RESUMO
PIP: The percentage of people living in poverty in Nicaragua's cities has increased significantly in recent years and reflects an increase in the number of households headed by women. Among the nongovernmental organizations created to help meet the needs of Nicaragua's population is Profamilia, the International Planned Parenthood Federation affiliate founded in 1971. Profamilia offers high quality sexual and reproductive health services at regional clinics operating in 9 out of 16 political subdivisions and manages a nationwide network of over 1000 community-based contraceptive distribution posts. Knowledge of modern contraception is almost universal in Nicaragua, and a 1992-93 health survey revealed that almost half of women of reproductive age were using contraception. Profamilia uses the mass media and other means to advertise its services, which are preferred by many over the free government services. In the communities, trained volunteer promoters distribute contraceptives and provide counseling. Because adolescent pregnancy and fertility rates are high, Profamilia has developed services, including educational workshops, that target youth. These workshops offer information on responsible sex behavior and ways to reduce the risk of pregnancy or infection. In addition, Profamilia offers training courses for teachers and educational sessions for parents, pregnant adolescents, and adolescent parents.^ieng
Assuntos
Instituições de Assistência Ambulatorial , Atenção à Saúde , Estudos de Avaliação como Assunto , Planejamento em Saúde , Agências Internacionais , Pobreza , Gravidez na Adolescência , Ensino , América , América Central , Demografia , Países em Desenvolvimento , Economia , Educação , Serviços de Planejamento Familiar , Fertilidade , Saúde , Instalações de Saúde , América Latina , Nicarágua , América do Norte , Organização e Administração , Organizações , População , Dinâmica Populacional , Comportamento Sexual , Fatores SocioeconômicosRESUMO
PIP: INPPARES, the International Planned Parenthood Federation affiliate in Peru, has provided family planning and other services to the Peruvian population since 1976. The organization concentrates upon interventions targeted to women of low socioeconomic status. One of the group's most important strategies has been to distribute contraceptives at the community level in rural and peri-urban areas of the country through a network of centers managed by promoters. These promoters are virtually all female. The organization in 1993 supplied 812 distribution centers. Promoters and their supervisors have received training in contraception, basic data recording, community work, and related topics. INPPARES, however, suspected that the quality of the project would be improved if promoters and supervisors were trained about the role of women in the community and their rights and identity as women. The personnel would then be able to better understand the role of contraception and reproductive health in women's lives. To that end, INPPARES in 1992-93 developed a project in coordination with the Manuela Ramos Association, a Peruvian women's organization. A questionnaire was given to forty promoters on issues related to women's roles, values, attitudes, the place of women in society and the family, family planning, sexual relations, and decision making. Their responses pointed to a real need to provide promoters and supervisors with more information through workshops on women in Peruvian society, women's identity and roles, women's sexual rights, and the quality of care in service provision. Four pamphlets were drafted from a seminar of fifty supervisors from both organizations to be used in a series of twelve workshops for 256 promoters. Post-intervention evaluation of the original forty participants confirm the significant effectiveness of both subjects covered and materials used in achieving desired project goals. Four workshops were subsequently held in which project results were presented to 261 promoters. Promoters and supervisors are now using flipcharts and pamphlets in their training activities.^ieng
Assuntos
Publicidade , Atitude , Atenção à Saúde , Agências Internacionais , Conhecimento , Pobreza , População Rural , Ensino , Direitos da Mulher , América , Comportamento , Demografia , Países em Desenvolvimento , Economia , Educação , Planejamento em Saúde , América Latina , Marketing de Serviços de Saúde , Organizações , Peru , População , Características da População , Psicologia , Comportamento Social , Classe Social , Fatores Socioeconômicos , América do SulRESUMO
PIP: 590 family health promoters work with the Salvadoran Demographic Association (ADS) to bring health care and family planning services to communities and individuals in need throughout the rural areas of El Salvador. In the 592 communities served by the association in 1992, family planning services and primary health care were promoted and provided to mothers and children, with cases needing major attention being referred to ADS's network of 38 reference doctors and clinics, or to public health centers. The promoters have potential family planning acceptors complete a detailed questionnaire to best determine which method of contraception is most appropriate and which, if any, may be contraindicated. The author describes the case of one such promoter of family health who is a certified midwife, a rural paramedic, a community leader, an health care volunteer, and a rural distributor of contraceptives working with ADS for the past ten years. She spends four hours every day wandering around searching for people in need of family planning, but have no access to contraception.^ieng
Assuntos
Publicidade , Atenção à Saúde , Planejamento em Saúde , Necessidades e Demandas de Serviços de Saúde , Pesquisa , População Rural , América , América Central , Demografia , Países em Desenvolvimento , Economia , El Salvador , Serviços de Planejamento Familiar , América Latina , Marketing de Serviços de Saúde , América do Norte , População , Características da PopulaçãoRESUMO
