Sociological research confirms the need to preserve the bond between mother and child. Studies of adopted children have established a clear relationship between their physical and psychological development and the age at which they were adopted. If this affective bond is not established in the early months of life, the negative effects which result may prove difficult to overcome. Yet, however late it comes, adoption is always preferable to the relative deprivation a child experiences when institutionalized. Studies conducted in Eastern Europe comparing children whose parents had requested an abortion but had not been granted permission with a control group of children revealed a pattern of inferior physical development and social adjustment in the 1st group. Intelligence, in addition to its important genetic foundation, requires physical nurturing and psychological stimulation from the surrounding environment, provided during the final months of pregnancy or the 1st few years of life. Religious doctrine postulates that universal maternal instinct allows the mother to overcome her problems, but this is often not the case. Infanticide dates back to the dawn of history. Access to contraception and legalized abortion have minimized the occurrence of unwanted births. Where effective family planning services are unavailable, there are more subtle and crueler ways of limiting family size. The incidence of the unwanted child could be drastically reduced by extending to all families the wide variety of modern contraceptives now available and by offering medical abortion services to those who want them.^ieng