Strengthening government health and family planning progress : findings from an action research project in rural Bangladesh

Abstract

An ongoing study at the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) is based on the premise that public sector health and family planning programs can be improved through an assessment of the dysfunctional aspects of their operations, the development of problem-solving capabilities, and the transfer of strategies successfully tested in a small-scale pilot project. This paper reports findings from a field trial implemented in a subunit of the project area at an early stage of the project. Operational barriers to public sector program implementation are discussed with regard to the quantity of work, the quality of work, supplies and facilities, integration of health and family planning, and leadership, supervision, and decision making. Initial results of the ICDDR,B intervention on these managerial processes are also indicated.

PIP: An ongoing study at the International Center for Diarrheal Disease Research, Bangladesh (ICDDR,B) is based on the premise that public sector health and family planning programs can be improved through an assessment of the dysfunctional aspects of their operations, the development of problem-solving capabilities, and the transfer of strategies successfully tested in a small-scale pilot project. This paper reports findings from a field trial implemented in a subunit of the project area at an early state of the project. Operational barriers to public sector program implementation are discussed with regard to the quantity of work, the quality of work, supplies and facilities, integration of health and family planning, and leadership, supervision, and decision making. Initial results of the ICDDR,B intervention on these managerial processes are indicated. Although field workers are hired, trained, given a job description, and posted, this does not assure that they will actually work the expected hours contacting rural families in their assigned areas. Many arrive late, do not work and leave early. The quantity of work increased considerably with the posting of ICDCR,B field staff in the demonstration area. The quality of male worker output was lower than that of female family welfare workers, who were relatively personable, direct and empahtetic, but still needed to improve. Lack of physical resources and supplies still exists. An impediment to integration of health and family planning was that health workers continued to emphasize health issues. Patterns of leadership, supervision and decision making emphasized adherence to bureaucratic procedure, narrowly defined reporting systems and mechanical inspection. Guidance, support and problem-solving capabilities are generally absent. The extension project is based on the assumption that careful diagnosis of organizational functioning will enable identification of areas where management interventions are appropriate and where national-level policy change can facilitate implementation at all levels.