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  • Title: Measuring accessibility to family planning services in rural Thailand.
    Author: Chayovan N, Hermalin AI, Knodel J.
    Journal: Stud Fam Plann; 1984; 15(5):201-11. PubMed ID: 6495360.
    Abstract:
    There are a variety of ways to conceptualize and measure accessibility to contraceptive services and supplies. Using detailed data for rural Thailand, a multiplicity of reasonable measures are developed that reflect time and/or distance to various government program outlets. Many of these are only moderately correlated with one another, and to an important extent, different measures show different associations with levels of contraceptive prevalence. Clearly there is a general need in this area of investigation to pay more attention to the measurement of accessibility as a community characteristic and to consider the sensitivity of results to alternate measures. A variety of ways to conceptualize and measure accessibility to contraceptive services and supplies are used to evaluate program accessibility in rural Thailand. Included are distance to a specific outlet, index of distances to various outlets, travel time to a specific outlet, index of travel times to various outlets, types of services provided, length of time that specified services and specified outlets have been available, convenience, in terms of ease and costs of transportation, quality of service in terms of waiting time and competence and attitude of the staff, and costs of family planning services. An alternative approach to measuring accessibility from data on individual respondents has been to develop community-level indicators. Thailand, the only country with detailed data collection on accessibility, has experienced rapid and pervasive changes in reproductive behavior during the last 2 decades. Contraceptive prevalence among married women of reproductive age increased from less than 15% in 1969 to almost 60% by 1981. This was more or less coincidental with the development of an active national program to promote family planning. A crucial aspect of the Thai program was the early implementation of a policy allowing nurses and auxiliary midwives to distribute oral contraceptives. Although costs vary by type of method and changes in prices, the cost structure is identical from village to village and is not, therefore, a matter of differential accessibility. A major conclusion is that there is a need for more attention to the measurement of accessibility and for further tests of the sensitivity of results to alternate measures. Particular focus should be given to capturing changes in accessibility over appropriate time periods, as well as measuring current configurations. In the future, it will become increasingly important to collect data on other dimensions of accessibility, e.g. the quality of services, the complement between the public and private sector and the extent of information, education, and communication (IEC) efforts.
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