Following government and donor priorities of the past, Bangladeshi NGOs working in reproductive health previously focused their efforts on door-to-door family planning. Many have now moved ahead to implement the government's Essential Services Package approach. They have discontinued door-to-door contraceptive distribution, and they are offering a wider range of services through clinics. It is not yet clear to what extent clients will avail themselves of the services the redesigned program offers. Decision-making becomes more complex when women must go out of their homes for services, and must incur added social, logistic, and direct costs. This paper presents findings from a three-year qualitative study assessing the effects of this reorientation in five rural and urban sites. In-depth individual interviews, group interviews, and clinic observations were conducted, using a variety of semi-structured guides. The findings confirm several assumptions underlying the new model: (1) demand for family planning is not "fragile"; (2) gender constraints will not prevent women from using services; (3) client priorities and criteria for assessing quality in health care are reasonably well understood; (4) clients and families are generally willing and able to pay for services; and (5) longstanding programs and their clients are able to adapt to new models and ways of thinking. Further interventions are needed in two areas: (a) a transparent system for providing need-based subsidies and credit; and (b) Better communication to explain how the new services are set up and to dispel expectations that developed in relation to the previous family planning program model.
Learning Objectives: At the conclusion of the session, the participant in this session will be able to: Describe the major policy changes in reproductive health services in Bangladesh. Evaluate the assumptions made under the Essential Services Package approach and the new evidence substantiating them. Identify areas where future interventions would be beneficial.
Keywords: Gender, Reproductive Health
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: JSI Research & Training Institute,Urban Family Health Partnership
Pathfinder International Rural Service Delivery Project
US Agency for International Development
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.