PIP: In Nicaragua, the recently opened Regional Family Planning (FP) Center in the capital of Chontales Province provides a variety of FP services to the 60,000 citizens of Juigalpa. These services include counseling, laboratory exams, gynecologic exams, and voluntary sterilization. the Asociacion Pro Bienestar de la Familia Nicaraguense (PROFAMILIA) opened the center, since FP services have been neglected in this province as compared to access to these services in the large population centers of Managua and Leon. A recent contraceptive prevalence survey shows that contraceptive prevalence in urban areas of Nicaragua is 62%, while it is just between 13-15% in rural regions, like Chontales and Zelaya. The center will also run a community distribution program for Chontales. As of May 1993, it had 25 community distribution posts in the region, providing contraceptives and training volunteers. PROFAMILIA hopes to open another regional center in Chinandega in the western part of Nicaragua in 1993. It plans on opening a central clinic in Grenada, the third largest city, to serve 120,000 people from Grenada and the small communities surrounding Grenada.^ieng
Assuntos
Técnicas de Laboratório Clínico , Anticoncepção , Aconselhamento , Atenção à Saúde , Órgãos Governamentais , Planejamento em Saúde , Exame Físico , Esterilização Reprodutiva , Instituições de Assistência Ambulatorial , América , América Central , Comportamento Contraceptivo , Países em Desenvolvimento , Diagnóstico , Serviços de Planejamento Familiar , América Latina , Nicarágua , América do Norte , Organização e Administração , OrganizaçõesRESUMO
PIP: The Program of Information, Education, and Services for Basic Family Health Care in Magdalena Medio and Bajo was designed to increase knowledge and use of contraception and to improve basic health practices and nutrition in the region, which includes municipios belonging to 9 different departments and a total population of 1,720,000. Poverty levels in the area are high. During the 1st year of the project, which was underway from February 1988-May 1991, home visits were made to inform each family about basic family health, to weigh and measure children under 5 not receiving health care elsewhere, and to refer families to the nearest health services. Talks were presented to small groups on family planning, intestinal parasites, sexually transmitted diseases, nutrition, vaccination, cancer prevention, malaria, acute diarrhea, and acute respiratory infection. Community workshops were presented in the 2nd year. Community distribution posts were created for contraceptive and other health product distribution. Information and communication materials from PROFAMILIA were used, and other materials were specially designed for the project by the Foundation for Development of Health Education in Colombia. PROFAMILIA's system of service statistics was used for quantitative evaluation of the information and education activities and sales of contraceptives, antiparasitics, and oral rehydration packets of each instructor. In the 3 years of the program, 89.086 cycles of pills, 398,772 condoms, 29,080 vaginal tablets, 209.791 antiparasitics, and 49,305 oral rehydration packets were sold. 9295 talks were presented to 143,227 residents of the region. 22,000 children were enrolled in the growth monitoring program, and almost 40,000 women were referred for prenatal care and cytology. The instructors gave 900 talks to distributors of contraceptives, antiparasitics, and oral rehydration packets. Surveys of women aged 15-49 residing in the municipios covered by the project were conducted at the beginning and end of program activities in order to assess project impact. 1673 women were interviewed in the 1st survey in June-July 1988 and 1660 were interviewed in the 2nd survey in March-April 1991. In general terms, the region of Magdalena Medio and sand Bajo showed important changes in contraceptive prevalence, maternal-child health, knowledge of AIDS, and family violence over the 3 years of the project. Knowledge of contraception improved throughout the region, especially in rural areas. The proportion of women in union using a method increased from 56.7% to 58.0%. There were no overall changes in the proportions of children vaccinated.^ieng
Assuntos
Atenção à Saúde , Educação em Saúde , Planejamento em Saúde , Pobreza , Avaliação de Programas e Projetos de Saúde , Pesquisa , Educação Sexual , América , Colômbia , Países em Desenvolvimento , Economia , Educação , América Latina , Organização e Administração , Classe Social , Fatores Socioeconômicos , América do SulRESUMO
In 1984, the Honduran Family Planning Association launched a contraceptive social marketing program by introducing the oral contraceptive, Perla. This report examines the impact of the program on overall oral contraceptive use, use by particular subgroups, source of supply, and costs. Although use of oral contraceptives increased only slightly over the period 1984-87 (from 12.7 percent to 13.4 percent among women in union aged 15-44), the social marketing program significantly increased its share of the oral contraceptive market (from 7 percent in 1984 to 15 percent in 1987, and from 20 percent to 40 percent of sales at pharmacies). For the Honduran Family Planning Association to have realized cost savings as a result of clients switching from community-based distribution programs and commercial supply sources to contraceptive social marketing programs, the association would have had to reallocate its resources. Instead, the number of distributors in the community-based distribution program increased, while the amount of couple-years of protection from oral contraceptives decreased.
