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  • Title: Providing FP services in rural Madagascar: an OR study comparing three models of service delivery.
    Journal: Afr Alternat; 1992 Mar; (4):10-2. PubMed ID: 12285347.
    Abstract:
    In 1987 the Power and Water Company of Madagascar (JIRAMA) with UNFPA support set up 3 models for introducing family planning (FP) education and providing clinic supplies and services: 20 high intensity mobile clinic sites, 2 medium density sites, and 16 MOH/MCH mobile clinics. An operations research (OR) study was designed with the collaboration of the Africa OR/TA Project to investigate rural demand, program intensity, and cost effectiveness of service delivery approaches. The programs were designed to provide FP services to 1500 women and to vaccinate 825 children against communicable diseases. 2300 acceptors were experienced just before the initiation of the OR study. The findings showed that the high intensity program had the highest number of new acceptors at 50/quarter vs. 34.5 in the medium intensity program and 9.8 in the mobile clinic program. The lowest costs were in the medium intensity clinics at US $4.27/new acceptor followed by US $5.09 in the high intensity sites. The mobile clinic was the most expensive at US $15.75; it also experienced a deterioration in continuation rates due to social and political upheaval in late 1991 which interfered with transport. The high and medium intensity sites both had improved continuation rates. Conversion of the mobile unit to either a medium or high intensity site needs to be made. This is feasible due to the availability of the highly experienced mobile team of trainers and supervisors. There is evidence that demand exists for FP services, and contraceptive prevalence is dependent on intensity and quality of services available. Adoption of FP would be propelled forward if the high intensity program is adopted, but the medium intensity program may be more cost effective. It is also possible that both models may be adopted depending on size, location, transport pattern, staffing, and other features at the delivery sites. The recommendation is to use medium intensity models with training, supervision, and supplies in smaller and more isolated areas. In larger population centers, staffing can be rearranged or added to for management of FP services and provision of community education.
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