Study No. 1 : Assessment of Utility of Protocol & IEC Material As Perceived by Tcs

Janani : Synopsis post Telecon : Aug 18th 2005

Study No. 1 : Assessment of Utility of Protocol & IEC Material as perceived by TCs

Janani program was primarily established in the field of family planning in Bihar, with a prime objective of supplementing the efforts of the government. The project also has under its gamut, issues concerning reproductive health. Janani has established a unique model that uses alternative channels of service delivery in low-resource settings.

Besides Bihar the program has now been further extended to some parts of two large states of India- Uttar Pradesh and Madhya Pradesh.

The program aims to:

a.  Make available the entire range of clinical and non-clinical family planning and reproductive health services at low cost to people, who are poor and therefore the most vulnerable.

b.  Induce partnership between the private and public sectors so that the large and under utilized resources of the private sector can be used to supplement the public sector.

Following are the three distinct and mutually reinforcing channels of service delivery:

1.  Network of shops that stock and sell condoms and oral contraceptives

2.  Titli Centres – a franchisee network of rural health providers. They sell non-clinical contraceptives and provide counseling regarding family planning and reproductive health to the village community

3.  Surya Clinics – a franchisee network of qualified doctors who provide the entire range of clinical family planning and reproductive health services

The whole process is supported by a package of IEC campaign to create awareness among people, promote the two franchisee networks and empower the community by managing their expectations from Titli Centres and Surya Clinics.

Titli Centres:

Janani has a large network of Rural Health Practitioners (RHPs) at the village level. They are provided training in family planning reproductive health issues. They sell condoms and oral contraceptive pills, provide counseling, do rapid tests like pregnancy test and detection of sugar and protein in urine and refer clients to Surya Clinics for clinical services. To enhance the accessibility of the services to the women, RHP’s wife (Woman Heath Practitioner) is also trained along with the male counterpart.

Titli Centres pay an annual membership fee of Rs. 500/- , which also serves as an indicator of their interest in the network.

RHPs and WHPs are critical as referral providers to Surya Clinic.

Janani is investing resources in:

a.  Training – A protocol is provided which is expected to serve as ready reference when the RHP and WHP are back in their setting

b.  IEC materials – These are provided free of charge at the time of training and at regular intervals during the year

This research intervention was planned over Dec –Jan 2003 to assess the following:

a.  Relevance of the protocol: Is it being used after training? Ease of use

etc. ?

b.  Relevance and utility of the IEC material?

c.  Willingness to buy the IEC material of provided at a price – which ones?

A survey using structured questionnaire was conducted over 550 villages spread over 39 districts of Bihar and Jharkhand. The survey covered 13 Titli Centres per district, covering a total of 524 across both states. A WHP and a RHP attached to that TC were randomly selected for interview.

Key findings of the survey:

1. Utility of protocol as reference material

·  The protocol was found to be useful, though there were some concerns voiced and improvements suggested. What percentage of the respondents found the protocols to be useful?

·  The concerns voiced with the protocol were mainly to do with the protocol providing information and advice only in simple cases. RHPs wanted advice for complicated cases as well in the protocols.

·  RHPs were concerned that the protocol suggests one way solving the problem. They would prefer to know different ways of solving the same problem i.e. different permutations and combinations of medicines; According to them symptoms should also be mentioned in the protocol.

2. Ways of improving the protocol as suggested by the RHPs:

·  A larger number of topics and questions should be covered Give a few examples, please

·  The book and the subject health matters should be organised in a better way, for easy reference

·  Planning of future complications, which could arise if a particular advice is followed, should be mentioned

·  Medicines which need to be stocked in the clinic should be listed

·  More illustrations and diagrams should be provided

3. Usage of protocol

·  Most RHPs, two thirds to be precise, had the protocol of Health with them. Slightly less than a half felt the need to refer to it on a regular basis. On an average about 20% of them referred it ‘frequently’.

·  Of the items that RHPs received free of cost from Janani, they felt that only some of them were useful. (What percentage?) The relevant items were: Pregnancy Test Report , Prescription Pad, Referral Pad, Niroghdham Magazine and Pregnancy Strip.

·  The RHPs (any number that w can put here?) use many of these items in their day-to-day work and for personal use. These include Niroghdham Report, Pen, Prescription Pad, Referral Pad, Calendar and the Magazines like Champak.

·  The RHPs are quite keen to buy the some of the above items, which they find useful and are also currently using. Examples of such items: Pregnancy Strip, Referral Pad, Pregnancy Test Report and Nirogdham Magazine. They said that they would also buy instruments like stethoscope and BP instrument.

·  The RHPs expect the following items to be provided free of cost even though they find it useful, they are not keen to pay for it -

·  Prescription Pad

·  Calendar

·  Pen

·  Cap

·  Lattoo for kids

·  The other items like diary, key chain, Surya Clinic Balloon, Dispenser, Magazines like Champak, pouches, Uristix, leaflets and flute are not found to be useful. Therefore it is recommended that these are not given to them in future.

Indica Research / 18th Aug 2005 Page 3