PIP: Researchers used data from 2 national surveys of maternal-child health and family planning (1984 and 1987) and from a 1989 study of economic costs by method and program to examine the impact of the contraceptive social marketing program of the Honduran Family Planning Association (ASHONPLAFA). ASHONPLAFA launched the program in 1984 by introducing the oral contraceptive (OC) Perla. Between 1984 and 1987, OC use increased minimally (12.7-13.4% among 15-44 year old women in union), yet the contraceptive social marketing program increased its share of the OC market (7-15% overall, 20-40% at pharmacies). The analysis showed that costs to ASHONPLAFA would fall if more women bought OCs from the contraceptive social marketing program instead of the community- based distribution (CBD) program, and if the resources earmarked to the CBD program in urban areas decreased. Yet, the number of distributors in the CBD program in urban areas actually increased, so ASHONPLAFA did not achieve cost savings. Further, the amount of couple-years of protection from OCs fell. The findings showed that market forces did not work and may not do so in like programs, where profit is not a goal and managers are not held accountable for cost increases. They also indicate that, in urban areas, the contraceptive social marketing program can serve more clients and the CBD program can be cut back. Further research is needed to examine whether and by how much ASHONPLAFA could reduce the CBD program without losing clients.
Assuntos
Anticoncepção/economia , Países em Desenvolvimento , Serviços de Planejamento Familiar/tendências , Conhecimentos, Atitudes e Prática em Saúde , Marketing de Serviços de Saúde/tendências , Adolescente , Adulto , Anticoncepcionais Orais/uso terapêutico , Uso de Medicamentos/tendências , Serviços de Planejamento Familiar/economia , Feminino , Honduras , Humanos , Marketing de Serviços de Saúde/economia , População Rural , População UrbanaRESUMO
This report presents the results of an operations research project to increase male involvement in family planning in Peru. Two community-based distribution (CBD) programs, PROFAMILIA of Lima and CENPROF of Trujillo, Peru, recruited male contraceptive distributors and compared their performance to that of female distributors recruited at the same time. Both programs found it harder to recruit men than women as distributors. Program supervisors, who were women, were less comfortable with men than with other women, even though there were no differences in distributor compliance with program norms. Male distributors were more likely to serve male clients and sell male methods (condoms), while female distributors were more likely to serve female clients and sell female methods (pills). Men sold as much or more total couple-years of protection than did women, and they recruited as many or more new acceptors. Gender was found to exert an impact on method mix independent of other distributor characteristics, such as age, education, marital status, and number of living children. The study suggests that family planning programs can influence method mix and client characteristics by recruiting men as CBD distributors.
PIP: The findings of an operations research (OR) project designed to compare the effectiveness of male vs. female contraceptive distributors in Peru are reported. The OR project was conducted by 2 private, nonprofit family planning agencies that have community-based distribution (CBD) programs: PROFAMILIA in Lima and CENPROF in Trujillo. The OR project sought to test 3 hypotheses: 1) male distributors would sell more condoms and female distributors would sell more oral contraceptives; 2) male distributors would serve more male clients and female distributors would serve more female clients; and 3) male distributors would sell less contraceptive protection than female distributors. Between 1987 and January 1988, the 2 agencies recruited new male and female distributors to serve in the project. Both agencies had a more difficult time recruiting male than female distributors. PROFAMILIA recruited 38 men and 171 women, while CENPROF recruited 52 men and 94 women. All but one of the supervisors in both agencies were female. The supervisors generally regarded the male distributors with skepticism, but the study found no significant difference in the reporting compliance of male and female distributors. The project confirmed hypotheses 1 and 2. In both agencies men sold twice as many condoms as did women, and women sold more oral contraceptives; and male distributors were more likely to serve men, while female distributors were more likely to serve women. The 3rd hypothesis, however, was unsupported. Men sold as much or more contraceptive protection than did women and recruited as many or more new acceptors. It is concluded that men can be effective CBD distributors, and that CBD programs can influence method and client mix by recruiting more men as distributors.
Assuntos
Serviços de Planejamento Familiar , Acessibilidade aos Serviços de Saúde , Dispositivos Anticoncepcionais Masculinos , Anticoncepcionais Orais , Serviços de Planejamento Familiar/métodos , Feminino , Humanos , Masculino , Peru , EspermicidasRESUMO
PIP: In 1991, an HIV prevention program advisor and a research/evaluation specialist for family planning programs discussed problems that affected HIV prevention and family planning services in Haiti before and after the coup of the Aristide government. Population activities began aimlessly in 1974 and HIV prevention efforts only began in 1988. After the coup, Haitians lost their newly found hope for meaningful development. All foreign assistance ended and they did not trust the army. In fact, other than essential child survival activities, no health and family planning services operated for several weeks. The situation grew worse after the economic embargo. 3 months after the coup, the US considered adding family planning assistance. Still little movement of condom, family planning, and health supplies left Port-au-Prince for the provinces which adversely affected all health related efforts. Condoms could no longer be distributed easily either in the socially marketed or US supplied condom distribution programs. Before the coup, HIV prevention and family planning programs depended on peer educators to educate the public (this approach made these programs quite successful), but the 2 experts feared that they would not return to those roles and that these programs would need to completely rebuild. Another concern was the large scale urban-rural migration making it difficult for them to continue care. Early in the AIDS epidemic, the Haitian government was on the defensive because the US considered Haitians as a high risk group so it did little to prevent HIV transmission. After 1988, HIV prevention activities in Haiti centered on raising awareness and personalizing the epidemic. The AIDS specialist noted, however, that a major obstacle to increasing knowledge is that AIDS is just 1 of many fatal diseases in Haiti. Moreover few health professionals in Haiti have ever had public health training.^ieng
Assuntos
Síndrome da Imunodeficiência Adquirida , Catolicismo , Participação da Comunidade , Preservativos , Atenção à Saúde , Emigração e Imigração , Estudos de Avaliação como Assunto , Serviços de Planejamento Familiar , Infecções por HIV , Entrevistas como Assunto , Marketing de Serviços de Saúde , Política , América , Região do Caribe , Cristianismo , Anticoncepção , Coleta de Dados , Demografia , Países Desenvolvidos , Países em Desenvolvimento , Doença , Economia , Haiti , Planejamento em Saúde , América Latina , América do Norte , Organização e Administração , População , Dinâmica Populacional , Religião , Pesquisa , Estados Unidos , VirosesRESUMO
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.
