The EC/UNFPA Initiative for Reproductive Health in Asia (RHI) coversseven countries in South and South East Asia. It targets populations withvery diverse reproductive health (RH) needs and, therefore, uses a wealthof different approaches. Altogether, the RHI consists of 42 projects, withmore than 90 stakeholders. In addition, networks set up by individualprojects enlist the collaboration of at least 100 community-based organisations(CBOs).For each country programme, a “country focus” was selected, takinginto account the country’s most urgent RH needs, the comparativeadvantage of civil society organisations and the recommendations ofUNFPA, which were endorsed by the local advisory group, where existing.As a result three different country focus areas were defined. In Bangladesh,the five projects aim to improve the quality of RH care, in particularthat of clinic-based RH services. The programmes in Cambodia, the LaoPeople’s Democratic Republic (PDR), Sri Lanka and Viet Nam all focuson providing reproductive and sexual health (R&SH) information andservices to young people and adolescents. The projects in Nepal and Pakistanconcentrate on strengthening community based RH information andservices.This report summaries a selection of some of the lessons learned,best practices and success stories resulting from the experience of overthree years of implementation of the RHI in the seven countries.
Quality of Care (QoC) in BangladeshThe RHI Bangladesh chose to focus its intervention on the delivery of acomprehensive package of RH services in urban under-served-areas, witha special emphasis on quality of care (QoC) and clinical contraception.The projects are designed to effectively complement and contributeto the implementation of the Health and Population Programme of theGovernment of Bangladesh (GoB), for which this is an area of majorconcern. The RHI in Bangladesh has addressed QoC in a holistic manner,targeting QoC within the clinical and non-clinical context of RH services,as well as within the context of overall management of the respectiveprojects, building organisational capacity at the same time. To ensureconsistency, both in the overall approach and in the identification of clinicaland non-clinical aspects within all projects, a QoC group was formed,composed of participating NGOs.
Main Lessons learned:
• Quality of Care increases client satisfaction
• To achieve Quality of Care, choices need to be made between theadaptation and new development of protocols and guidelines
• The process of improving Quality of Care is usually lengthy andshould be uninterrupted
• Quality of Care increases client attendance
Quality of Care increases client satisfaction: In Bangladesh, providershave a reputation for not treating clients well. For example, poor communitymembers were hesitant to visit clean and well decorated clinics,assuming that the services were not meant for them or would be tooexpensive. The RHI programme tried to change this by introducing RHservice protocols and by training the service providers on how to behavetowards and communicate with clients. Clients were then asked aboutthe conduct of service providers during exit interviews, which showed anincrease in client satisfaction. At the same time, clients were educatedin the type of care they should expect.To achieve Quality of Care, choices need to be made between theadaptation and new development of protocols and guidelines: The availabilityof standard protocols and guidelines for clinical services, whichwere developed by the GoB in collaboration with NGOs saved time and resources. In addition, the adaptation thereof also contributed to an internallycoherent and homogenous approach to family planning and RHservices in Bangladesh.
The process of improving Quality of Care is usually lengthy andshould be uninterrupted: Improving QoC is a labour-intensive processthat requires time, effort and motivation. This holds particularly true forbehavioural change, which is necessary if a better understanding of theclient situation is to be achieved. Service providers need encouragementto see the value in using RH service protocols and giving time to communicatewith clients. Close monitoring and supervision is required, aswell as regular refresher training to sustain quality and to compensatefor the dropout of service providers.Quality of Care increases client attendance: Investing in QoC pays offin the end. The improved management of clinics, service delivery procedures,behaviour of service staff towards clients, as well as more cleanliness,have led to a substantial increase in clients (between 19% and 48% withinone year). For example, one of the RHI project hospitals expanded theirfacilities from ten beds to 35 beds and also introduced blood bank services,while offering daily RH services, including family planning. As a result,the number of total services rendered increased from 23,861 in 2000to 35,527 in 2001.