PIP: Operations research is the study of factors that can be controlled by program administrators. One of these factors is the frequency of performing program activities. The operational variable is the frequency of having clinical sessions in medical back-up posts in a community-based distribution (CBD) program in Lima, Peru. The study covered 42 posts in urban marginal areas of Lima. 3 performing frequencies were compared: 1) once a month; 2) twice a month; and 3) weekly. A randomized block design was used. The study lasted 12 months--from August, 1985-July, 1986. 3 output indicators were chosen: 1) effectiveness; 2) efficiency; and 3) cost-effectiveness. Outputs include program acceptors, total visits, IUD insertions, sessions and family planning (FP) visits. The once-per-month posts finished 98% of scheduled sessions while the twice-a-month and weekly sessions finished 97% and 96%, respectively. Mean duration of the clinic sessions held by the monthly and twice-monthly posts was 2.9 hours (s.d.=.84 and .73, respectively). Mean duration for the weekly group was 2.8 hours (s.d.=.67). About 73% of the FP talks scheduled for the monthly post were really accomplished compared to 66% for the twice-monthly and weekly groups. The 42 posts held 1136 clinic sessions during the year and had 11,196 visits, including 5371 FP visits. 1705 women accepted a FP method at the posts. 77% were IUD takers; 15% chose pills; and 8% accepted barrier methods. There were 4768 IUD visits. There were 414 pill visits and 18% barrier method visits. About 89% of all FP visits were IUD-related. 87% of all IUD insertions were referred by CBD workers and 5% by supervisors. There were 2954 total visits in monthly posts; 3501 in twice-monthly; and 5641 in weekly posts. Output went up linearly with session frequency, but in lesser proportion than the rise in the number of sessions held. Differences are statistically significant for all outputs. Twice-a-month posts had 1.5-2.1 times the output of once-a-month posts; weekly posts had about 1.3-1.6 times the output as twice-a-month posts, depending on the variable chosen. With output level of nearly 11,200 visits per year, twice-a-month sessions were estimated to be 7-38% more cost-effective than once-a-month sessions; 6-28% more cost-effective than weekly sessions.
Assuntos
Atenção à Saúde/métodos , Serviços de Planejamento Familiar/organização & administração , Serviços de Saúde Comunitária/economia , Serviços de Saúde Comunitária/organização & administração , Análise Custo-Benefício , Atenção à Saúde/economia , Feminino , Humanos , Pesquisa Operacional , Peru , Saúde da População UrbanaRESUMO
PIP: In the poor neighborhoods of the capital city of Port au Prince Haiti are 100s of brightly painted beauty parlors, displaying signs like "Femme Moderne, studio de beaute." They are popular and cheap; between 70 and 80% of the population use them. In the south of the city, a team of health promotion volunteers are turning some 64 beauty parlors into AIDS education and condom distribution centers with the help and cooperation of the owners. The majority of these beauty parlors are owned and run by women who cannot find work elsewhere, including many immigrants from the Dominican Republic. Some proprietors work as prostitutes in the evenings because they cannot survive on the earnings of the parlors. These proprietors are now becoming AIDS educators-- talking to customers, handing out leaflets and distributing free condoms. The team of young volunteers responsible for this education program belong to the Center for Haitian Social Services (CHASS); a nonprofit, voluntary organization set up in 1987 as a community response to the lack of government health and social services. A CHASS volunteer explains: "The beauty parlors were chosen as a focal point for reaching the population. To start with, 1 box of condoms was distributed every week, not the owners are distributing 3 or 4 boxes. We encourage them to keep a record of numbers taken, client's age, sex, marital status and so on." The majority of volunteer health promoters are ex-students who have given up their studies because of lack of funds. Many cannot find jobs, and they are encouraged to develop skills in their volunteer work which could help them find employment in the future. The team of volunteers meets every Saturday to discuss the program and training needs that arise. "At first the focus of our training was on AIDS, but now we need more information about other related issues." The most urgent need is to find out what local people's thoughts and understandings are about the disease. CHASS has designed a questionnaire in Creole and French for use in a knowledge, attitude, and practice survey. Volunteers are interviewing over 1000 local residents, and will randomly select 200 questionnaires to analyze. Information gathered will provide a basis for planning and orienting health education messages. "The problem with planning any educational program," explains Daniel Bernier, "is that Haitians work most of their waking hours--and so we are trying to organize mass education at traditional public gatherings, such as at Church and the gaga (a traditional religious ceremony).^ieng
Assuntos
Síndrome da Imunodeficiência Adquirida , Comunicação , Preservativos , Coleta de Dados , Atenção à Saúde , Educação em Saúde , Pessoal de Saúde , Conhecimento , Desenvolvimento de Programas , Estudantes , Voluntários , América , Região do Caribe , Anticoncepção , Países em Desenvolvimento , Doença , Educação , Serviços de Planejamento Familiar , Infecções por HIV , Haiti , Saúde , Planejamento em Saúde , América Latina , América do Norte , Organização e Administração , Pesquisa , Estudos de Amostragem , VirosesRESUMO
Three operations research experiments were carried out in three provinces of Colombia to improve the cost-effectiveness of Profamilia's nonclinic-based programs. The experiments tested: (a) whether a contraceptive social marketing (CSM) strategy can replace a community-based distribution (CBD) program in a high contraceptive use area; (b) if wage incentives for salaried CBD instructors will increase contraceptive sales; and (c) whether a specially equipped information, education, and communication (IEC) team can replace a cadre of rural promoters to expand family planning coverage. All three strategies proved to be effective, but only the CSM system yielded a profit. Despite this, Profamilia discontinued its CSM program soon after the experiment was completed. Unexpected government controls regulating the price and sale of contraceptives in Colombia made the program unprofitable. As a result, family planning agencies are cautioned against replacing CBD programs with CSM. Instead, CBD programs might adopt a more commercial approach to become more efficient.
Assuntos
Serviços de Saúde Comunitária/economia , Anticoncepção/economia , Marketing de Serviços de Saúde/economia , Colômbia , Serviços de Saúde Comunitária/provisão & distribuição , HumanosRESUMO
PIP: The 5-year-old community contraceptive distribution program developed by PROFAMILIA, Colombia's private family planning organization, has given excellent results, but several cost-effectiveness comparisons with social marketing programs have suggested that commercial distribution programs are superior. The community contraceptive distribution program has a high content of information and education activities, which produced significant increases in knowledge and use of contraception in the communities covered. It has been a fundamental support for the social marketing program, creating much of the demand for contraceptive products that the social marketing program has filled. The social marketing program has given good results in terms of volume of sales and in cost-effectiveness since 1976, prompting calls for replacement of the community contraceptive distribution program by the social marketing program in those sectors where knowledge and use of contraception have achieved acceptable levels. An experiment in the Department of Santander in 1984 and 1985 gave very favorable results, suggesting that community contraceptive distribution programs should be replaced by social marketing programs in all more developed markets. But economic problems in 1985 and the decision of manufacturers to decrease the profit margin for PROFAMILIA jeopardized the social marketing program. The community distribution program covered about 20% of the market. Reduced profits in the social marketing program threatened its continued expansion, at the same time that potential demand was growing because of increases in the fertile aged population and increased use of contraception. To meet the need, PROFAMILIA combined the community contraceptive distribution and social marketing programs into a new entity to be called community marketing. The strategy of the community marketing program will be to maintain PROFAMILIA's participation in the market and aid the growth of demand for contraceptives through educational and informational activities. The distribution scheme must continue to cover all the established points of sale in pharmacies despite the reduced profit margins.^ieng
Assuntos
Custos e Análise de Custo , Atenção à Saúde , Estudos de Avaliação como Assunto , Instituições Privadas de Saúde , Planejamento em Saúde , Administração de Serviços de Saúde , Serviços de Saúde , Marketing de Serviços de Saúde , Medicina , Organização e Administração , Farmácias , América , Colômbia , Países Desenvolvidos , Países em Desenvolvimento , Economia , Saúde , América Latina , América do SulRESUMO
PIP: The latest statistics on new acceptors reported by the International Planned Parenthood Federation/Western Hemisphere Region (IPPF/WHR) for 1986 show important growth in male methods, condoms and sterilization (up 33%). The area included is Latin America and the Caribbean. The most popular method for new acceptors is the IUD (43% of new users); the second most popular method is the pill (27% of new users); and the third is sterilization (14% of new users). Total increase in new acceptors in clinics and community programs combined was 13%. Other methods, including diaphragms, spermicides, and natural family planning, increased 65% in clinic clients and 223% in community based distribution programs. During 1982-1986, the total number of new acceptors rose by 26% to 1.5 million; total number of visits to a clinic rose 15% to 3.3 million, and the number of clinics rose 39% to 1899.^ieng
Assuntos
Comportamento Contraceptivo , Anticoncepção , Atenção à Saúde , Serviços de Planejamento Familiar , Sistemas de Distribuição no Hospital , Agências Internacionais , Organizações , Aceitação pelo Paciente de Cuidados de Saúde , Política , América , Região do Caribe , América Central , Países Desenvolvidos , Países em Desenvolvimento , Planejamento em Saúde , América Latina , América do Norte , Organização e Administração , América do SulRESUMO
PIP: A recent study by PROFAMILIA, the private Colombian family planning organization, indicates that community based distribution programs and social marketing programs are not totally interchangeable forms of contraceptive distribution. Comparison of the efficacy of different systems in making contraceptives more accessible to the low income population led the researchers to conclude that social marketing programs work as well as community based distribution programs in rural areas which already have high rates of contraceptive usage. Community based distribution programs appear more effective than social marketing programs in areas where contraceptive usage is not yet well established. PROFAMILIA researchers conducted operational studies in 3 different states, each of which had a community based distribution program. In the first state the community based distribution program was suspended and a vender who had previously supplied only urban outlets added rural pharmacies to his route. The vender handled 3 kinds of pills, 2 types of spermicidal suppositories, and condoms. In a neighboring state, 3 instructors belonging to the community based distribution program were offered commissions of about 10% of the value of the products if the distributors they supervised met monthly sales quotas. The community based distribution program was left unchanged in the third state but a 2-member mobile team was trained to travel through the region by jeep, talking to community groups about the advantage of contraception. At the end of 18 months, sales of contraceptives had declined in the state where the community based distribution program was replaced by the social marketing program. The decline was believed to be related to unforeseen price increases for pills and devaluation of the Colombian peso. The social marketing project was however much more cost effective than the other 2, which continued to require PROFAMILIA subsidies. Contraceptive usage increased in the other 2 areas. The greatest subsidies were required in the program with the mobile information team, which also showed the largest increase in usage. Initial contraceptive usage levels were much lower in the area served by the mobile team. Surveys conducted before and after the program changes measured trends in contraceptive knowledge and use and the level of unmet need for contraception. Based on the survey findings, the researchers concluded that under some conditions commercial marketing programs can be substituted for community based distribution programs without negative consequences. Community based distribution programs have a greater probability of increasing usage in zones where contraception is not widely practiced. The researchers warned that commercial distribution systems expose family planning organizations to economic and political dangers such as price increases.^ieng
Assuntos
Atenção à Saúde , Educação , Planejamento em Saúde , Administração de Serviços de Saúde , Serviços de Saúde , Marketing de Serviços de Saúde , Medicina , Organização e Administração , Farmácias , Avaliação de Programas e Projetos de Saúde , Pesquisa , América , Colômbia , Comportamento Contraceptivo , Países Desenvolvidos , Países em Desenvolvimento , Economia , Saúde , América Latina , Pobreza , Comportamento Sexual , América do SulRESUMO
PIP: Profamilia in Colombia was the 1st institution in a Latin American country to start an Integrated Project on Family Planning and Parasite Control (IP). The objective of the project is to improve and strengthen family planning prevalence in the area. The incorporation of parasite control into the community-based distribution network has been a useful and healthy strategy to deliver 2 primary health components. In 1979, Tolima North was chosen as an IP pilot area. An IEC program was established to inform and educate the community on its health problems and the needed solutions. The campaign was designed in stages. The combination of IEC activities plays an important role to create credibility and discard misinterpretation of a given action which has been adopted. During the reinforcement stage, the use of different media, or a combination of media, and methodology approaches have to be analyzed carefully to keep these IEC activities dynamic. Implementation of the IEC program is carried out on the field by Profamilia personnel and instructors (field workers). Each instructor is assigned an area where she organizes meetings for local groups such as farmers and cattle raisers. The field worker does the following activities: establishes contacts with key persons of organizations to arrange group discussions; meets with these groups to deliver health and family planning lectures; visits the distributors to train and give refresher courses; and identifies new distributors. Audiovisual aids and printed materials assist field workers in their presentations. In addition, radio campaigns provide effective means to disseminate information. Profamilia's program underwent 3 stages: preliminary, pilot area development and expansion and self-reliance.^ieng
Assuntos
Controle de Doenças Transmissíveis , Comunicação , Atenção à Saúde , Educação , Planejamento em Saúde , Serviços de Informação , Organizações , Pesquisa , População Rural , Instituições Filantrópicas de Saúde , América , Colômbia , Demografia , Países Desenvolvidos , Países em Desenvolvimento , Serviços de Planejamento Familiar , Saúde , América Latina , Organização e Administração , População , Características da População , Saúde Pública , América do SulRESUMO
PIP: SOMARC is currently providing support to contraceptive social marketing efforts in Bolivia, Brazil, and Paraguay. The distinctly different family planning climates in these 3 countries have provided SOMARC with an opportunity to practice programmatic flexibility in project strategy and design. In Bolivia, the SOMARC strategy for implementing contraceptive social marketing is primarily a private sector venture in which donated products will be imported by local distributors and sold through the traditional channels. Distribution services through a network of local private family planning groups will provide SOMARC with direct access to Bolivian trade unions and work organizations. These family planning groups will in turn be strengthened by their association with the social marketing program as a potential source of revenue. In Brazil, where many low-priced contraceptives are already on the market, SOMARC's role will be in the areas of communication and promotion to increase contraceptive prevalence. The first task will be to identify target areas where there is a combination of low prevalence and an existing market infrastructure. A Brazil Contraceptive Social Marketing Program Advisory Council has been formed to provide a consolidated approach to family planning activities. Efforts toward developing a contraceptive social marketing program in Paraguay remain at an exploratory level. The introduction of social marketing in Paraguay is complicated by the existence of a pervasive contraband system. Although consumer awareness of contraception is high, the contraceptive prevalence rate is low. Efforts in all 3 countries reflect SOMAR's strategy of broadening the scope of project alternatives to meet the special needs of each nation.^ieng
Assuntos
Publicidade , Comércio , Atenção à Saúde , Marketing de Serviços de Saúde , Setor Privado , América , Bolívia , Brasil , Países Desenvolvidos , Países em Desenvolvimento , Economia , Planejamento em Saúde , América Latina , Organização e Administração , Paraguai , América do SulRESUMO
A community-based family planning operations research project was undertaken in selected low income communities of Rio de Janeiro; project field work began in February 1982. Prevalence data were collected and service delivery strategies were tested, including home visits promoting family planning, home distribution of condoms, and the introduction of community family planning depots. A high baseline contraceptive prevalence rate (CPR) of 70.1 percent was found for nonpregnant women currently in union, as well as substantial use of the private sector for contraceptive supply, despite the presence of free or subsidized sources within the communities. However, the most economically disadvantaged subgroups made the greatest use of the subsidized sources. The provision of additional service delivery sites may have contributed to a small increase in contraceptive prevalence noted over the life of the project; however, the high baseline CPR precluded a large increase in contraceptive use as a result of the program.
PIP: A community-based family planning operations research project was undertaken in selected low income communities of Rio de Janeiro; this activity represented the 1st attempt to obtain contraceptive prevalence data in fanelos (slums) of Rio. Project field work began in February, 1982. Prevalence data were collected and service delivery strategies were tested, including home visits promoting family planning, home distribution of condoms, and the introduction of community family planning depots. A high baseline contraceptive prevalence rate (CPR) of 70.1% was found for nonpregnant women currently in union, as well as substantial use of the private sector for contraceptive supply, despite the presence of free or subsidized sources. 4800 women between the ages of 15 and 44 years of age were interviewed for the baseline survey. 4442 women were reinterviewed at follow-up, 3600 of whom were nonpregnant women currently in union. Contraceptive prevalence at follow-up among this latter group was 4.6% higher than at the time of the baseline survey. The proportions of women using each source of contraceptive supply remained fairly stable between the baseline and follow-up surveys. The data suggest a small switch from a temporary to a permanent method of family planning, associated in part with the increases in age and parity between the baseline and the follow-up surveys. The provision of additional service delivery sites may have contributed to the small increase in contraceptive prevalence noted over the life of the project; however, the high baseline CPR precluded a large increase in contraceptive use as a result of the program. The operations research data thus suggested that continued home visits would not be cost effective in the communities included in the study.
Assuntos
Comportamento Contraceptivo , Áreas de Pobreza , Pobreza , População Urbana , Adolescente , Adulto , Brasil , Serviços de Planejamento Familiar , Feminino , Seguimentos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Gravidez , Política Pública , Fatores SocioeconômicosRESUMO
PIP: The Colombian Association for Family Welfare (PROFAMILIA) and Indonesia's Community Development Association (PDA) operate social marketing projects which might more appropriately be called social sales projects. Unlike other social marketing projects, these 2 projects seek profits from their contraceptive sales. The profits are then used to subsidize other programs operated by these 2 nonprofit organizations. Indonesia's PDA initiated its sales project in 1974. It operates both an urban contraceptive retail sales (CRS) program and a rural community-based distribution sales (CBD) program. The CRS program sells 3 types of condoms, which it delivers directly to the 1750 retailers involved in the program. The condoms sell for US$.03-US$.07, somewhat more than condoms sold in most social marketing projects. The CBD project covers 10,200 villages in 157 of Indonesia's 620 districts. Each village has a CBD volunteer who sells oral contraceptives (OCs) and condoms and also promotes family planning and rural development. The program sells Norinyl, Ovostat, and Eugynon for US$.19-US$.30/cycle. PDA runs other profit-making projects. For example, it sells promotional T-shirts and calendars at its vasectomy clinics and through its CBD program. PDA also established the taxable Population and Development Corporation, which engages in marketing activities. Profits from the corporation are channeled back to PDA. PROFAMILIA also operates both an urban sales program and a rural community-based distribution program. In the urban program, condoms are sold at normal retail prices and OCs at prices 30% below retail prices. The profits derived form the urban sales are used to subsidize the rural project. In 1981, the urban program began selling 6 noncontraceptive products, e.g., distilled water and disposable diapers. Currently, the program sells only distilled water, as the other products failed to yield a profit. A table provides sales information for both the PDA and PROFAMILIA programs.^ieng
Assuntos
Comércio , Preservativos , Anticoncepção , Anticoncepcionais Orais , Atenção à Saúde , Economia , Instituições Privadas de Saúde , Planejamento em Saúde , Serviços de Saúde , Marketing de Serviços de Saúde , América , Ásia , Sudeste Asiático , Colômbia , Países Desenvolvidos , Países em Desenvolvimento , Serviços de Planejamento Familiar , Saúde , Indonésia , América Latina , Organização e Administração , População Rural , América do Sul , População UrbanaRESUMO
PIP: Profamilia in the Dominican Republic began a program called "Popular Promoters" in 1973 in which rural women were referred to family planning clinics, and in 1976 the community-based distribution program was formally begun. Between October 1974-October 1975, Profamilia had gained experience in the distribution of contraceptives in rural areas of the country. At the start, the community program continued promotion of family planning primarily in rural areas while offering contraceptive directly to those seeking them. By 1977, 105 communities and 12 provinces had been added to the program and 6500 women were being served. 14,500 of the 15,200 couples served in 1980 used pills. There were 23,000 users in 1984, 12,000 of whom were new acceptors. Over 34% of Profamilia's 66,000 clients are in the community-based distribution program. The program also maintains a strong educational component which each year offers over 400 talks in its 170 rural and urban communities on themes related to family planning, including health, education, nutrition, and use of available resources. Among early problems of the program were opposition from physicians, difficulty of recruiting volunteers who met the personality and other requirements, myths and incorrect beliefs of the community regarding family planning, the belief among men that contraception would encourage infidelity among women, and official pronatalist policies. The promoters work directly with the 170 distributors and also parrticipate in other community development activities such as the establishment of community organizations. Large families are seen as just 1 of the problems of the communities, most of which are impoverished, lack employment opportunities, and suffer other disadvantages of underdevelopment. Distributors are chosen by communities for leadership and other personality traits. Acceptance of family planning encourages efforts to assume control of other aspects of life.^ieng
Assuntos
Agentes Comunitários de Saúde , Atenção à Saúde , Educação , Educação em Saúde , Pessoal de Saúde , Planejamento em Saúde , Serviços de Informação , Educação Sexual , América , Atitude , Comportamento , Região do Caribe , Países Desenvolvidos , Países em Desenvolvimento , República Dominicana , Economia , Serviços de Planejamento Familiar , Saúde , Conhecimentos, Atitudes e Prática em Saúde , América Latina , América do Norte , Organização e Administração , Mudança Social , Planejamento SocialRESUMO
PIP: The advertising and marketing consultant for Jamaica's Commercial Distribution of Contraceptives (JCDC) program, states that the program has reached a state of maturity that has resulted in some inertia. Although still the leader among contraceptive social marketing (CSM) programs in reaching the greatest percentage of its target market, product sales are no longer on an upswing, and retail outlets are not increasing in number. The project is hoping that the introduction of a new thin condom can help, but more than 1 new product may be needed to recapture momentum. The JCDC began in 1974 when Westinghouse Health Systems won a 3 year Agency for International Development (AID) award to create a Jamaican CSM program. Challenges facing the new social marketing project included: oral contraceptives (OCs) were sold only by prescription; most pharmacies were located in urban areas; many consumers associated condoms with prostitution and disease; and retailers were reluctant to carry contraceptives and ignorant of OC side effects. The 1st breakthrough came when Westinghouse obtained government permission to sell a project pill without prescription. After market research, project managers chose the name "Perle" for the JCDC's pill, manufactured in the US by Syntex as Noriday. "Panther" became the project's condom. Prices were set at US17 cents for a Panther 3-pack and 34 cents for a Perle cycle. Advertising messages appeared on television, radio, bus shelters, cinema screens, billboards, and point of purchase displays. By the end of the 1st year's sales, a soft goods manufacturer had asked permission to produce Panther T-shirts and a Reggae composer had popularized songs about the product. Such promotional tactics boosted sales of all contraceptives on the island. About 690,000 Panther condoms and 450,000 other brands were sold in 1976; 195,000 Perle cycles were purchased compared with 135,000 cycles for all other brands combined. By 1977, Westinghouse was reducing advertising and concentrating on expanding retail sales outlets. Panther was being sold through 1108 outlets; Perle was distributed via 267 predominantly pharmacy outlets. In 1977 AID's contract with Westinghouse ended and the Jamaican National Family Planning Board took over the project management. With its subsidy markedly reduced, the JCDC soon was experiencing difficulty in Jamaica's troubled economy; as well as difficulty in expanding sales outlet. Despite the project's financial pinch, the JCDC has -- with some success -- used imaginative tactics like contests to spur sales.^ieng